Post-stroke Fatigue is an Independent Predictor of Post-stroke Disability and Burden of Care: A Path analysis Study

Mandliya, Alok; Das, Abhijit; Unnikrishnan, Janardhanan P.; Amal, M.G.; Sarma, P. Sankara; Sylaja, PN

doi:10.1080/10749357.2015.1110273

Cited by 43 publications

(24 citation statements)

References 33 publications

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“…Fatigue might be assessed as a mediator of this longitudinally. Post-stroke fatigue and depression had overlapping yet distinct effects on functional outcome measures; these findings add to a path analysis study on disability among stroke survivors (Mandliya et al, 2016 ). The current results underscore the importance of recognizing fatigue clinically, and the need to understand the underlying pathophysiology.…”

Section: Discussionsupporting

confidence: 52%

“…Fatigue influences mobility (Ponchel et al, 2015 ), as measured using the Berg Balance Scale (BBS) or mobility tests (Michael et al, 2006 ; Duncan et al, 2015 ). There remains a need to dissect the complex inter-relationships between these prevalent sequelae and cognitive and mobility outcomes (Mandliya et al, 2016 ). There is little evidence that post-stroke fatigue is directly associated with cognition; however, a recent synthesis of evidence suggested that fatigue may heighten the influence of depressive symptoms (Ponchel et al, 2015 ), and therefore, there may be an indirect relationship between fatigue and cognition that is mediated by depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance

MacIntosh

Edwards

Kang

et al. 2017

Front. Aging Neurosci.

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Background: Fatigue and depressive symptoms are common and often inter-related stroke sequelae. This study investigates how they are related, directly or indirectly, to mobility and cognitive outcomes within 6 months of stroke.Methods: Participants were recruited from 4 stroke centers in Ontario, Canada. Post-stroke fatigue was assessed using the Fatigue Assessment Scale (FAS). Depressive symptoms were screened using the Center for Epidemiological Studies Scale for Depression (CES-D). Factor analyses were used to construct scores from mobility (distance traveled during a 2-min walk test, Chedoke-McMaster Stroke Assessment leg score, and Berg Balance Scale total score) and cognitive (Montreal Cognitive Assessment, Trail-Making Tests A and B, and five-word free recall) tests. Direct associations were assessed in linear regression models and indirect effects were assessed in path models. Covariates were age, sex, education, antidepressant use, days since stroke, and stroke severity (National Institute of Health Stroke Severity Scale score).Results: Fatigue and depressive symptoms were highly correlated (r > 0.51, p < 0.0001). Depressive symptoms were associated with cognition (β = −0.184, p = 0.04) and indirectly with mobility, mediated by fatigue (indirect effect = −0.0142, 95% CI: −0.0277 to −0.0033). Fatigue was associated with mobility (β = −0.253, p = 0.01), and indirectly with cognition, mediated by depressive symptoms (indirect effect = −0.0113, 95% CI: −0.0242 to −0.0023).Conclusions: Fatigue and depressive symptoms are related distinctly to cognitive and mobility impairments post-stroke. Fatigue was associated with poorer lower limb motor function, and with cognition indirectly via depressive symptoms.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance

MacIntosh

Edwards

Kang

et al. 2017

Front. Aging Neurosci.

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“…Of the patients with a first stroke, up to 75% will suffer PSF in the first year following stroke [1]. PSF has a detrimental impact on the recovery of neurological function, quality of life and rehabilitation of stroke survivors [2][3][4][5]. However, the pathogenesis of PSF remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Elevated plasma high‐sensitivity C‐reactive protein at admission predicts the occurrence of post‐stroke fatigue at 6 months after ischaemic stroke

Liu

Wang

et al. 2020

Euro J of Neurology

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Background and purpose Post‐stroke fatigue (PSF) is a common neuropsychiatric affective symptom occurring after stroke. Evidence indicates activated inflammatory pathways are involved in modulating the stroke and fatigue. High‐sensitivity C‐reactive protein (hs‐CRP) is one of the most sensitive indicators of inflammation. Our aim was to estimate the association between plasma hs‐CRP and PSF after acute ischaemic stroke. Methods In all, 212 acute ischaemic stroke patients were consecutively recruited within the first 14 days after stroke onset and followed up for 6 months. Plasma hs‐CRP levels were assayed by enzyme linked immunosorbent assay. Fatigue severity was assessed using the Fatigue Scale for Motor and Cognitive Functions. A score ≥ 43 is defined as PSF. Results Sixty‐eight stroke patients (32.1%) were diagnosed with PSF at 6 months’ follow‐up. In the patients with PSF, plasma hs‐CRP levels were significantly higher compared with those in non‐PSF patients (t = −8.524, P ≤ 0.001). In multivariate analyses, plasma levels of hs‐CRP were independently associated with PSF at 6 months (odds ratio 3.435, 95% confidence interval 2.222–5.309; P ≤ 0.001) after adjusting other recorded variables. Based on the receiver operating characteristic curve, the optimal cut‐off value of plasma hs‐CRP levels as an indicator for the prediction of PSF was projected to be 0.52 mg/dl, which yielded a sensitivity of 77.9% and a specificity of 74.3%, with the area under the curve 0.794 (95% confidence interval 0.725–0.864; P ≤ 0.001). Conclusion Elevated plasma hs‐CRP levels at admission were associated with PSF 6 months after stroke, suggesting that these alterations might predict the development of PSF in stroke patients.

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“…Stroke was known as the leading cause of adult disability and resulted in great social burden [1,2]. Approximately a third of stroke patients suffered from the recurrence of stroke, and 75 % of them had cardiac disease [3,4].…”

Section: Introductionmentioning

confidence: 99%

Effect of Community Exercise for Patients with Stroke: A Systematic Review and Meta-analysis

Peng

Zhou

Jiang

2019

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin

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Background Community exercise might be beneficial to stroke recovery. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the effect of community exercise on stroke patients. Methods PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of community exercise vs. usual care on stroke were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome were 6-Minute walk test and walking speed. Metaanalysis was performed using random-effect model. Results Four RCTs involving 497 patients were included in the metaanalysis. Overall, compared with control intervention, community exercise intervention was found to significantly improve 6-Minute walk distance (Std. mean difference=0.48; 95% CI=0.22 to 0.74; P=0.0003), and walking speed (Std. mean difference=0.40; 95% CI=0.10 to 0.70; P=0.009) in stroke patients, but resulted in no influence on Berg Balance Scale (Std. mean difference=0.39; 95% CI=−0.29 to 1.07; P=0.26), muscle strength (Std. mean difference=0.05; 95% CI=-0.34 to 0.43; P=0.82) and mental quality of life (Std. mean difference=0.04; 95% CI=−0.25 to 0.34; P=0.77). Conclusions Compared to control intervention, community exercise was found to significantly increase 6-Minute walk test, walking speed and Berg Balance Scale, but showed no influence on Berg Balance Scale, muscle strength and mental quality of life.

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Post-stroke Fatigue is an Independent Predictor of Post-stroke Disability and Burden of Care: A Path analysis Study

Abstract: PSF, therefore, is an important determinant of post-stroke disability and should be evaluated for successful post-stroke rehabilitation.

Cited by 43 publications

References 33 publications

Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance

Post-stroke Fatigue and Depressive Symptoms Are Differentially Related to Mobility and Cognitive Performance

Elevated plasma high‐sensitivity C‐reactive protein at admission predicts the occurrence of post‐stroke fatigue at 6 months after ischaemic stroke

Effect of Community Exercise for Patients with Stroke: A Systematic Review and Meta-analysis

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