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ORIJINAL ARAŞTIRMA

İnme Sonrası Yorgunluğun Fiziksel Fonksiyonlar, Depresyon-Anksiyete ve Fonksiyonel Bağımsızlık Üzerine Etkisi
Effect of Poststroke Fatigue on Physical Functions, Depression-Anxiety and Functional Independence
Received Date : 29 Jun 2021
Accepted Date : 30 Nov 2021
Available Online : 07 Dec 2021
Doi: 10.31609/jpmrs.2021-85191 - Makale Dili: TR
J PMR Sci. 2022;25(2):173-80
ÖZET
Amaç: Bu çalışmanın amacı inme sonrası yorgunluk (İSY) gelişimindeki risk faktörlerini araştırmak; İSY’nin fiziksel fonksiyonlar, depresyon, anksiyete ve fonksiyonel bağımsızlık üzerine etkisini incelemektir. Gereç ve Yöntemler: Çalışmaya yatarak tedavi edilen 18 yaşından büyük, subakut ve kronik inmeli 43 hasta dahil edildi. Yorgunluk, yorgunluk şiddet ölçeği (YŞÖ) kullanılarak değerlendirildi. Yorgunluğun fiziksel, kognitif ve psikososyal etkisini değerlendirmek için yorgunluk etki ölçeği (YEÖ) kullanıldı. Depresyon ve anksiyete, hastane anksiyete ve depresyon ölçeği (HADÖ) ile değerlendirildi. Fonksiyonel değerlendirme, fonksiyonel bağımsızlık ölçeği motor (FBÖ-M) ve fonksiyonel bağımsızlığı ölçeği kognitif (FBÖ-K) ölçekleri ile yapıldı. Hastaların ambulasyon durumu fonksiyonel ambulasyon sınıflaması (FAS) ile değerlendirildi. Fiziksel zindelik ve dayanıklılık 3 dakika yürüme testi (3DYT) ile ölçüldü. Atiklik ve yürüme hızı 10 metre yürüme hızı (10MYH) ile değerlendirildi. Bulgular: Hastaların %69,8’inde yorgunluk, %55,8’inde depresyon mevcuttu. Yorgun olanlarla olmayanların karşılaştırılmasında yaş, cinsiyet, inme süresi, lezyon yeri, etkilenen vücut yarısı, inme etiyolojisi, 10MYH, 3DYT, HADÖ, FBÖ-K, FBÖ-M benzerdi (p>0,05). YŞÖ ile hasta yaşı arasında zayıf, pozitif bir korelasyon izlendi (r=0,304, p=0,047). YŞÖ ile 3DYT ve 10MYH arasında negatif korelasyon vardı (r=-0,369, p=0,015 ve r=-0,337, p=0,041, sırasıyla), YŞÖ ile YEÖ ve yorgunluk etki ölçeğinin fiziksel subskalası (YEÖ-F) arasında pozitif korelasyon izlendi (r=0,465, p=0,002 ve r=0,339, p=0,026, sırasıyla). Cinsiyet, yaş, inme üzerinden geçen süre, inme etiyolojisi, etkilenen vücut yarısı ve depresyon varlığının İSY gelişiminde belirgin etkisi olmadığı görüldü. Sonuç: İnme hastalarında sık görülen yorgunluk, yürüme hızı ve mesafesi gibi fiziksel fonksiyonları olumsuz yönde etkiler. Depresyon-anksiyete ve fonkisyonel bağımsızlık gibi yorgunlukla karşılıklı olarak etkileşebilecek klinik parametreler açısından ise net bir fark olduğunu söylemek güçtür.
ABSTRACT
Objective: To investigate the risk factors in the development of post-stroke fatigue (PSF) and to examine the effects of PSF on physical functions, depression, anxiety, and functional independence. Material and Methods: The study included 43 adult patients with subacute and chronic stroke. Fatigue severity scale (FSS) and fatigue impact scale (FIS) were used to evaluate fatigue and the effects of fatigue related limitations (physical, cognitive, psychosocial). Depression and anxiety were evaluated with the hospital anxiety- depression scale (HADS). Functional performance was assessed with functional independence measure-motor (FIM-M) and functional independence measure-cognitive (FIMC) scales. Functional ambulation classification was used to evaluate the ambulation. 3-minute walk test (3MWT) and 10-meters walking speed test (10MWS) were used to evaluate fitness, endurance, agility and walking speed. Results: Fatigue and depression were present in 69.8% and 55.8% of the patients respectively. There was no difference in age, gender, duration of stroke, lesion site, affected body half, stroke etiology, 10MWS, 3MWT, HADS, FIM-C, FIM-M in comparison to those who were fatigued and those who were not (p>0.05). A positive correlation was observed between FSS and age, FIS, physical subscale of FIS (r=0.304, p=0.047; r=0.465, p=0.002; r=0.339, p=0.026 respectively). There was a negative correlation between FSS and 3MWT and 10MWS (r=-0.369, p=0.015 and r=-0.337, p=0.041, respectively). Gender, age, time since stroke, stroke etiology, affected body side and depression didn’t have a significant effect on PSF. Conclusion: PSF is a common problem that affects physical functioning such as walking speed and distance negatively.
REFERENCES
  1. Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology. 2013;80:409-16. [Crossref]  [PubMed]  [PMC] 
  2. Chen YK, Qu JF, Xiao WM, et al. Poststroke fatigue: risk factors and its effect on functional status and health-related quality of life. Int J Stroke. 2015;10:506-12. [Crossref]  [PubMed] 
  3. Naess H, Nyland H. Poststroke fatigue and depression are related to mortality in young adults: a cohort study. BMJ Open. 2013;3: e002404. [Crossref]  [PubMed]  [PMC] 
  4. Cumming TB, Packer M, Kramer SF, et al. The prevalence of fatigue after stroke: A systematic review and meta-analysis. Int J Stroke. 2016;11:968-77. [Crossref]  [PubMed] 
  5. Nadarajah M, Goh HT. Post-stroke fatigue: a review on prevalence, correlates, measurement, and management. Top Stroke Rehabil. 2015;22:208-20. [Crossref]  [PubMed] 
  6. Parks NE, Eskes GA, Gubitz GJ, et al. Fatigue impact scale demonstrates greater fatigue in younger stroke survivors. Can J Neurol Sci. 2012;39:619-25. [Crossref]  [PubMed] 
  7. Ozyemisci-Taskiran O, Batur EB, Yuksel S, et al. Validity and reliability of fatigue severity scale in stroke. Top Stroke Rehabil. 2019;26: 122-7. [Crossref]  [PubMed] 
  8. Soyuer F, Ünalan D, Öztürk A. [Fatigue in stroke patients]. Journal of Turkish Cerebrovascular Diseases. 2008;14:73-7. [Link] 
  9. Aydemir Ö, Güvenir T, Küey L ve ark. [Validity and Reliability of Turkish Version of Hospital Anxiety and Depression Scale]. Türk Psikiyatri Dergisi. 1997;8:280-7. [Link] 
  10. Snaith RP. The Hospital Anxiety and Depression Scale. Health Qual Life Outcomes. 2003; 1:29. [Crossref]  [PubMed]  [PMC] 
  11. Küçükdeveci AA, Yavuzer G, Elhan AH, et al. Adaptation of the functional independence measure for use in Turkey. Clin Rehabil. 2001;15:311-9. [Crossref]  [PubMed] 
  12. Chae J, Zorowitz RD, Johnston MV. Functional outcome of hemorrhagic and nonhemorrhagic stroke patients after in-patient rehabilitation. Am J Phys Med Rehabil. 1996;75:177-82. [Crossref]  [PubMed] 
  13. Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients. Standards for outcome assessment. Phys Ther. 1986;66:1530-9. [Crossref]  [PubMed] 
  14. van de Port IG, Kwakkel G, Schepers VP, et al. 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? Cerebrovasc Dis. 2007;23:40-5. [Crossref]  [PubMed] 
  15. Naess H, Waje-Andreassen U, Thomassen L, et al. Health-related quality of life among young adults with ischemic stroke on long-term follow-up. Stroke. 2006;37:1232-6. [Crossref]  [PubMed] 
  16. Mead G, Bernhardt J, Kwakkel G. Stroke: physical fitness, exercise, and fatigue. Stroke Res Treat. 2012;2012:632531. [Crossref]  [PubMed]  [PMC] 
  17. Duncan F, Kutlubaev MA, Dennis MS, et al. Fatigue after stroke: a systematic review of associations with impaired physical fitness. Int J Stroke. 2012;7:157-62. [Crossref]  [PubMed] 
  18. Kutlubaev MA, Shenkin SD, Farrall AJ, et al. CT and Clinical Predictors of Fatigue at One Month after Stroke. Cerebrovasc Dis Extra. 2013;3:26-34. [Crossref]  [PubMed]  [PMC] 
  19. Snaphaan L, van der Werf S, de Leeuw FE. Time course and risk factors of post-stroke fatigue: a prospective cohort study. Eur J Neurol. 2011;18:611-7. [Crossref]  [PubMed] 
  20. Crosby GA, Munshi S, Karat AS, et al. Fatigue after stroke: frequency and effect on daily life. Disabil Rehabil. 2012;34:633-7. [Crossref]  [PubMed] 
  21. Michael K, Macko RF. Ambulatory activity intensity profiles, fitness, and fatigue in chronic stroke. Top Stroke Rehabil. 2007;14:5-12. [Crossref]  [PubMed] 
  22. Michael KM, Allen JK, Macko RF. Fatigue after stroke: relationship to mobility, fitness, ambulatory activity, social support, and falls efficacy. Rehabil Nurs. 2006;31:210-7. [Crossref]  [PubMed] 
  23. Simon GE. Treating depression in patients with chronic disease: recognition and treatment are crucial; depression worsens the course of a chronic illness. West J Med. 2001;175:292-3. [PubMed]  [PMC] 
  24. Sheng P, Hou L, Wang X, et al. Efficacy of modafinil on fatigue and excessive daytime sleepiness associated with neurological disorders: a systematic review and meta-analysis. PLoS One. 2013;8:e81802. [Crossref]  [PubMed]  [PMC] 
  25. Lee CH, Giuliani F. The role of ınflammation in depression and fatigue. Front Immunol. 2019;10:1696. [Crossref]  [PubMed]  [PMC] 
  26. Ingles JL, Eskes GA, Phillips SJ. Fatigue after stroke. Arch Phys Med Rehabil. 1999;80:173-8. [Crossref]  [PubMed] 
  27. Feigin VL, Barker-Collo S, Parag V, et al; Auckland Regional Community Stroke Study Group. Prevalence and predictors of 6-month fatigue in patients with ischemic stroke: a population-based stroke incidence study in Auckland, New Zealand, 2002-2003. Stroke. 2012;43:2604-9. [Crossref]  [PubMed] 
  28. Staub F, Bogousslavsky J. Post-stroke depression or fatigue. Eur Neurol. 2001;45:3-5. [Crossref]  [PubMed] 
  29. Morley W, Jackson K, Mead GE. Post-stroke fatigue: an important yet neglected symptom. Age Ageing. 2005;34:313. [Crossref]  [PubMed] 
  30. Miller KK, Combs SA, Van Puymbroeck M, et al. Fatigue and pain: relationships with physical performance and patient beliefs after stroke. Top Stroke Rehabil. 2013;20:347-55. [Crossref]  [PubMed] 
  31. Andersen G, Christensen D, Kirkevold M, et al. Post-stroke fatigue and return to work: a 2-year follow-up. Acta Neurol Scand. 2012;125:248-53. [Crossref]  [PubMed] 
  32. Glader EL, Stegmayr B, Asplund K. Poststroke fatigue: a 2-year follow-up study of stroke patients in Sweden. Stroke. 2002;33:1327-33. [Crossref]  [PubMed] 
  33. Badaru UM, Ogwumike OO, Adeniyi AF, et al. Variation in functional independence among stroke survivors having fatigue and depression. Neurol Res Int. 2013;2013:842980. [Crossref]  [PubMed]  [PMC] 
  34. Chaudhuri A, Behan PO. Fatigue in neurological disorders. Lancet. 2004;363:978-88. [Crossref]  [PubMed] 
  35. Holmqvist A, Lindstedt MB, Möller MC. Relationship between fatigue after acquired brain injury and depression, injury localization and aetiology: An explorative study in a rehabilitation setting. J Rehabil Med. 2018;50:725-31. [Crossref]  [PubMed] 
  36. Dobryakova E, DeLuca J, Genova HM, et al. Neural correlates of cognitive fatigue: cortico-striatal circuitry and effort-reward imbalance. J Int Neuropsychol Soc. 2013;19:849-53. [Crossref]  [PubMed]