Interrelationship between fatigue and recovery of physical function in stroke survivors: a longitudinal mixed-methods study

Abstract

BACKGROUND: Research has shown that late fatigue post-stroke is associated with poorer long-term outcomes, but the association between early fatigue with concurrent outcomes like physical function within six months is underexplored. AIM: To explore the interrelationship between stroke survivors' adaptation to fatigue and physical function changes during hospitalization and at one, three, and six months post-stroke. DESIGN: A prospective longitudinal cohort study with a convergent mixed-methods design. METHODS: Adults (≥18 years) with first-ever ischemic stroke were included. Fatigue, physical function, and data from semi-structured interviews were collected at four time points. A mixed-effect model was used to explore the quantitative relationship, with physical function as the dependent outcome and fatigue as the fixed-effect variable. Directed content analysis was used for qualitative data. A side-by-side display was used to present mixed-methods findings. RESULTS: Thirty-two survivors were in the quantitative arm; nine of those were in the qualitative arm. Quantitative analysis showed that each unit increase in fatigue decreased physical function by 0.27, adjusting for age, depression, and time. Qualitative findings confirmed that fatigue hindered recovery and pre-stroke activity resumption. Survivors described a vicious cycle between fatigue and function, with varying fatigue patterns and exacerbating factors within six months. CONCLUSIONS: Fatigue and physical function were interrelated within six months after stroke. Given the small, single-center sample, these results should be interpreted cautiously. Still, our findings highlight the value of early, systematic fatigue assessment and collaborative discussions between survivors and health professionals to guide individualized management strategies. CLINICAL REHABILITATION IMPACT: Managing post-stroke fatigue requires both survivor-led strategies (e.g., self-monitoring, rest, pacing) and professional support to address contributing conditions. Routine follow-up should include systematic fatigue assessment, collaborative discussion of management options, and periodic re-evaluation to optimize recovery.