Linda N. Bakken

Physical impairment, depressive symptoms and pre-stroke fatigue are related to fatigue in the acute phase after stroke

Purpose. The aim of this study was to describe prevalence of fatigue and its relationship with demographic and clinical variables during the first 2 weeks (acute phase) following a stroke. Method. Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patients medical records. The sample consists of 115 patients with first-ever stroke admitted to two hospitals in Norway in 2007 and 2008. Post-stroke fatigue was measured with the Fatigue Severity Scale (FSS). The FSS measure was applied in the analysis as a continuous variable, and also used to categorise patients into three groups of fatigue intensity: no fatigue (mean FSS-score <4), moderate fatigue (mean FSS-score = 4–4.9) and severe fatigue (mean FSS-score ≥5). Patients who reported fatigue lasting longer than 3 months before the stroke were defined as having prestroke fatigue. Results. Pre-stroke fatigue was reported by 34 patients (30%). After stroke, 24% had severe fatigue, and fatigue was more common for women (57%). Controlling for sex and prestroke fatigue, the multivariate analysis showed that prestroke fatigue, lower physical function and depressive symptoms were related to post-stroke fatigue. Conclusion. Pre-stroke fatigue and fatigue during the acute phase needs to be assessed in relation to physical functioning and depression during recovery and the rehabilitation process.

Sleep-Wake Patterns during the Acute Phase after First-Ever Stroke

This study describes the pattern of day and night sleep and explores relationships between these patterns and sociodemographic and clinical factors as well as sleep environmental context and the patients subjective sleep quality. Data from 110 patients with first-ever stroke was collected by structured interview surveys, medical record, and objective estimated sleep data from wrist actigraphy. The variability in estimated sleep is large. Half the patients slept either <6 hours or >8 hours per night, and 78% had more than nine awakenings per night. Men slept less than women, and patients sleeping at home had fewer awakenings than those who slept in hospital. It was estimated sleep during daytime in all, except 4, patients. Longer stay in hospital was related to more daytime sleep, and the subjective sleep quality correlated with estimated sleep time, wake time, and wake percentage.

Stages of Change--continuous measure (URICA-E2): psychometrics of a Norwegian version.

Title Stages of Change – Continuous Measure (URICA-E2): psychometrics of a Norwegian version. Aim This paper is a report of research to translate the English version of the Stages of Change continuous measure questionnaire (URICA-E2) into Norwegian and to test the validity of the questionnaire and its usefulness in predicting behavioural change. Background While the psychometric properties of the Stages of Change categorical measure have been tested extensively, evaluation of the psychometric properties of the continuous questionnaire has not been described elsewhere in the literature. Method Cross-sectional data were collected with a convenience sample of 198 undergraduate nursing students in 2005 and 2006. The English version of URICA-E2 was translated into Norwegian according to standardized procedures. Findings Principal components analysis clearly confirmed five of the dimensions of readiness to change (Precontemplation Non-Believers, Precontemplation Believers, Contemplation, Preparation and Maintenance), while the sixth dimension, Action, showed the lowest Eigenvalue (0·93). Findings from the cluster analysis indicate distinct profiles among the respondents in terms of readiness to change their exercise behaviour. Conclusion The URICA-E2 was for the most part replicated from Reed’s original work. The result of the cluster analysis of the items associated with the factor ‘Action’ suggests that these do not adequately measure the factor.

Subjective sleep quality in relation to objective sleep estimates: comparison, gender differences and changes between the acute phase and the six-month follow-up after stroke.

AIMS To describe sleep experiences after stroke using subjective and objective indicators and identify possible gender differences in sleep in the acute phase and at 6-month follow-up. BACKGROUND Sleep disturbances after stoke are recognized, but poorly described. Gender differences in sleep exist in other populations, but have not been reported after stroke. DESIGN A longitudinal cohort study. METHOD Subjective sleep quality was measured with the Pittsburgh Sleep Quality Index and objective sleep was estimated with actigraphy in 100 patients in the acute phase and six months after stroke, from April 2007-March 2009. FINDINGS Subjective sleep quality was better and objective wake percentage was lower at follow-up than in the acute phase after stroke. Actigraphy estimated low sleep efficiency and many awakenings at both time points. Subjective and objective measures were correlated at the 6-month follow-up, but not in the acute phase. Womens subjective sleep efficiency and total score on the Pittsburgh Sleep Quality Index were worse than mens in the acute phase, but actigraphy estimated that women slept more than men in the course of a day. Womens subjective sleep quality was better at follow-up than in the acute phase. Men reported worse subjective sleep quality, but better subjective sleep efficiency at follow-up than in the acute phase, and also had lower objective wake percentage at follow-up. CONCLUSIONS Subjective sleep quality was poor and actigraphy indicated disturbed sleep-wake patterns in the acute phase and at 6-month follow-up. Gender differences existed in subjective and objective sleep in the acute phase, but not at follow-up.