PITCH: Understanding Post-Stroke Fatigue: A Clinical Perspective

Problem

Post-Stroke Fatigue is a multidimensional construct incorporating both physical and cognitive components. Existing research predominantly investigates outcome measurement in a research setting yet does not link to clinical practice. There is no consensus as to how it should be measured, for example whether to use uni- or multi-dimensional scales. As a result, there is likely to be substantial variation in clinical practice. This disparity likely extends to management. The only review to investigate interventions for post-stroke fatigue found that study methodological quality was poor throughout, and no studies’ primary outcome was fatigue (1).

Aim:

The survey aimed to gain further depth into understanding how physiotherapists and occupational therapists assess and manage post-stroke fatigue in the United Kingdom.

1.Wu S, Kutlubaev MA, Chun HY, Cowey E et al. Interventions for post-stroke fatigue. Cochrane Database of Systematic Reviews.

Approach

The cross-sectional survey was created, received and answered electronically using Qualtrics software, an online survey creation and analysis site. Participants were Physiotherapists (members of the Association of Chartered Physiotherapists in Neurology) and Occupational Therapists (members of Royal College of Occupational Therapy Specialist Section-Neurological Practice). All completed surveys are submitted to Qualtrics, where the data is collated for the research team to analyse. Those who did not reply initially will be sent a reminder email after two weeks, and the same standardised protocol will be followed. Responses are numerically coded to determine frequency or classified into themes.

Findings

Following distribution of the invitation emails, 98 individuals responded (62 physiotherapists, 36 occupational therapists). 56 respondents work in community care, 21 in acute care, 16 in sub-acute care and 5 in primary care settings. When assessing a patient believed to be experiencing post-stroke fatigue, 59% of respondents would not use a scale while 41% use one of 6 ratified scales. Initial thematic analysis found that during subjective history taking, respondents question stroke survivors on their pre-stroke fatigue levels, sleep hygiene, the effect of fatigue on their psychosocial health and medication usage. A multitude of management strategies are being carried out across the UK including education, fatigue diaries, pacing interventions and group fatigue management programmes.

Consequences

This study provides a novel insight into current assessment and management strategies used in clinical practice for post-stroke fatigue. It is clear there are a wide variety of assessment and management tools currently used, with no strategies more significantly utilised than others. There is also variation in how healthcare professionals understanding of post-stroke fatigue is as a construct. Further data analysis will describe variation between occupational therapists and physiotherapists understanding, assessment and management of post-stroke fatigue. Future research should aim to further understand healthcare professionals clinical reasoning regarding assessment and management of post-stroke fatigue.