title: Prevalence of fatigue in patients 3 months after stroke and association with early motor activity: a prospective study comparing stroke patients with a matched general population cohort.
abstract: BACKGROUND
  Fatigue is a common complaint after stroke. Reasons for higher prevalence are still unclear. This study aimed to determine if fatigue prevalence in stroke patients is different to that of age and gender matched general population controls, and to explore whether early motor activity was associated with reduced likelihood of fatigue three months after stroke.
  
  
  METHODS
  This was a prospective multicenter cohort study of stroke patients admitted to eleven regional Norwegian hospitals, within 14 days after stroke. Stroke patients (n = 257) were age and gender matched to participants in a general population health survey (HUNT3-survey) carried out in a regional county of central Norway. The single-item fatigue questionnaire from the HUNT3-survey was administered to both groups to compare prevalence. The association between early motor activity (time in bed, time sitting out of bed, and time upright) and fatigue at three months after stroke (Fatigue Severity Scale) was tested with logistic regression. Simple models including each activity outcome, with adjustment for stroke severity and pre-stroke function, were tested, as well as a comprehensive model that included additional independent variables of depression, pain, pre-stroke fatigue, age and gender.
  
  
  RESULTS
  Prevalence was higher after stroke compared with the general population: 31.1% versus 10.9%. In the simple regression models, none of the early motor activity categories were associated with fatigue three months after stroke. In the comprehensive model, depression, pain and pre-stroke fatigue were significantly associated with post-stroke fatigue. Time in bed through the daytime during hospital stay approached statistical significance (p = 0.058) with an odds ratio for experiencing fatigue of 1.02 (95% CI 1.00-1.04) for each additional 5.4 minutes in bed.
  
  
  CONCLUSIONS
  Stroke patients had higher prevalence of fatigue three months after stroke than the age and gender matched general population sample, which may be partly explained by the stroke population being in poorer health overall. The relationship between early motor activity (and inactivity) and fatigue remains unclear. Further research, which may help drive development of new treatments to target this challenging condition, is needed.
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. thor@sutmap.com.
authors.forename: Thorlene
authors.initials: T
authors.lastname: Egerton
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. anne.hokstad@ntnu.no.|The Stroke Unit, Department of Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway. anne.hokstad@ntnu.no.
authors.forename: Anne
authors.initials: A
authors.lastname: Hokstad
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. torunn.askim@ntnu.no.|Department of Physiotherapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway. torunn.askim@ntnu.no.
authors.forename: Torunn
authors.initials: T
authors.lastname: Askim
authors.affiliation: Florey Institute of Neuroscience and Mental Health, Melbourne, Australia. julie.bernhardt@florey.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. bent.indredavik@ntnu.no.|The Stroke Unit, Department of Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway. bent.indredavik@ntnu.no.
authors.forename: Bent
authors.initials: B
authors.lastname: Indredavik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003863:Depression / Q000453:epidemiology; D004434:Early Ambulation; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology*