Abstract:
Pathologic fatigue is not ameliorated by rest, is perceived as abnormal, and may be characterised as chronic; with multiple, often unknown causes. A significant proportion of stroke survivors experience persistent, significant post-stroke fatigue (PSF) affecting their daily lives. PSF independently predicts decreased functional independence, institutionalisation, and case-fatality. Evidence concerning the aetiology of, and risk factors for, PSF is currently limited and inconsistent. Intervention studies for management of PSF are rare. Patient psychoeducation programmes, which focus on sharing information about fatigue, and the principles and techniques of fatigue management, have been successfully utilized to alleviate fatigue associated with other medical conditions. The current study evaluated the feasibility and efficacy of a novel psychoeducation intervention for PSF when compared to more general stroke education. Empirically proven techniques were assembled into a 6-hour group psychoeducation Fatigue Management Group (FMG) programme, and contrasted with a 6-hour Stroke Education Group (SEG). Study measures included multiple fatigue measures, to ascertain the most appropriate fatigue measures to utilise with PSF, and mood and other functional outcome measures. The findings indicate that the FMG intervention was feasible and well tolerated by participants. Both groups experienced a significant reduction in PSF by the end of the programme, which may have been due to the choice of using a group format and/or a wide focus of psychoeducation materials. There was also significant improvement in social functioning for both groups, which was likely to be a benefit stemming from the socialisation opportunities afforded by the group format. The findings support the Fatigue Severity Scale, Short Form-36 Vitality subscale, and Checklist of Individual Strength as valid measures of PSF, whilst bringing into question the Visual Analogue Scale for Fatigue. The success of this feasibility study suggests that a full trial of the intervention on a larger scale would be a useful next step in alleviating PSF. A future trial should consider using three conditions, contrasting FMG with SEG and a usual care condition, thus enabling better understanding of whether effects related to unique or shared content material and/or to participation in a group.