Exploring the perception of health care professionals around Post-stroke fatigue in Saudi Arabia: a qualitative interview study Wafa Alahmari12, Ahmed Alhowimel3, Mazyad Alotaibi3,Pip Logan2, Eirini Kontou2 Neil Coulson2 .1College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University , Saudi Arabia. 2Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, United Kingdom. 3Physical Therapy and Rehabilitation Department, Prince Sattam Bin Abdulaziz University, Saudi Arabia. • Post-stroke fatigue (PSF) is common. Globally, there are ≈33 million stroke survivors, and at least half of these individuals experience fatigue. • PSF is disabling consequence of stroke, considered to be a complex multidimensional phenomenon. • Patients with PSF have difficulty in resuming social, familial, and professional activities and have low QOL scores. • How to manage and prevent fatigue is ranked by stroke survivors and health professionals among the top 10 research priorities relating to life after stroke. • The study aimed to explore experience of physicians, physiotherapists and occupational therapists in managing patients with post-stroke fatigue (PSF) in Saudi Arabia. • Using purposive sampling, 24 participants who had a minimum of 2- years of experience with stroke patients. • Face-to-face interviews. • Semi-structured interviews were undertaken with professionals from three professional groups, physicians (n= 8), physiotherapists (n=8) and occupational therapists (n=8) • Audio recorded, transcribed verbatim and analysed using inductive thematic analysis. • Interviews were conducted with 24 health care professionals • Mean years of experience of handling stroke patients is 9.04 (SD 5.08). • Four main themes were generated. • Across all three professional groups, there appeared to be a general lack of awareness around post-stroke fatigue and particularly in relation to its assessment and management. • Specific concerns were expressed around the difficulties of communicating with patients identified as experiencing post-stroke fatigue and an absence of educational support materials. • AARNES, R., STUBBERUD, J. & LERDAL, A. 2019. A literature review of factors associated with fatigue after stroke and a proposal for a framework for clinical utility. Neuropsychological rehabilitation, 1-28. • HINKLE, J. L., BECKER, K. J., KIM, J. S., CHOI-KWON, S., SABAN, K. L., MCNAIR, N. & MEAD, G. E. 2017. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association. Stroke, 48, e159-e170. Background Results Discussion and Conclusion Aim References Methods 1. Factors associated with PSF. Past medical history and patients’ conditions. PSF and Comorbidity. PSF and old age. PSF and Gender. Medical factors. Cognitive impairments. Depression, and lack of sleep. Lack of motivation Fear and lackof confidence to move around. Fear and lack ofconfidence to move around. Mental fatigue. Psychological factors. Functional and life style factors.
Evaluation and measurement of PSF. Assessing endurance level to measure PSF Rule out the Confounding factors. Sleep management. Screen and manage aggravating Exercises therapy. Energy conservation techniques. Multidisciplinary team approach. 2. Management of PSF. Key themes and subthemes 3. Lack of awareness of PSF among patients, caregivers & HCP. 4. Areas to improve in the current management of PSF. Assessing functional level to measure PSF. Gradual endurance training. Exercise Group therapy. Medication. Antidepressant medication. Stimulant medication. Breathing exercises. Rest periods between exercises. Subjective methods to evaluate PSF. Ability to complete exercise sessions. Check medications with nurse. Referral between Therapist and physicians. Social worker’s recommendations to the physician. Therapist recommending working as a team. Patient and caregiver education. Increase knowledge. Necessity to learn appropriate PSF assessment Include PSF in patients’ education materials. Needs to set clinical guidelines and management pathway of PSF. Raise awareness and educate. Patients’ lack of awareness about PSF. Patients not reporting PSF. Caregiver and family misunderstand PSF. Perspectives of therapists on PSF. PSF neglected from HCP. Patients perceive PSF as normal phenomenon. PSF is endurance level. HCP never takes it up to seminars or conferences. PSF not important.