Fatigue after ischaemic stroke: A five-year longitudinal study of prevalence and latent trajectory subgroups
Kristin Haugskott Tiller, Hild Fjærtoft, Siw Tone Innstrand, Stian Lydersen, Heather Allore, Geske Luzum, Fredrik Ildstad, Bent IndredavikObjective
To investigate the prevalence and longitudinal course of post-stroke fatigue and identify subgroups with distinct fatigue trajectories up to 5 years post-stroke.
Design
A prospective, longitudinal, multi-centre cohort study.
Setting
Hospital stroke units in the Central-Norway health region.
Participants
Incident ischaemic stroke patients were recruited during acute hospitalisation between June 2015 and November 2017. Data were collected during the hospital stay and at 3 months, 1 year, 3 years, and 5 years.
Main measures
Fatigue was assessed using the 7-item Fatigue Severity Scale with
Results
A total of 693 participants were included. The prevalence of clinical fatigue was 24% (3 months), 28% (1 year), 30% (3 years), and 28% (5 years). A Sankey diagram illustrated substantial variability in fatigue status across time points. Using group-based trajectory modelling, four latent subgroups with distinct fatigue trajectories were identified: (1) low fatigue, (2) emerging fatigue, (3) improving fatigue, and (4) high fatigue.
Conclusion
One quarter to one third of the study population consistently exhibited fatigue up to 5 years post-stroke. High variability in fatigue status over time was evident, indicating individual-level heterogeneity in the longitudinal course. This was further confirmed by the identification of four latent subgroups with distinct post-stroke fatigue trajectories. Early detection of individuals at risk of an adverse fatigue trajectory and differentiated follow-up may improve outcomes for stroke survivors.