Fatigue is Associated with Reduced Participation and Health-Related Quality of Life Five Years After Perimesencephalic Subarachnoid Haemorrhage: A Multicentre Cross-Sectional Study

Abstract

Objective: To determine whether fatigue is associated with participation and health-related quality of life 5 years after perimesencephalic subarachnoid haemorrhage. Design: Multicentre cross-sectional study. Subjects: Forty-six patients with perimesencephalic subarachnoid haemorrhage. Methods: Fatigue was assessed with the Fatigue Severity Scale, participation (frequency, restrictions, satisfaction) with the Utrecht Scale for Evaluation of Rehabilitation-Participation, healthrelated quality of life with the Stroke-Specific Quality of Life Scale-12, symptoms of depression and anxiety with the Hospital Anxiety and Depression Scale, and coping with the Coping Inventory for Stressful Situations. Results: A total of 46 patients were included (63% men, mean age 50.4 ± 9.4 years), with a mean time of 4.7 ± 1.6 years after perimesencephalic subarachnoid haemorrhage onset. Fatigued patients (33%) had worse participation (p < 0.01) and health-related quality of life (p < 0.001) than non-fatigued patients, and more often had hypertension, depression, anxiety and emotion-oriented coping (p < 0.05). Fatigue severity was inversely and independently (p < 0.005) associated with participation frequency (B = –3.62), satisfaction (B = –4.54), having restrictions (odds ratio = 2.48, 95% confidence interval 1.079–5.685), and health-related quality of life (B = –0.19), adjusted for depression, anxiety, and/or hypertension. Conclusion: Five years after perimesencephalic subarachnoid haemorrhage, one-third of patients still reported fatigue, which was associated with worse participation and health-related quality of life. Future studies should examine whether these patients may benefit from rehabilitation aimed at fatigue. LAY ABSTRACT A subarachnoid haemorrhage (SAH) is a subtype of stroke. Of all patients with SAH, approximately 10% are diagnosed with non-aneurysmal perimesencephalic subarachnoid haemorrhage (PM-SAH). PM-SAH is generally considered a benign form of SAH; however we have previously found that one-third of patients with PM-SAH are still fatigued 5 years after PM-SAH. Fatigue may be related to reduced participation and health-related quality of life, both of which are considered important rehabilitation outcomes. Therefore, this study examined whether fatigue is associated with participation and health-related quality of life after PM-SAH. The results showed that, 5 years after PM-SAH, fatigued patients had worse participation and quality of life than non-fatigued patients. In addition, more severe fatigue was associated with worse participation, regarding frequency, satisfaction and restrictions, and with worse health-related quality of life. Further studies are necessary to determine whether patients with PM-SAH may benefit from rehabilitation aimed at fatigue.

Keywords

• Fatigue
• Participation
• Health-related quality of life
• Mood
• Coping
• Perimesencephalic subarachnoid hemorrhage