Use of the Fatigue Severity Scale to assess clinically reliable temporal changes in post-stroke fatigue by stroke type and subtype

Suzanne Barker-Collo; Rita Krishnamurthi; Valery Feigin; Balakrishnan Nair; Alan Barber; Amanda G. Thrift; Anna Ranta; Derrick Bennett; Jeroen Douwes; El-Shadan Tautolo; Dominique A. Cadilhac; Varsha Parag; Bruce Arroll

doi:10.1071/IB24034

RESEARCH ARTICLE (Open Access)

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Use of the Fatigue Severity Scale to assess clinically reliable temporal changes in post-stroke fatigue by stroke type and subtype

Suzanne Barker-Collo

^A ^* , Rita Krishnamurthi ^B , Valery Feigin ^B , Balakrishnan Nair ^B , Alan Barber ^C , Amanda G. Thrift ^D , Anna Ranta ^E , Derrick Bennett ^F , Jeroen Douwes ^G , El-Shadan Tautolo ^H , Dominique A. Cadilhac ^D , Varsha Parag ^I and Bruce Arroll ^J ^§

+ Author Affiliations

- Author Affiliations

^A School of Psychology/Te Kura Matai Hinengaro, The University of Auckland/Waipapa Taumata Rau, Private Bag 92019, Auckland, New Zealand.

^B National Institute for Stroke and Applied Neurorehabilitation, Auckland University of Technology, Auckland, New Zealand.

^C Department of Neurology, Auckland City Hospital, Centre for Brain Research, University of Auckland, Auckland, New Zealand.

^D Stroke and Ageing Research Department of Medicine School of Clinical Sciences at Monash Health, Victorian Heart Hospital, Monash University, Clayton, Vic, Australia.

^E Department of Medicine, University of Otago, Wellington, New Zealand.

^F Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.

^G Research Centre for Hauora and Health, Massey University, Wellington, New Zealand.

^H Department of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.

^I National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand.

^J Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

^* Correspondence to: s.barker-collo@auckland.ac.nz

^§ All authors writing on behalf of the ARCOS-5 steering committee.

Handling Editor: Julia Schmidt

Brain Impairment 25, IB24034 https://doi.org/10.1071/IB24034

Submitted: 23 April 2024 Accepted: 3 October 2024 Published: 24 October 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

A recent consensus statement on post-stroke fatigue noted the Fatigue Severity Scale (FSS) should be the primary outcome measure in post-stroke fatigue research. It also noted that data to calculate clinically reliable changes on the FSS have not been established for stroke. We present FSS data collected at 1 and 12 months post stroke, allowing the assessment of clinically reliable change by stroke type and subtype for ischaemic stroke (IS).

Methods

The sample included all participants of the fifth Auckland Region Community Outcomes of Stroke study (ARCOS-V) who consented and had FSS data (n = 338). Stroke type was recorded (IS, intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH)), and IS subtypes were defined using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. ‘Clinically reliable change’ between 1 and 12 month FSS scores was calculated using Jacobsen and Traux’s updated formula.

Results

Participants with ICH had the highest FSS scores at 1 month. Across IS subtypes, those with small vessel disease had the highest FSS scores at 1 month, and this increased at 12 months. Statistically significant reductions in mean FSS were found for patients with IS of other aetiology and SAH. Regarding clinically reliable changes, the greatest proportion of individuals had no clinically reliable change in FSS, up to 20% experienced reliable reductions, and 0–11% experienced reliable increases in FSS scores.

Conclusion

Although most participants had no clinically reliable change in fatigue between 1 and 12 months, statistically significant reductions in FSS were identified for patients with IS and SAH. Of those who did experience reliable change, the majority had reductions in fatigue over time.

Keywords: clinically reliable change, cut-offs for reliable change, fatigue, ischaemic subtype, longitudinal, stroke.

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