Experiences and Perceptions of Post-Stroke Fatigue Among Stroke Survivors in Saudi Arabia: A Qualitative Interview Study

Abstract

Purpose

Post-stroke fatigue (PSF) is a debilitating condition that negatively impacts the quality of life of stroke survivors. The rehabilitation of stroke survivors is important for their quality of life, and rehabilitation programs that cater to the needs of these patients are required. However, there is very little published information on their needs, especially in the Middle East. Therefore, this study aimed to explore stroke survivors’ perceptions and experiences of PSF and its causes, its impact on their daily life, their coping strategies, and support from physicians and caregivers in the context of Saudi Arabia.

Patients and Methods

This qualitative interview study was conducted with eight post-stroke survivors from two tertiary stroke centers in Saudi Arabia.

Results

The responses in the interviews showed high heterogeneity. From the responses, five main themes and several subthemes were generated: (1) description of PSF as both a physical and psychological experience; (2) perceived causes of PSF (physical causes, psychological causes, and stroke-related causes); (3) impact of PSF on daily life (activities of daily living and social interactions); (4) coping strategies for PSF (pacing, self-motivation, and social participation); and (5) perspectives about support from caregivers and healthcare practitioners (lack of support, provision of information about PSF and its management, physiotherapy interventions, encouragement, and overprotectiveness).

Conclusion

Stroke survivors have variable physical and psychological experiences of PSF and variable perceptions of its causes and impact. High heterogeneity was also noted in the perception of support provided by healthcare providers and families or caregivers—ranging from lack of support to overprotection. Similarly, patients’ perceptions of the role of physiotherapy and their attitude towards physiotherapy were also variable. Despite this, the findings do highlight the need for more individualized understanding of PSF and the development of treatment strategies that consider biological, psychological, and social factors.

Keywords:

• cerebrovascular stroke
• fatigue
• inductive thematic analysis
• patient perspective
• Saudi Arabia
• semi-structured interview

What the Study Has Added

Stroke survivors in Saudi Arabia have varied perceptions of post-stroke fatigue and were generally of the opinion that the support provided by caregivers and healthcare practitioners is inadequate. The findings imply that better educational and management tools that consider both the physical and psychological components of PSF are required. From this perspective, the biopsychosocial model would provide a suitable framework for devising strategies for the management of PSF.

Ethics Approval and Informed Consent

This study was approved by the Faculty of Medicine and Health Sciences Ethics Committee of the University of Nottingham (Ethics No. 2631603). Ethical approval was also obtained from King Fahad Medical City (IRB No. 00010471). The lead researcher received permission from the stroke unit directors at KFMC and SNAHC to access hospital registry records, select eligible participants, and obtain their contact information in order to invite them to face-to-face interviews. Written informed consent was obtained from all participants. All participants were given an information sheet to read and an informed consent form to sign in which they were assured that they were free to withdraw at any point and that their responses could be published in an anonymized fashion. Study complies with the Declaration of Helsinki.

Acknowledgments

We want to thank everyone who took part for their contributions. We also want to thank King Fahad Medical City Hospital and Sultan Bin Abdelaziz Humanitarian City Hospital for permitting us to conduct the research at their facilities. This work was supported by the Princess Nourah bint Abdulrahman University Researchers Supporting Project (grant number PNURSP2023R267), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

There are no conflicts of interest to declare.

Additional information

Funding

This work was supported by the Princess Nourah bint Abdulrahman University Researchers Supporting Project (grant number PNURSP2023R267), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. This study is also part of the PhD scholarship fund from Princess Norah University at the University of Nottingham.