A population based study of the prevalence of fatigue following transient ischaemic attack and minor stroke

BACKGROUND AND PURPOSE: Fatigue is common after stroke and can be attributable to the increased physical effort associated with severe neurological deficits; however, its presence in those with little motor deficit raises the possibility of confounding by other factors, such as comorbidity, anxiety, and medication. To control for such factors and determine the extent of stroke-specific fatigue, we compared patients with minor stroke who had little or no residual neurological deficit with patients with TIA; both groups had undergone similar investigations and treatment. METHODS: The prevalence of fatigue 6 months after TIA or minor stroke was assessed in consecutive patients using the Chalder fatigue scale in a population-based incidence study (Oxford Vascular Study). Patients were included if they were independent in self-care Barthel Index (>or=18/20) and without major cognitive impairment (Mini-Mental State Examination >or=24/30). Stroke severity at baseline was assessed with the National Institute of Health Stroke Scale (NIHSS). Other potential causes of fatigue were assessed including anxiety, depression, recent life events, medication, and abnormalities in biochemistry or hematologic tests. RESULTS: Seventy-six participants had minor stroke (mean age, 74.1 years; 42 men) and 73 had TIA (mean age, 72.5 years; 40 men). At 6-month follow-up, median Barthel Index score was 20 (interquartile range, 20-20) in both groups. However, fatigue was more common after stroke than TIA (56% vs 29%; OR, 3.14; 95% CI, 1.51-6.57; P=0.0008). This difference was present both in patients with modified Rankin score of 0 at 6 months (23.8% vs 10.3%) and patients with modified Rankin score >or=1 (69.2% vs 48.6%), and remained more frequent in stroke patients after adjustment for potential confounders. Within the group of patients with stroke, the prevalence of fatigue increased with initial stroke severity (87% NIHSS >or=4 vs 48% NIHSS <or=3; P=0.0087); however, stroke patients with initial NIHSS of 0 were still more fatigued than patients with TIA (57% vs 29%; P=0.015). CONCLUSIONS: The prevalence of fatigue after minor stroke is higher than after TIA, suggesting that it is not simply a consequence of the stress of a recent acute cerebral event, comorbidity, medication, or other potential confounders. The high levels of fatigue in stroke patients without neurological impairment suggest it has a central origin rather than being the result of increased physical effort required after stroke

Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to understand interventions to support physical activity behaviour in people with stroke : an overview of reviews

Objective. Physical activity in people with stroke remains low despite considerable research. This overview aimed to provide high-level synthesis and aid clinical decision-making. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to classify interventions to understand which components improve physical activity behaviour in people with stroke. Data Sources. CINAHL, Cochrane Database, MEDLINE, PEDro, PsychINFO, SPORTDiscus Review. MethodsA systematic search was conducted (November 2023) to identify reviews of interventions to improve physical activity in people with stroke. Results were screened and assessed for eligibility. Participant characteristics, intervention classification using COM-B, and effect of intervention were extracted. Quality was assessed using AMSTAR2, and Corrected Cover Analysis for study overlap. Narrative synthesis was used to understand components of interventions to improve physical activity behaviour. Results. 1801 references were screened and 29 full-text references assessed for eligibility. Twenty reviews were included. Quality ranged from critically low (n = 3) to high (n = 10). Study overlap calculated using corrected cover area indicated slight overlap (0.028) and minimal reporting bias. The majority of participants were mobile with mild stroke and community dwelling. Twenty-three interventions were classified using COM-B. Three of twelve interventions classified to one aspect of the COM-B were effective. Fourteen of sixteen effective interventions combined at least two COM-B elements, ten of these combined capability and motivation. Conclusion. Interventions including at least two elements of the COM-B are most likely to improve physical activity in mobile stroke survivors. Further research is needed to understand physical activity behaviour in those with moderate to severe stroke

Somatosensory Assessment after Central Nerve Damage: the Need for Standardized Clinical Measures

Following stroke, somatosensory loss is a common and important predictor of the extent of functional recovery. The clinical value of somatosensory assessment has, however, been repeatedly questioned in the medical literature. The major criticism concerns test reliability and patient variability. Given the importance of identifying clinically significant signs of sensory loss the challenge is to design a short, quantifiable and reliable test. This paper selectively reviews the problems surrounding somatosensory assessment and considers some of the important features when developing a standardized clinical measure

Somatosensory recovery: A longitudinal study of the first 6 months after unilateral stroke

Purpose. The aim of this study was to characterize the recovery pattern of stroke patients in the first 6 months following stroke. Method. Using the Rivermead Assessment of Somatosensory Performance (RASP), the Motricity index and the Barthel Activities of Daily Living (ADL) index, a case series of serial somatosensory and motor measurements was made on 18 patients with a diagnosis of a first ever stroke. Patients comprised 2 distinct groups, acute and subacute. The acute group were seen weekly for the first month post onset and the subacute group were seen monthly for 6 months. Participants were seen at hospital, regional rehabilitation unit and/or the participant's home. Standard local rehabilitation was given. Results. The somatosensory subtest of proprioception demonstrated the greatest level of recovery. No patient achieved full recovery on all somatosensory subtests. Motor and functional recovery demonstrated continual improvement over time, somatosensory recovery showed marked variation in subtests both within and between patients. Conclusion. Of the 18 patients tested there were no consistent, generalizable, recognizable patterns of sensory recovery demonstrated

Sensory Impairments of the Lower Limb after Stroke: A Pooled Analysis of Individual Patient Data

To obtain more generalizable information on the frequency and factors influencing sensory impairment after stroke and their relationship to mobility and function. Method: A pooled analysis of individual data of stroke survivors (N = 459); mean (SD) age = 67.2 (14.8) years, 54% male, mean (SD) time since stroke = 22.33 (63.1) days, 50% left-sided weakness. Where different measurement tools were used, data were recoded. Descriptive statistics described frequency of sensory impairments, kappa coefficients investigated relationships between sensory modalities, binary logistic regression explored the factors influencing sensory impairments, and linear regression assessed the impact of sensory impairments on activity limitations. Results: Most patients’ sensation was intact (55%), and individual sensory modalities were highly associated (κ = 0.60, P < .001). Weakness and neglect influenced sensory impairment (P < .001), but demographics, stroke pathology, and spasticity did not. Sensation influenced independence in activities of daily living, mobility, and balance but less strongly than weakness. Conclusions: Pooled individual data analysis showed sensation of the lower limb is grossly preserved in most stroke survivors but, when present, it affects function. Sensory modalities are highly interrelated; interventions that treat the motor system during functional tasks may be as effective at treating the sensory system as sensory retraining alone.

The rivermead assessment of somatosensory performance (RASP): standardization and reliability data. Clin. Rehabil. 16, 523–533. doi:10.1191/ 0269215502cr522oa

Objective: To develop a standardized, clinically relevant, quantitative assessment of somatosensory performance in patients with stroke. Design: Prospective observational study and test evaluation. Setting: Local Oxford hospitals and a regional neurological rehabilitation centre. Subjects: Stroke patients with a rst, lateralized acute stroke in hospital, and age-matched control subjects. Method: Each patient was assessed in a structured way using a new battery of formal tests of somatosensory performance. Results: A total of 100 patients and 50 controls were fully investigated. Control subjects performed at or near ceiling on all tests, but patients showed impaired performance on all tests. The Rivermead Assessment of Somatosensory Performance (RASP) showed good intra-rater and inter-rater reliability for all subtests. There were however only weak relationships between scores of sensory impairment and scores of motor impairment or mobility and dependence. Conclusions: The RASP provides a practical and reliable assessment of sensory loss, which provides the clinician with a comprehensive picture of the patient&apos;s performance and can be used to inform and monitor rehabilitation and recovery. in uence on everyday activities and rehabilitation outcome. 2-4 Patients with both sensory and motor loss show a worse prognosis than patients with motor loss only. 5 Accurate and reliable diagnostic instruments may help in establishing the effectiveness of clinical treatments

A long-term self-managed handwriting intervention for people with Parkinson's disease: results from the control group of a phase II randomized controlled trial

Objective: To report on the control group of a trial primarily designed to investigate exercise for improving mobility in people with Parkinson’s disease (pwP). The control group undertook a handwriting intervention to control for attention and time spent practising a specific activity. Design: Secondary analysis of a two-arm parallel phase II randomized controlled trial with blind assessment. Setting: Community. Participants: PwP able to walk ≥100 m and with no contraindication to exercise were recruited from the Thames Valley, UK, and randomized (1:1) to exercise or handwriting, via a concealed computer-generated list. Intervention: Handwriting was undertaken at home and exercise in community facilities; both were delivered through workbooks with monthly support visits and involved practice for 1 hour, twice weekly, over a period of six months. Main measures: Handwriting was assessed, at baseline, 3, 6 and 12 months, using a pangram giving writing speed, amplitude (area) and progressive reduction in amplitude (ratio). The Movement Disorder Society (MDS)–Unified Parkinson’s Disease Rating Scale (UPDRS) item 2.7 measured self-reported handwriting deficits. Results: In all, 105 pwP were recruited (analysed: n = 51 handwriting, n = 54 exercise). A total of 40 pwP adhered to the handwriting programme, most completing ≥1 session/week. Moderate effects were found for amplitude (total area: d = 0.32; 95% confidence interval (CI): −0.11 to 0.7; P = 0.13) in favour of handwriting over a period of 12 months; effects for writing speed and ratio parameters were small ≤0.11. Self-reported handwriting difficulties also favoured handwriting (UPDRS 2.7: odds ratio (OR) = 0.55; 95% CI: 0.34 to 0.91; P = 0.02). No adverse effects were reported. Conclusion: PwP generally adhere to self-directed home handwriting which may provide benefit with minimal risk. Encouraging effects were found in writing amplitude and, moreover, perceived ability

sj-docx-1-cre-10.1177_02692155231224365 - Supplemental material for Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews

Supplemental material, sj-docx-1-cre-10.1177_02692155231224365 for Use of the Capability, Opportunity and Motivation Behaviour model (COM-B) to Understand Interventions to Support Physical Activity Behaviour in People with Stroke: An Overview of Reviews by Sarah Paterson, Helen Dawes, Charlotte Winward, Emilia Bartram, Emma Dodds, Jane McKinon, Helen Gaskell and Johnny Collett in Clinical Rehabilitation</p