Introduction: Post-stroke fatigue (PSF) is a debilitating part of stroke recovery with long-term effects. Risk factors contributing to PSF, whether they are modifiable, and if they change over time remain understudied. In this study, we determine factors associated with PSF and how they evolve from the subacute to chronic phase of recovery.
Methods: A consecutive series of patients presenting to our urban tertiary referral comprehensive stroke center with acute ischemic stroke were seen in follow-up 2-3 months post-event and given the Functional Assessment of Chronic Illness (FACIT) to evaluate for PSF. It was re-administered via telephone 1-2 years post-infarct. Demographics, stroke characteristics (NIH Stroke Scale (NIHSS), size and location of infarct), medical comorbidities, and outcomes (modified Rankin scale (mRS)) were also evaluated. Regression analyses were used to determine factors associated with PSF at each time point.
Results: 108 patients were seen in follow-up a mean 2 months post-stroke, 59 of whom were reached by phone a mean 21 months post-event. The characteristics of those reached were similar to those not reached. Stroke attributes such as follow-up NIHSS (p=.035) and mRS (p<.001) were associated with lower FACIT scores in the subacute setting, while comorbid medical conditions including chronic obstructive pulmonary disease (COPD, p=.038) and body mass index (p=.020) were associated with chronic PSF. Anxiety was associated with PSF both subacutely (p<.001) and chronically (p=.002).
Conclusions: PSF in the subacute period appears to be due to stroke characteristics (most notably stroke severity), while chronic fatigue occurs in the setting of other comorbid medical conditions such as obesity and COPD. This has significant clinical implications when considering both patients at risk for PSF and potential treatments, which appear to differ significantly between different recovery time points.