Few studies have examined sub-group trajectories of functional changes over time after stroke. Post-stroke fatigue is a common condition, even in individuals who recover well physically. However, evidence is lacking in how fatigue may be expressed differently within subgroups characterizing various functional health-related quality of life (HRQoL) trajectories. The purpose of this original study was to investigate typical trajectories in HRQoL (function) from 1 to 4 years after stroke and the association with fatigue at 4-years follow-up.
This is a prospective observational study with a total of 144 individuals who experienced predominantly mild to moderate strokes. Patient-reported data from the ‘Stroke-Specific Quality of Life’ (SS-QOL) scale (at 1 and 4 years) and the ‘Fatigue Severity Scale’ (at 4 years) were used as outcome measures. The SS-QOL scale is a stroke-specific HRQoL instrument that covers multiple functional domains. Latent class growth analysis (LCGA) was estimated for three major components from the SS-QOL; ‘physical health,’ ‘visual-language,’ and ‘cognitive-social-mental.’ The LCGA analysis identified the number of trajectories, their characteristics, and the prevalence of these trajectories. Sociodemographic and stroke-related covariates were used for general adjustment of the outcome measures and for predicting the identified latent trajectories.
The LCGA analysis identified 5-7 distinct trajectories describing stability, deterioration, and improvement in functional HRQoL. Most participants belonged to trajectories characterized by stability and good function from 1 to 4 years across all outcome measures. Fatigue was most strongly associated with LCGA trajectories characterized by poorer function or deterioration, and was more common among women than men, as well as among those living alone within the ‘cognitive-social-mental’ functional component. Fatigue was more frequent among younger and older participants compared to middle-aged participants in the ‘visual-language’ component.
The results demonstrate that a significant portion of individuals experience changes in function after the first-year post-stroke. The majority of participants showed stable and good functional trajectories, and these individuals experienced significantly less fatigue compared to those with persistently poor or deteriorating trajectories. Although the current study is decent in sample size for conventional regression analysis, it may be considered smaller for a LCGA as several of the identified classes were of minor size. Findings related to the small classes need to be interpreted with caution, and need replication, whereas the findings related to the majority classes may be considered sturdier.
Functional recovery and improved HRQoL over the long term are crucial for reducing fatigue and should be a key focus in rehabilitation efforts.
Functioning
Stroke
