Poststroke Fatigue and Daily Activity Patterns During Outpatient Rehabilitation:An Experience Sampling Method Study

OBJECTIVE: To advance our understanding of poststroke fatigue by investigating its momentary and time-lagged relationship with daily activities.DESIGN: Longitudinal observational study using the experience sampling method (ESM).SETTING: Outpatient rehabilitation care.PARTICIPANTS: Thirty individuals with stroke (N=30).INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: ESM is a structured diary method that allows assessing real-time symptoms, behavior, and environment characteristics in the flow of daily life, thereby capturing moment-to-moment variations in fatigue and related factors. Using a mobile application, individuals with stroke were followed during 6 consecutive days, and were prompted at 10 random moments daily to fill in a digital questionnaire about their momentary fatigue and current activity: type of activity, perceived effort and enjoyment, and physical activity levels.RESULTS: Based on all completed digital questionnaires (N=1013), multilevel regression analyses showed that fatigue was significantly associated with type of activity and that fatigue was higher when participants had engaged in physical activity. Fatigue was also higher during activities perceived as more effortful and during less enjoyable activities. Time-lagged analyses showed that fatigue was also predicted by physical activity and perceived effort earlier during the day. Importantly, the relationship between these daily activity characteristics and fatigue differed substantially across individuals.CONCLUSIONS: This study illustrates the need for ESM to design personalized rehabilitation programs and to capture fatigue and other patient-reported outcomes in daily life.</p

Dealing with patients with behavioural problems after acquired brain injury: nurses’ experiences with the antecedent behaviour consequence method

Context: Behavioural problems are common after brain injury and can cause feelings of distress in the nursing staff, which can in turn have a negative influence on the behaviour of the patient. Nurses often do not feel they have the necessary skills to apply behavioural interventions in daily practise. They may benefit from the ABC (Antecedent-Behaviour-Consequence) method. Objective(s): This study examined nurses’ impressions of the effects after implementation of the ABC method on a brain-injury ward. Method(s): This study is part of the long-term follow-up (LT-FU) of our longitudinal group intervention study. Nurses were asked to complete a questionnaire once at the time of the LT-FU. Outcome measures were based on the theory of planned behaviour (Ajzen, 1991). Descriptive statistics were used. Findings: After implementation of the ABC method, most nurses reported they perceived behavioural control, received social support, had few feelings of fear, and had confidence in the way they deal with behavioural problems. Moreover, nurses reported positive changes in all these topics since working with the method. Limitations: Although first findings are interesting, we must also underline that the absence of a baseline measurement is a shortcoming of the study. Implications: Training nursing staff in managing behavioural problems with the ABC method might give them more perceived control and decrease feelings of distress and fear. Further longitudinal research is needed to investigate these experiences of the nursing staff to examine whether this has a positive effect on their well-being, job-satisfaction, and the behavioural problems of patients