title: Is fatigue an independent factor associated with activities of daily living, instrumental activities of daily living and health-related quality of life in chronic stroke?
abstract: BACKGROUND
  To determine the longitudinal association of poststroke fatigue with activities of daily living (ADL), instrumental ADL (IADL) and perceived health-related quality of life (HRQoL) and to establish whether this relationship is confounded by other determinants.
  
  
  METHODS
  A prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation was conducted. ADL, IADL and HRQoL were assessed in 223 patients at 6, 12 and 36 months after stroke. Fatigue was determined by the Fatigue Severity Scale. Random coefficient analysis was used to analyze the impact of fatigue on ADL, IADL and HRQoL. The association between fatigue and outcome was corrected for potential confounders, i.e. age, gender, comorbidity, executive function, severity of paresis and depression. The covariate was considered to be a confounder if the regression coefficient of fatigue on outcome changed by >15%.
  
  
  RESULTS
  Fatigue was significantly related to IADL and HRQoL but not to ADL. The relation between fatigue and IADL was confounded by depression and motor impairment. Depression biased the relation between fatigue and HRQoL, but fatigue remained independently related to HRQoL.
  
  
  CONCLUSIONS
  Fatigue is longitudinally spuriously associated with IADL and independently with HRQoL. These findings suggest that in examining the impact of poststroke fatigue on outcome, one should control for confounders such as depression.
authors.affiliation: Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands. i.v.d.port@dehoogstraat.nl
authors.forename: I G L
authors.initials: IG
authors.lastname: van de Port
authors.forename: G
authors.initials: G
authors.lastname: Kwakkel
authors.forename: V P M
authors.initials: VP
authors.lastname: Schepers
authors.forename: C T I
authors.initials: CT
authors.lastname: Heinemans
authors.forename: E
authors.initials: E
authors.lastname: Lindeman
mesh_terms: D000203:Activities of Daily Living; D002908:Chronic Disease; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome