Relieving Post-stroke Fatigue Using a Group-based Educational Training Approach

Abstract

RELIEVING POST-STROKE FATIGUE USING A GROUP-BASED EDUCATIONAL TRAINING APPROACH Catherine Emery (nee Emenheiser), PhD A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2015 Tony Gentry, PhD, Professor Occupational Therapy Department Post-stroke fatigue is a common problem that may limit participation in everyday activities. Emerging evidence suggests that group-based training in fatigue management may be an efficient means of reducing the effects of post-stroke fatigue. This mixed methods, quasiexperimental study proposed to determine whether a group-based educational program could be successful in relieving post-stroke fatigue and improving participation in daily activities. A convenience sample of stroke survivors (n=20) from retirement communities in southeastern PA were invited to participate in the research. Participants were screened for depression, motor and cognitive recovery, and sleep quality. Fatigue was measured using the Fatigue Severity Scale (FSS) and activity participation was measured using the Physical SelfMaintenance ScaleInstrumental Activities of Daily Living (PSMS-IADL). The measures were administered in a double pre-test, double post-test format over three seven-week phases; a non-intervention period; a group-based intervention period, and a post-intervention period. Qualitative information was gathered using a self-made Intervention Satisfaction Survey. Data analysis involved measures of central tendency for the demographic information. Tabulations of the survey responses were completed to judge the effectiveness of the group-based program or its’ components from the participants’ perspectives. Results indicated a statistically significant reduction in reported fatigue post-intervention (p= .022), which continued for sevenweeks (p= .240). There was a strong effect size for the post-intervention reduction of fatigue (r= .69). There was a trend toward improved participation in daily activities. Distribution across groups for presence of social support, age, sex, and level of care was found to be equivalent after one-way chi square analysis. There was no significant influence of these variables on fatigue or participation when used as grouping variables in RM-ANOVA. Participants reported feeling most confident scheduling activity to include rest periods and least confident managing sleep problems. Limitations include small sample size, demographics not being representative of the general stroke population, use of self-report measures with possible ceiling effect of PSMS-IADL, instrumentation effect given multiple administrations, and history effects as groups occurred at different time of the year. Overall, the results indicate that participation in a groupbased educational program was effective in reducing post-stroke fatigue in chronic stroke.