Jaracz Krystyna, Mielcarek Liliana, Kozubski Wojciech
Department of Neurological and Psychiatric Nursing, University of Medical Sciences, Poznań.
Neurol Neurochir Pol. 2007 Jan-Feb;41(1):36-43.
Although poststroke fatigue concerns almost 60% of patients, still little is known about its pathogenesis and contributing factors. Therefore, the purpose of this study was to evaluate the severity of fatigue in terms of its impact on physical, psychological and social functioning as well as to determine the relation between fatigue and clinical, demographic and psychological factors.
Patients (n = 50) with acute first-ever stroke admitted to the neurological department were interviewed at 3 months after discharge. Poststroke fatigue was assessed using the Polish version of the Fatigue Impact Scale. Neurological status was examined with the Scandinavian Stroke Scale, functional status with the Barthel Index, and emotional status with the Beck Depression Inventory. Styles of coping with stress were identified using the Coping Inventory for Stressful Situations. Sex, age, type of stroke and lesion location were documented as well.
Ninety percent of patients demonstrated high level of fatigue in physical functioning, 16% in the psychological domain, and 18% in the social domain. In the univariate analyses, impact of fatigue on patients functioning significantly correlated with age, lower mood, neurological and functional status, as well as with styles of coping. Emotion-oriented coping was associated with lower level of fatigue, whereas the reverse was found regarding task-oriented coping. In the multivariate analyses the emotion-oriented style of coping was the most important correlate of fatigue.
The causes of poststroke fatigue appear to be multifactorial. Psychological factors, especially coping strategies, might be an important area for future interventions.
尽管近60%的中风患者存在中风后疲劳问题,但其发病机制和促成因素仍鲜为人知。因此,本研究的目的是评估疲劳对身体、心理和社会功能的影响程度,以及确定疲劳与临床、人口统计学和心理因素之间的关系。
对入住神经科的首次急性中风患者(n = 50)在出院后3个月进行访谈。使用疲劳影响量表的波兰语版本评估中风后疲劳。用斯堪的纳维亚中风量表检查神经功能状态,用巴氏指数检查功能状态,用贝克抑郁量表检查情绪状态。使用应激情境应对量表确定应对压力的方式。同时记录性别、年龄、中风类型和病变部位。
90%的患者在身体功能方面表现出高度疲劳,16%在心理领域,18%在社会领域。在单因素分析中,疲劳对患者功能的影响与年龄、情绪低落、神经和功能状态以及应对方式显著相关。以情绪为导向的应对方式与较低的疲劳水平相关,而以任务为导向的应对方式则相反。在多因素分析中,以情绪为导向的应对方式是疲劳最重要的相关因素。
中风后疲劳的原因似乎是多因素的。心理因素,尤其是应对策略,可能是未来干预的一个重要领域。