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      The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study

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          Abstract

          Background

          Post-stroke fatigue is a typical complication following stroke. However, existing research primarily focused on its underlying mechanisms, and its impact on rehabilitation outcomes has yet to be uncovered.

          Objective

          This study aims to explore the impact of post-stroke fatigue on rehabilitation outcomes during hospitalization.

          Method

          This was a prospective multicenter observational study including 46 stroke patients receiving comprehensive rehabilitation treatment. Patients’ basic information was recorded upon admission and patients’ functional independence was assessed with Functional Independence Measure (FIM) both upon admission and discharge. One week after rehabilitation treatment, fatigue, positivity in daily activity, attention, and memory were assessed. Serum biochemical indicators and levels of C-reactive protein (CRP) were assessed weekly following admission. The pain scores were assessed during the first week of hospitalization to calculate the average. Correlation analysis, linear regression and propensity score matching (PSM) were used to analyze the impact of fatigue on FIM scores at discharge and length of hospital stay.

          Result

          The proportion of patients with low fatigue was 39.13% and significant improvement was revealed in FIM scores upon admissions and discharge [(50.67±18.61) vs. (75.13±21.04), P<0.05]. Positivity in daily activity, attention, and age are factors that influence post-stroke fatigue. After PSM, low-fatigue group (Fatigue score< 3) showed significant higher motor function independence at discharge [(54.39 ± 15.42) vs. (41.89 ± 14.90), P<0.05] and shorter hospital stay [(28.54±9.13)d vs. (37.32 ± 9.81)d, P<0.05] than high-fatigue group. There was a significant difference (P<0.05) in level of CRP between the first inpatient week and the third week, with declining trend.

          Conclusion

          Post-stroke fatigue can affect the rehabilitation outcomes regarding motor function independence and length of hospital stay.

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          Most cited references37

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          Heart Disease and Stroke Statistics—2020 Update

          Salim S. Virani, Alvaro Alonso, Emelia Benjamin … (2020)
          Circulation
          Article 0 comments Cited 2642 times – based on 0 reviews     Review now
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            Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

            Fakher Rahim, Yasir Waheed (2022)
            Summary Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.
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              Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

              Carolee Winstein, Joel Stein, Ross Arena … (2016)
              The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke.
              Article 0 comments Cited 645 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hongji Zeng: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Jiaying Yang: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SoftwareRole: VisualizationRole: Writing – review & editing
                Junfa Wu: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Yu Ding: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Project administrationRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Shuya Yuan: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – review & editing
                Rui Wang: Role: ConceptualizationRole: Data curationRole: InvestigationRole: ResourcesRole: SoftwareRole: Writing – review & editing
                Weijia Zhao: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: SoftwareRole: Writing – review & editing
                Xi Zeng:
                ORCID: https://orcid.org/0009-0008-6079-5008
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – review & editing
                Nadinne Alexandra Roman: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 31 May 2024
                Publication date Collection: 2024
                Volume: 19
                Issue: 5
                Electronic Location Identifier: e0302574
                Affiliations
                [1 ] School of Public Health, Zhengzhou University, Zhengzhou, China
                [2 ] Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
                [3 ] Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
                [4 ] National Center for Neurological Disorders, Shanghai, China
                [5 ] Department of Neurology, The Second Medical Center, PLA General Hospital, Beijing, China
                [6 ] NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Diseases, Zhengzhou, China
                Transilvania University of Brasov: Universitatea Transilvania din Brasov, ROMANIA
                Author notes

                Competing Interests: The authors have declared that no competing interests.

                Author information
                https://orcid.org/0009-0008-6079-5008
                Article
                Publisher ID: PONE-D-23-43644
                DOI: 10.1371/journal.pone.0302574
                PMC ID: 11142535
                PubMed ID: 38820361
                SO-VID: d948d7b6-4ebb-4df3-b501-301df806adcd
                Copyright © © 2024 Zeng et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 29 December 2023
                Date accepted : 8 April 2024
                Page count
                Figures: 3, Tables: 5, Pages: 15
                Funding
                Funded by: the non-profit central research institute fund of Chinese academy of medical science
                Award ID: 2020-PT310-01
                Award Recipient :
                ORCID: https://orcid.org/0009-0008-6079-5008
                This study was supported by the non-profit central research institute fund of Chinese academy of medical science (2020-PT310-01). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Signs and Symptoms
                Subject: Fatigue
                Subject: Medicine and Health Sciences
                Subject: Rehabilitation Medicine
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Hospitals
                Subject: Biology and Life Sciences
                Subject: Biochemistry
                Subject: Proteins
                Subject: C-Reactive Proteins
                Subject: Medicine and Health Sciences
                Subject: Clinical Medicine
                Subject: Signs and Symptoms
                Subject: Pain
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognition
                Subject: Memory
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Learning and Memory
                Subject: Memory
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: Antiplatelet Therapy
                Custom metadata
                Data Availability The authors do not have permission to share data. However, the data can be obtained under a reasonable request from Research Management Association of The First Affiliated Hospital of Zhengzhou University (E-mail: fccweijy@ 123456zzu.edu.cn ; Phone number: 0371-67739261).

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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