| ObjectivesStroke is a common sudden disease,and post-stroke fatigue(PSF),as one of the common complications of stroke patients,is also the focus and difficulty of nursing work.The purpose of this study was to understand the status of PSF in patients with first-ever ischemic stroke and analyze its related influencing factors by evaluating relevant scales and clinical data,and to explore the effect of Cognitive and Graded Activity Training(COGRAT)intervention program on PSF in patients with first-ever ischemic stroke,so as to provide a referential basis for clinical medical staff to identify and intervene in PSF,and thus improve the prognosis of patients with PSF and enhance their life qualities.Methods1.Study on the status and influencing factors of post-stroke fatigue in patients with firstever ischemic strokeA total of 241 hospitalized patients who met the inclusion and exclusion criteria in the department of Neurology and Rehabilitation of a 3a hospital in Yangzhou,Jiangsu Province from January to March 2021 were continuously selected as the research subjects.The score of Fatigue Severity Scale(FSS)was used to determine whether patients had PSF or not.If FSS score≥36,it indicated that patients had PSF and were included in the fatigue group;if FSS score<36,it indicated that patients had no PSF and were included in the non-fatigue group.A self-designed questionnaire was used to collect the general clinical data of patients,the Selfrating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)were used to assess the degree of anxiety and depression,the Mini-Mental State Examination(MMSE)was used to evaluate patients’ cognitive function,the Pittsburgh Sleep Quality Index(PSQI)was used to evaluate the sleep status of the patients,and the Modified Rankin Scale(MRS)was used to evaluate patients’ functional prognosis.SPSS 23.0 was used for statistical analysis.Continuous variates were displayed as mean±standard deviation or median and interquartile range,and t-test or Mann-Whitney U test were used,respectively.Count variates were displayed as frequency and percentage,chi-square test was used,and rank sum test was performed if necessary.Spearman correlation analysis was used to analyze the correlation between PSF and general clinical data.Binary Logistic regression was used to analyze the influencing factors of PSF in patients with first-ever ischemic stroke.2.COGRAT on post-stroke fatigue in patients with first-ever ischemic strokeA total of 103 first-ever ischemic stroke patients with PSF admitted to the rehabilitation department of a 3a hospital in Yangzhou,Jiangsu Province from July 2021 to September 2022 were continuously selected as the research subjects,and were divided by lots into the intervention group(n=51)and control group(n=52).The control group was received routine rehabilitation treatment;while the intervention group was given COGRAT intervention on the base of routine rehabilitation treatment,including cognitive treatment(4 times a week,for 30 minutes over 12 weeks)and graded activity programme(4 times a week,1 hour over 12 weeks).FSS,SAS,SDS and Functional Independence Measure(FIM)were used to assess the degree of fatigue,anxiety,depression and functional prognosis of PSF patients before intervention,at the end of intervention and 3 months after intervention.Two-way repeated measurement analysis of variance was used to compare the difference effect of FSS score,SAS score,SDS score and FIM score between the two groups before intervention,at the end of intervention and 3 months after intervention.Results1.Study on the status and influencing factors of post-stroke fatigue in patients with firstever ischemic stroke(1)In this study,a total of 241 patients with first-ever ischemic stroke were included for analysis,of which 112 patients had PSF,with an incidence of 46.5%.(2)Univariate analysis showed that there were significant differences in age,MRS score,SAS score,SDS score,MMSE score and sleep disorder between the fatigue group and the non-fatigue group(P<0.001).(3)Spearman analysis revealed that PSF was positively correlated with age(r=0.353,P<0.001),MRS score(r=0.499,P<0.001),SAS score(r=0.510,P<0.001),SDS score(r=0.596,P<0.001),sleep disorder(r=0.457,P<0.001),and negatively correlated with MMSE score(r=0.275,P<0.001).(4)Binary Logistic regression analysis showed that age(OR=1.100,P<0.001),MRS>2(OR=31.386,P<0.001),SAS score(OR=1.109,P=0.031),SDS score(OR=1.093,P=0.024)and MMSE score(OR=1.814,P=0.001)were influencing factors for PSF.2.COGRAT on post-stroke fatigue in patients with first-ever ischemic stroke(1)Comparison of fatigue degree between the two groups:before intervention,there was no significant difference in FSS scores between the control group(50.48±3.45)and the intervention group(50.88±3.23)(P>0.05);at the end of intervention,the FSS scores of the control group and the intervention group were(46.38±3.59)and(44.39±3.21),respectively,and the fatigue degree of the intervention group was significantly lower than that of the control group(P=0.004);3 months after intervention,FSS score of the intervention group(42.47±3.38)decreased more significantly than that of the control group(46.31±3.42),and the difference was statistically significant(P<0.001).At the end of intervention and 3 months after intervention,FSS scores in both groups were lower than those before intervention(P<0.05),and at 3 months after intervention,the FSS scores were also lower than those at the end of intervention,with statistical difference in the intervention group(P<0.05),while there was no statistical significance in the control group(P>0.05).(2)Comparison of anxiety degree between the two groups:before intervention,there was no significant difference in SAS scores between the control group(48.13±6.92)and the intervention group(47.65±6.70)(P>0.05);at the end of intervention,the SAS scores of the control group and the intervention group were(45.29±6.85)and(43.11±6.44),respectively,compared with the control group,anxiety scores of the intervention group were decreased,but the difference was not statistically significant(P>0.05);3 months after intervention,the SAS score of the intervention group(43.21±6.19)was lower than that of the control group(46.08±6.49),and the difference was statistically significant(P=0.024).At the end of intervention and 3 months after intervention,the SAS scores of the two groups were lower than those before intervention(P<0.05).(3)Comparison of depression degree between the two groups:before intervention,there was no significant difference in SDS scores between the control group(54.38±4.93)and the intervention group(55.25±4.99)(P>0.05);at the end of intervention,the SDS scores of the control group and the intervention group were(50.96±4.83)and(48.82±4.77),respectively,and the depression score of the intervention group was significantly lower than that of the control group(P=0.026);3 months after intervention,the SDS score of the intervention group(47.55±4.32)was significantly decreased compared with that of the control group(50.50±4.83),and the difference was statistically significant(P=0.001).At the end of intervention and 3 months after intervention,the SDS scores of the two groups were lower than those before intervention(P<0.05),and the scores of 3 months after intervention were also lower than those at the end of intervention(P<0.05).(4)Comparison of functional prognosis between the two groups:before intervention,the total FIM scores,motor FIM scores and cognitive FIM scores in the control group were(58.92±10.47),(34.88±7.33)and(24.04±3.26),respectively,while those in the intervention group were(58.92±10.93),(34.90±7.65),(24.02±3.39),respectively,and there was no statistical significance between the two groups(P>0.05);at the end of intervention,the total FIM scores,motor FIM scores and cognitive FIM scores of the control group were(88.23±10.96),(61.17±8.24)and(27.06±3.15),respectively,while those of the intervention group were(95.80±11.66),(67.59±8.72)and(28.22±3.37),respectively,compared with the control group,the scores of the intervention group were all higher and there were significant differences in the total FIM scores and motor FIM scores(P<0.01);3 months after intervention,the total FIM scores,motor FIM scores and cognitive FIM scores in the control group were(99.81±11.33),(71.56±8.70)and(28.25±3.15),respectively,while those in the intervention group were(108.49±12.56),(78.98±9.87)and(29.51±3.40),respectively,compared with the control group,the scores of the intervention group were all higher and there were significant differences in the total FIM scores and motor FIM scores(P<0.001).At the end of intervention and 3 months after intervention,the total FIM scores,motor FIM scores and cognitive FIM scores in the two groups were higher than those before intervention(P<0.05),and these scores at 3 months after intervention were also higher than those at the end of intervention(P<0.05).Conclusion1.PSF was common in patients with first-ever ischemic stroke,and it was more likely to occur in patients with older age,higher MRS Score,higher anxiety and depression score,and lower cognitive function score.This suggested that clinical medical workers should pay attention to the screening and evaluation of post-stroke fatigue in stroke patients,and could improve the degree of fatigue by improving the functional prognosis,negative emotion and cognitive function of stroke patients.2.The fatigue degree,negative emotion and functional prognosis of first-ever ischemic stroke patients with post-stroke fatigue who received COGRAT intervention were significantly better than those who received routine rehabilitation treatment. |
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