Original Paper

Is Fatigue an Independent Factor Associated with Activities of Daily Living, Instrumental Activities of Daily Living and Health-Related Quality of Life in Chronic Stroke?
I.G.L. van de Port^{a, b}, G. Kwakkel^{a, b, d}, V.P.M. Schepers^{a, b}, C.T.I. Heinemans^c, E. Lindeman<sup>a, b

a</sup>Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, and
^bRudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center, and
^cDepartment of Health Psychology, Utrecht University, Utrecht, and
^dDepartment Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands

Address of Corresponding Author

Cerebrovasc Dis 2007;23:40-45 (DOI: 10.1159/000095757)

  Key Words

• Fatigue
• Cerebrovascular accident
• Activities of daily living
• Quality of life

  Abstract

Background: To determine the longitudinal association of poststroke fatigue with activities of daily living (ADL), instrumental ADL (IADL) and perceived health-related quality of life (HRQoL) and to establish whether this relationship is confounded by other determinants. Methods: A prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation was conducted. ADL, IADL and HRQoL were assessed in 223 patients at 6, 12 and 36 months after stroke. Fatigue was determined by the Fatigue Severity Scale. Random coefficient analysis was used to analyze the impact of fatigue on ADL, IADL and HRQoL. The association between fatigue and outcome was corrected for potential confounders, i.e. age, gender, comorbidity, executive function, severity of paresis and depression. The covariate was considered to be a confounder if the regression coefficient of fatigue on outcome changed by >15%. Results: Fatigue was significantly related to IADL and HRQoL but not to ADL. The relation between fatigue and IADL was confounded by depression and motor impairment. Depression biased the relation between fatigue and HRQoL, but fatigue remained independently related to HRQoL. Conclusions: Fatigue is longitudinally spuriously associated with IADL and independently with HRQoL. These findings suggest that in examining the impact of poststroke fatigue on outcome, one should control for confounders such as depression.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

I.G.L. van de Port, MSc
Rehabilitation Center De Hoogstraat
Rembrandtkade 10
NL-3583 TM Utrecht (The Netherlands)
Tel. +31 3025 61382, Fax +31 3025 11344, E-Mail i.v.d.port@dehoogstraat.nl

  Article Information

Participating rehabilitation centers in the Netherlands: Rehabilitation Center De Hoogstraat, Utrecht; Rehabilitation Center Amsterdam, Amsterdam; Rehabilitation Center Heliomare, Wijk aan Zee, and Rehabilitation Center Blixembosch, Eindhoven.

Received: March 8, 2006
Accepted: May 15, 2006
Published online: September 12, 2006
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 35