Our study showed that fatigue was reported in 64.5%
of the patients. It was determined in our study that age,
gender, working status, duration of stroke and comorbid
diseases did not affect the fatigue level. In a Turkish
study, fatigue was detected in 55.7% (n=70) of stroke
cases. Fatigue is one of the most important complaints
following stroke, and was detected in 39-72 % of those
who have experienced it
11. Stein et al.
32 found that
76% of patients made a complaint related to fatigue
within 8 months following the stroke. Ingles et al.
33
found that 68% of patients complained about fatigue
while this rate was 36% in the control group. In other
studies, fatigue was reported in 57% of patients and
post-stroke fatigue was reported in 51.3% of the patients
15,34. Our results were parallel to those of the abovementioned
studies. Many studies demonstrated that most
of the patients suffering stroke experienced fatigue and
there was no relationship between fatigue and sociodemographic
characteristics
5,33. Colle et al.
11 did
not find a relationship between fatigue and related factors (age, gender, time since stroke). Lerdal et al.
22
reported that there was no relationship between fatigue
and gender, level of education or age while unemployed
patients reported fatigue significantly more frequently
than employed patients. In our study, however, it was
found that patients who were university graduates
experienced higher levels fatigue. It was thought that this
difference may have resulted from the fact that the
studies were carried out on different sampling groups.
Besides, it can be easily seen when working conditions
are examined that university graduates are employed in
works which are both physically and mentally more
intense and tiring in our country and this fact may have
also resulted in the above-mentioned difference.
According to researchers, being active in the social and
business life may become a factor increasing the fatigue
for the university graduates by making it hard for them to
face the changes in their life styles following the stroke.
When mean fatigue levels of the patients were
considered by their age groups, it was found that fatigue
level of the patients aged 44 and below (4.32±1.87) was
lower than the other age groups and it was observed that
fatigue levels increased at age groups of 45-54 and 55-
64 but this difference was not found statistically
significant (P>0.05). As the age of retirement is around
65 in our country, it can be said that individuals within
this age group do not usually work. The elderly people
and especially those having a chronic disease and
needing physical assistance/care live in the same house
with their daughters, sons, daughters-in-low and
grandchildren and their requirements are met by the
family members. Since the people of this age group have
a sedentary life style, they experience lower levels of fatigue when compared to the younger age groups
leading more active lives. Demographic factors such as
age, gender and comorbidity did not have significant
relationships with fatigue and the instrumental activities
of daily life or health-related quality of life
6. Glader et
al.
4 found that elderly female stroke patients showed
more marked fatigue. In our study, no difference was
observed between female and male patients with regard
to fatigue, with an average of fatigue of 4.93 in both
groups. In Turkey, women both work at home (cooking,
taking care of the children, cleaning the house etc.) and
take part in the business life. As for men, they work
outside the house but they do not help women at home.
It's thought that since both men and women have similar
life conditions, there is no difference in their fatigue
levels. These results are attributed to the differences of
sampling groups in the studies and to the socio-cultural
differences peculiar to the country. It was detected that
fatigue levels of those having a comorbid disease
(5.00±2.13) were higher than those lacking a comorbid
disease (4.76±1.90) but that there was no statistically
significant difference (P<0.05). Since fatigue is a
subjective concept, this result is thought to possibly
originate from different perception of the patients. Van de
Port et al.
6 found that fatigue was experienced in 68%
of patients within 6 months following the stroke, whereas
74% of patients felt fatigued within 1 year and 58% within
3 years after the stroke. Schepers et al.
35 found
fatigue rates to be 64.1% within six months after the
stroke and to be 69.5% within one year after the stroke.
In our study, however, the highest average fatigue (5.53)
was observed within first 6 months group. Thus, being
able to measure this symptom constitutes an important
part of the management of this disease as well as
understanding its role in the overall impact of the
disease. Rehabilitation nurses should carefully evaluate
the presence and severity of fatigue as it is related to
activity, self-care and quality of life in patients with
stroke.
The highest scores were found in the following items:
“exercise brings on my fatigue” and “my motivation is
lower when I am fatigued”. Choi-Kwon et al.15 found a
mean score of 2.9 while the highest score was obtained
in the item “I am easily fatigued” (5.01) followed by “my
motivation is lower when I am fatigued” (4.58). Michael et
al.1 found a mean total FSS score of 3.9 while 46% of
the sample fell into the range that defines fatigue.
Patients suffering from stroke scored highest on the
following statements; “my motivation is lower when I am fatigued” (5.42), “exercise brings on my fatigue” (4.2),
and “fatigue interferes with my physical functioning”
(4.32). In another study, the highest scores were noted
on the items “exercise brings on my fatigue” (4.8), “my
motivation is lower when I am fatigued” (5.8), and
“fatigue interferes with my physical functioning” (4.5)
34.
In our study, the fatigue level was found to be high
but there was no relationship between level of fatigue
and quality of life. When the relationship between level of
fatigue and quality of life was examined in the literature,
it was found that fatigue reduced patients' quality of life3,6,15. “In a study, relationships found between
fatigue and the general perception of health,
energy/vitality, overall physical and mental score of
quality of life30” It is thought that stroke patients try
hard to cope with these symptoms even though patients
experience symptoms of fatigue. It is thought that the
differences between the results of the studies originate
from the varying characteristics of the sample groups in
terms of age and duration of illness etc.
In conclusion, fatigue remains a frequent and
persistent symptom experienced after a stroke has
occurred. It is of basic importance for the nursing care
management of patients experiencing fatigue that fatigue
should be identified and evaluated. In this study, it was
shown that post-stroke fatigue is a significant problem of
patients and the level of fatigue was determined.
The nurse establishing one-to-one interaction with
the patient must enable the patient to explain the effects
of fatigue on his or her life and to express his individual
abilities and interests. Nurses should describe activities
which reduce or induce fatigue in patients. Energy
conservation strategies should be taught to patients and
should be configured into the daily activities of patients
with stroke by planning activities and resting times.
Besides, the patients and the families should be
supported by nurses in shaping these activities and
making environmental changes. Nurses should
coordinate the care and the treatment which is provided
to the patient by other members of the health team and
encourage the therapists and the patients to
communicate with each other.
Relevance to clinical practice: This study highlighted
the importance the fatigue of stroke patients. It is
recommended that our study can be used to determine
the fatigue of stroke patients in Turkey.