Estimated Prevalence of Fatigue Following Stroke and Transient Ischemic Attack Is Dependent on Terminology Used and Patient Gender

IntroductionThe prevalence of fatigue following stroke and Transient Ischaemic Attack (TIA) is disputed, with prevalences ranging from 30% to 72% reported. We hypothesized that methods and descriptors used may substantially affect the prevalence reported.MethodsSubjects completed validated assessments of fatigue and sleepiness (the Fatigue Severity Scale [FSS] and Epworth Sleepiness Scale [ESS]) as well as 5-point Likert scores on frequency of symptoms using the 5 statements of fatigue derived from patient interviews.ResultsAmong the 91 subjects, the mean FSS score was 3.8. FSS score correlated more strongly with the statement “I have a lack of energy” (r = 0.470; ρ < 0.001; Spearman's rho) than with the statement “I feel physical fatigue” (r = 0.349; ρ = 0.001). The statement “I have a lack of energy” also produced the highest prevalence of severe symptoms, with 37% agreeing that they had the symptom “often” or “always.” Agreement between Likert scales was only fair, the best being that for “I have a lack of energy” and “I feel physical fatigue” (κ = 0.50). There was a gender difference in simple expression of fatigue, with the statement “I feel physical fatigue” correlating strongly with FSS score in males (r = 0.61; ρ < 0.001) but not correlating in females (r = 0.039; ρ = 0.29). Depending on which definition of fatigue was used, the prevalence of fatigue varied between 13% and 63%. FSS score correlated weakly with ESS score (r = 0.287; ρ = 0.008). Our data indicate significant variation in the prevalence of fatigue among subjects with stroke and transient ischemic attack depending on the descriptors and methods used to define it.ConclusionThere is a significant difference between the genders in how fatigue is expressed.