Abstract
Background and PurposeLittle is known about the associations of post-stroke fatigue or its influence on survival. The vitality component of the Short Form 36 (SF-36) is a valid and reliable measure of post-stroke fatigue. We sought to identify associates of post-stroke fatigue and determine whether fatigue predicted survival.MethodsWe used SF-36 vitality scores obtained by postal questionnaires from 1080 UK patients randomised in the International Stroke Trial, at a mean of 64 weeks after stroke onset. We used logistic regression to explore factors at randomisation which predicted SF-36 vitality at follow-up, and the relationship between SF-36 vitality and both SF-36 mental health and SF-36 emotional role function at follow-up. We used Cox proportional hazards to explore the influence of SF-36 vitality at follow-up on subsequent survival, using four different statistical models for handling missing data.ResultsFemale sex, increasing age, lower mental health and lower emotional role function scores were associated with greater degrees of fatigue after stroke (i.e. lower vitality scores) but these factors explained <30% of the variance (R2) in fatigue. In two models, fatigue at follow-up was associated with shorter subsequent survival.ConclusionIncreasing age, female sex, emotional role function and mental health were associated with increased fatigue at a mean of 64 weeks after stroke onset, but explained less than 30% of the variance. Fatigue was associated with reduced subsequent long-term survival in 2/4 models. Further work is needed to identify the biological substrate of fatigue and to clarify its influence on survival.
Highlights
Fatigue is common after stroke, with estimates of prevalence ranging from 16% [1] to 70% [2]
Our aims were to determine: a) what factors at stroke onset predicted Short Form 36 (SF-36) vitality scores [13] measured a few months later, b) the relationship between SF-36 vitality measured in survivors a few months after stroke and mood (SF-36 mental health domain and emotional role function domain) and c) influence of SF-36 vitality in survivors on subsequent survival
The distribution of the vitality scores for men and women is shown in figure 1
Summary
Fatigue is common after stroke, with estimates of prevalence ranging from 16% [1] to 70% [2]. In the general non-stroke population, fatigue is often a symptom of depression. Several cross-sectional studies [1,3,4,5,6,7,8] and one longitudinal study [9] have sought associations of fatigue after stroke using different generic fatigue scales. Studies of fatigue after stroke suggested that it is more common in brain stem lesions [7], but other studies have not shown such an association [1,4,6,8,9,11,12]. Little is known about the associations of post-stroke fatigue or its influence on survival. We sought to identify associates of post-stroke fatigue and determine whether fatigue predicted survival
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