title: Post-stroke Fatigue is an Independent Predictor of Post-stroke Disability and Burden of Care: A Path analysis Study.
abstract: Post-stroke fatigue (PSF) is a common and one of the most distressing symptoms in stroke survivors. However, little is known about the relationship between severity of fatigue and the overall impact it has on post-stroke disability and burden of care. We aimed to examine the role of PSF in post-stroke disability and burden of care among stroke survivors after their first-ever stroke.
  
  
  METHODS
  We prospectively recruited 163 subjects (35 females) from patients examined consecutively in a tertiary stroke care center in India, after their first-ever ischemic or hemorrhagic stroke (>3 months after event). In addition to demographic and clinical characteristics, the following assessments were done - SF-36 vitality domain (fatigue), Modified Rankin Scale (functional recovery), Hospital anxiety and depression scale (depression), Functional independence measure (disability and burden of care). We used path analysis to identify a model that will capture the interactions of fatigue, depression, and degree of functional recovery in stroke survivors.
  
  
  RESULTS
  The severity of PSF positively correlated with the severity of disability and PSF had significant contribution to disability over and above functional recovery and depression, with all three factors accounting for 43% of the variance. Among the four models that were proposed to explore these relationships, the best fitting model showed that the effect of PSF is mediated through both the direct effect of fatigue on disability and through its interaction with depression, which remained a separate contributor to post-stroke disability and burden of care.
  
  
  CONCLUSIONS
  PSF, therefore, is an important determinant of post-stroke disability and should be evaluated for successful post-stroke rehabilitation.
authors.affiliation: 1 Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Trivandrum, Kerala, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Mandliya
authors.forename: Abhijit
authors.initials: A
authors.lastname: Das
authors.forename: J P
authors.initials: JP
authors.lastname: Unnikrishnan
authors.forename: M G
authors.initials: MG
authors.lastname: Amal
authors.forename: P Sankara
authors.initials: PS
authors.lastname: Sarma
authors.forename: P N
authors.initials: PN
authors.lastname: Sylaja
mesh_terms: D000368:Aged; D017281:Cost of Illness; D003863:Depression / Q000209:etiology / Q000451:nursing / Q000534:rehabilitation*; D004185:Disability Evaluation; D005221:Fatigue / Q000150:complications / Q000209:etiology / Q000451:nursing / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000451:nursing; D000071939:Stroke Rehabilitation
keywords: Anxiety; Depression; Keywords; Post-stroke disability; Post-stroke fatigue; Stroke severity