Abstract
BackgroundFatigue is a common symptom in Stroke. Several self-report scales are available to measure this debilitating symptom but concern has been expressed about their construct validity.ObjectiveTo examine the reliability and validity of a recently developed scale for multiple sclerosis (MS) fatigue, the Neurological Fatigue Index (NFI-MS), in a sample of stroke patients.MethodSix patients with stroke participated in qualitative interviews which were analysed and the themes compared for equivalence to those derived from existing data on MS fatigue. 999 questionnaire packs were sent to those with a stroke within the past four years. Data from the four subscales, and the Summary scale of the NFI-MS were fitted to the Rasch measurement model.ResultsThemes identified by stroke patients were consistent with those identified by those with MS. 282 questionnaires were returned and respondents had a mean age of 67.3 years; 62% were male, and were on average 17.2 (SD 11.4, range 2–50) months post stroke. The Physical, Cognitive and Summary scales all showed good fit to the model, were unidimensional, and free of differential item functioning by age, sex and time. The sleep scales failed to show adequate fit in their current format.ConclusionPost stroke fatigue appears to be represented by a combination of physical and cognitive components, confirmed by both qualitative and quantitative processes. The NFI-Stroke, comprising a Physical and Cognitive subscale, and a 10-item Summary scale, meets the strictest measurement requirements. Fit to the Rasch model allows conversion of ordinal raw scores to a linear metric.
Highlights
IntroductionIt can be considered to be ‘a feeling of early exhaustion, weariness and aversion to effort’ [3], or a ‘lack of energy with an increased need to rest’ [4]
Fatigue is a common symptom in stroke [1,2]
Themes identified by stroke patients were consistent with those identified by those with multiple sclerosis (MS). 282 questionnaires were returned and respondents had a mean age of 67.3 years; 62% were male, and were on average 17.2 (SD 11.4, range 2–50) months post stroke
Summary
It can be considered to be ‘a feeling of early exhaustion, weariness and aversion to effort’ [3], or a ‘lack of energy with an increased need to rest’ [4]. The extent of fatigue has been shown to increase with stroke severity[5]. It can have a considerable impact upon lifestyle and has, for example, been shown to be an independent predictor for the need to move into an institutional setting post-stroke [6]. Given the importance of post-stroke fatigue, several fatigue scales have been used to ascertain the extent of. Fatigue is a common symptom in Stroke. Several self-report scales are available to measure this debilitating symptom but concern has been expressed about their construct validity
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