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Quantitative analysis of fatigue after stroke: The patient’s perspective
Gwendoline Bungansa
NRS 433-0501
Grand Canyon University Phoenix Arizona
July, 17 2016

Introduction
Waking up to a new normal is how a stroke patient describes his experience after a stroke. A stroke is a brain attack which happens when part of the brain is being deprived of blood supply. Stroke is not planned hence, stroke survival face varied problems as a result of the stroke incident. Fatigue is a common problem post stroke and though people experience fatigue prior to a cardiovascular accident, the fatigue post stroke as reported by patients is different. Post stroke fatigue is not related to energy exhaustion from being active (www.stroke.org.). Barbour and Mead’s research is praised for their methodology in protecting human participants, data collection, data management and analysis, and discussion of finding in an investigation of patients’ perspective of fatigue post stroke.
Problem and Purpose
Given that stroke patients face varied complication post a cardiovascular accident including fatigue, it was worth investigating if fatigue matter to these patients. It is reported that fatigue is common and depressing for stroke survivors. A survey of 88 patients posts stroke, 68% complaint of fatigue while 40% stated that fatigue was their worst problem post stroke. When another researcher studied 90 stroke survivors, fifty percent of the patient reported that fatigue was their major problem. Furthermore, it was noted that stroke survivor experiencing fatigue had higher risk of institutionalization and low survival rates. From these reviews, Barbour and Mead’s objective was to investigate patients’ perception of post stroke fatigue, its causes, and factors that lessen fatigue.

Protection of Human Participants
The researcher respected patients’ right. Participants in this study were stroke patient receiving rehabilitation at Edinburg rehabilitation venter between the period of July to September 2009. Authorization was obtained from the Lothian Research Ethics Committee. Participants were selected based on the following criteria: Patient has had a stroke for at least one month, patient reported fatigue and nurses identify patient has suffering from fatigue. According to Bowrey (2014) participants should be provided information and their consent obtained before enrollment into the study. The participants should be given facts about the clinical trial including aims and duration of study, what is expected of participants, the risk, and potential benefits of the study. Barbour and Mead respected the patients’ right. This is evident in the statement that “Eligible patients were given a patient information sheet and those who consented were included in the study.” Secondly evident shows that patient’s right to choose to participate or not was respected. This is evident in the statement that after reading the patient information provided three of the identified patient declined participation because they thought they were not eligible for the study because they thought they were not experiencing fatigue. To treat a patient, it is important to understand the patient’s health belief. Looking at the prevalence and distressing impact of post stroke fatigue, it is important to understand what stroke patients think about its cause, what makes it worst and what reliefs fatigue.
Data collection
Using a quantitative methodology in this research, the researcher investigated the relation between the dependent variable, fatigue variable and the independent variables, the nature, exacerbating, and relieving factors of fatigue. Data was collect between a period of three months; July to September 2009. The National Institute of Stroke Scale and Fatigue Assessment Scale were used to diagnosis fatigue and to measure the severity of fatigue respectively. The researcher then conducted semistructured interview using open and close ended questions to investigate the patients’ perspective of the causes of their feeling of fatigue, what makes it worst and what factors reliefs fatigue. The researcher then mapped and interpreted data finding, and linking themes while preserving the aim of the study.
Data Management and Analysis
The researcher used both a quantitative and qualitative data collection and analysis methodology. The quantitative data collection and analysis will be examined. Fifteen participants were utilized in this study. After collection of data through semistructured interviews. Data collected was documented on paper collection forms. Data was classified based on patients’ responses on the nature of fatigue after the cardiovascular accident, and the etiology of fatigue, the exacerbating and the relieving factors. Responses were analyzed based on percentages of responses to concepts. For example, 80% of patients reported that their feeling of fatigue was due to the stroke or due to brain recovery post stroke. 40% of patients reported that fatigue was due to insufficient sleep time as sleep was interrupted by assistance with activities of daily living. However, there is no report on the utilization of any statistical software for accuracy of the analysis of data. Without evident mentioned of having another researcher or editor for data analysis, conclusions could be subject to researcher bias.
Finding/Interpretation of Findings
The nature of fatigue after a stroke as reported by patients is different from that experience prior to stroke. The severity of fatigue is influence by external factors such as sleep interruption on rehab units by noise, or staff activities, and boredom. Significant proportion of patients reported that rest, good sleep and exercises improved or relieved post stroke fatigue. This findings of factors that exacerbate fatigue are consistent with reality. Hospitals and rehabilitation centers are busy and crowded environment with ongoing activities that comprises a person’s sense comfort and ability to come to rest and sleep. For patients who already have a comprise sleep pattern due to their illness such as a stroke, the effect of lack of sleep like fatigue would be prominent.
The researcher identifies and recognizes limitations of the study. The sample size of fifteen is questionable to make generalized conclusion of findings for a quantitative study. The participants were identified based on the nurses’ recommendation of whether the patients were experiencing fatigue. Hence a risk for staff bias which could lead to missing out on some patients who were actually experiencing fatigue. The researcher also recognize depression as an extraneous factor that could influence feeling of fatigue though treatment for depression was reported as a standardized post stroke assessment and management.
Implication for Practice and Future Research.
The result of the study showed that a significant percentage of the patients reported that their fatigue started at the time of the stroke. Other factors such as poor sleep related to hospital, admission, boredom exacerbated fatigue. Good sleep, rest, rehabilitation, exercised were reported to improve fatigue. To this effect it is important to for health professional to recognize that poor sleep, lack of activities in rehabilitation units causes fatigue and hence design strategies to eliminate or minimize these factors. Some patients recommended that better access to internet, television, and in house activities would elevate boredom. From personal experience, patients enjoy social games, and the ability to access the outside world via internet access and television. This reduces the negative feelings on institutionalization and improves enhances patient outcome.
The based on the findings, the researcher recommended future research in the following areas: * Neuroimaging studies to investigate the relationship between fatigue and the site and size of brain lesions. * Based on the understanding that sleep apnoea is one of the complication of a cardiovascular accident, further study is needed to determine if fatigue post stroke is related to sleep apnoea. * The effect of graded exercise treatment of fatigue post stroke is worth studying based on the fact that graded exercises has proven effective in treating chronic fatigue syndrome.
Conclusion
Barbour and Mead’s research studying fatigue post stroke based on patients’ perspective is praised for its methodology in protecting human participants, data collection, data management and analysis, and discussion of findings. Protecting participants by obtaining authorization and patient’s consent for studies, data was collected analyzed and interpreted with conclusions that would improve health practice. The responses from patient suggest that fatigue after a stroke could be cause by brain lesions but that external factors such as hospital and rehabilitation units’ admissions, insufficient or disturbed sleep, inactivity makes fatigue worst. Patients identify exercise as an activity that relief fatigue. Although post stroke fatigue is undetermined if it is related to what site and size of brain lesions, or if the fatigue is related to sleep apnoea, this study lays a way for further studies which can help elevate fatigue in stroke patients. Furthermore, patients testified that exercised relieved fatigue hence, it is worth noting that rehabilitation exercises do not only treatment physical impairment but can also be effective in relieving fatigue.

Reference
Barbour, V. L., & Mead, G. E. (2012). Fatigue after Stroke: The Patient's Perspective. Stroke Research and Treatment, 2012, 1-6. doi:10.1155/2012/863031

Bowrey S, Thompson JP (2014) Nursing research: ethic, consent and good practice. Nursing Times; 110:1/3.20-23 Fatigue. (2014). Retrieved from http://www.stroke.org/we-can-help/survivors/stroke-recovery/post-stroke-conditions/physical/fatigue

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