Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation: a longitudinal cohort study

Abstract

Purposes

To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation.

Methods

People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3).

Results

Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity.

Conclusions

Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity.

IMPLICATIONS FOR REHABILITATION

• Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation.

• In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation.

• A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue.

Keywords:

• Stroke
• physical activity
• perceived fatigue
• activity pacing
• latent class analyses
• health promotion
• quality of life

Acknowledgements

The authors would like to thank all participants for their contribution to the ReSpAct study. Furthermore, we would like to thank the following eighteen organizations for their support to the ReSpAct study: Adelante zorggroep, Bethesda Ziekenhuis, De Trappenberg, De Vogellanden, Maasstad Ziekenhuis, Medisch Centrum Alkmaar, Militair Revalidatiecentrum Aardenburg, Revalidatiecentrum Leijpark, Revalidatiecentrum Reade, Revalidatie Friesland, Revant, Rijnlands Revalidatiecentrum, RMC Groot Klimmendaal, Scheper Ziekenhuis, Sint Maartenskliniek, Sophia Revalidatie, Tolbrug Revalidatie, ViaReva.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the Dutch Ministry of Health, Welfare and Sport [319758] and supported by Stichting Special Heroes Nederland.