DEVELOPMENT OF A PHYSIOTHERAPY TREATMENT APPROACH TO MANAGE POST STROKE FATIGUE

W. Alahmari1,2, P. Logan2, E. Kontou2, A. Alhowimel3, M. Alotaibi3, N. Coulson2
1Princess Nourah Bint Abdulrahman University, College of Health and Rehabilitation Sciences, Riyadh, Saudi Arabia, 2University of Nottingham, Division of Rehabilitation, Ageing and Wellbeing, Nottingham, United Kingdom, 3Prince Sattam Bin Abdulaziz University, Physical Therapy and Rehabilitation Department, Al Kharj, Saudi Arabia

Background: Globally, there are around 33 million stroke survivors, and almost half of them experience Post Stroke Fatigue (PSF). Methods to manage and prevent PSF is ranked among the top 10 research priorities relating to life after stroke. PSF is a complex, multidimensional debilitating manifestation and is not well understood.

Purpose: This project has adopted the Medical Research Council framework for complex interventions in order to design and identify effective physiotherapy approach to treat PSF. The aims of this project are - to understand the effectiveness physiotherapy interventions in the treatment of PSF; to explore the perceptions of stroke patients, health care practitioners in Saudi Arabia (physicians, physiotherapists and occupational therapists) about PSF; and to understand the current clinical management and knowledge of PSF among physiotherapists in Saudi Arabia.

Methods: A mixed-methods approach was used. Firstly, to investigate the effectiveness of physiotherapy interventions, a systematic review and meta-analysis were conducted. Following this, perceptions and experiences regarding PSF were explored through in-depth one to one interviews with 8 stroke patients. A further 24 interviews with health care practitioners to understand their perceptions of PSF were conducted. Finally, the current clinical management methods and PSF related knowledge of physiotherapists in Saudi Arabia were assessed via an online survey.

Results: The results from the systematic review showed that physiotherapy interventions, such as caregiver mediated exercise using e-health support and graded group activity training exercises has a general inclination towards positive effects on reducing PSF.  Results from the second qualitative study with stroke survivors highlight the lack of awareness about fatigue after stroke and lack of motivation in physiotherapy sessions. The interview study with health care professionals revealed a general lack of awareness around post-stroke fatigue and particularly in relation to its assessment and management. 168 physiotherapists completed the online survey. Around 91.7% were Saudi nationals, and the participants were working for an average of 4.81 (5.08) years with stroke patients. PSF screening was not included in the routine assessment by 95.5% of the survey participants. In the management of PSF, therapists preferred bed and chair exercises, walking, and functional training exercises. Around 57.7% of the survey participants do not include any PSF related information in the educational materials they offer their patients, and 59.5% of participants therapists do not include such information in the educational materials given to the caregivers.

Conclusion(s): This project has revealed specific intervention components such as endurance training, group exercises including caregiver mediated exercise, self-management strategies, CBT, and motivation to continue physiotherapy sessions, to be part of the intervention to manage PSF. It is vital to increase PSF related awareness among stroke patients and their caregivers so that they can seek appropriate help. Furthermore, it is equally important to increase the knowledge and skills in the management of PSF among health care practitioners.

Implications:
  • PSF must be appropriately acknowledged, and routine assessment of stroke survivors must include investigations to diagnose PSF. 
  • Awareness of PSF to patients and caregivers must be facilitated through educational materials. 
  • The biopsychosocial model needs to consider in the management of PSF. 
 

Funding, acknowledgements: This project supported by a Ph.D. scholarship from Princess Nourah Bint Abdulrahman University, KSA, at the University of Nottingham UK 

Keywords: Post stroke fatigue, Physiotherapy intervention, Rehabilitation

Topic: Neurology: stroke

Did this work require ethics approval? Yes
Institution: university of Nottingham
Committee: Faculty of Medicine and Health Sciences Ethics Committee
Ethics number: 263 1803


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