van de Port I G L, Kwakkel G, Schepers V P M, Heinemans C T I, Lindeman E
Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat, Utrecht, The Netherlands.
Cerebrovasc Dis. 2007;23(1):40-5. doi: 10.1159/000095757. Epub 2006 Sep 12.
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.
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%.
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.
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.
确定中风后疲劳与日常生活活动（ADL）、工具性日常生活活动（IADL）以及感知的健康相关生活质量（HRQoL）之间的纵向关联，并确定这种关系是否受到其他决定因素的混淆。
对连续入院接受住院康复治疗的中风患者进行前瞻性队列研究。在223名患者中风后6个月、12个月和36个月时评估ADL、IADL和HRQoL。通过疲劳严重程度量表确定疲劳情况。采用随机系数分析来分析疲劳对ADL、IADL和HRQoL的影响。针对潜在的混杂因素，即年龄、性别、合并症、执行功能、轻瘫严重程度和抑郁，对疲劳与结局之间的关联进行校正。如果疲劳对结局的回归系数变化超过15%，则将该协变量视为混杂因素。
疲劳与IADL和HRQoL显著相关，但与ADL无关。疲劳与IADL之间的关系受到抑郁和运动障碍的混杂影响。抑郁使疲劳与HRQoL之间的关系产生偏差，但疲劳仍与HRQoL独立相关。
疲劳在纵向与IADL存在虚假关联，与HRQoL独立相关。这些发现表明，在研究中风后疲劳对结局的影响时，应控制诸如抑郁等混杂因素。
