Elisabeth Anne de Vries, Wendy Boerboom, Rita H.J.G. van den Berg-Emons, Fop van Kooten, Gerard M. Ribbers, Majanka H. Heijenbrok-Kal
Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. E-mail: ldvries@rijndam.nl
DOI: 10.2340/16501977-2800

Objective: To examine the association of fatigue with long-term participation in aneurysmal subarachnoid haemorrhage survivors.
Design: Cohort study, 4 years post-onset.
Subjects: A total of 59 patients with aneurysmal subarachnoid haemorrhage.
Methods: Participation performance was assessed with the Sickness Impact Profile-68, participation autonomy and problem experience with the Impact on Participation and Autonomy questionnaire, and community integration with the Community Integration Questionnaire. Fatigue was assessed with the Fatigue Severity Scale and depression with the Center for Epidemiologic Studies-Depression scale. Multivariable linear regression analyses were performed.
Results: Fifty-nine survivors (mean age 53. 0 years, standard deviation (SD) 10. 8 years) were included, of which 59. 3% was fatigued. Fatigued patients had significantly worse participation scores than non-fatigued patients regarding performance (p < 0. 001), autonomy indoors (p = 0. 001), autonomy outdoors (p = 0. 002) and problem experience (p = 0. 001), but not regarding community integration. More severe fatigue was related to worse participation in terms of performance (B = 2. 79, p < 0. 001) and problem experience (B = 0. 08, p = 0. 003), adjusted for depression and inpatient rehabilitation.
Conclusion: Four years after onset, many survivors of aneurysmal subarachnoid haemorrhage have persistent fatigue, which is independently associated with reduced participation in activities of daily living. Therefore, future studies should investigate whether rehabilitation programs that focus on fatigue are effective in improving long-term participation outcome after aneurysmal subarachnoid haemorrhage.

A subarachnoid haemorrhage (SAH) is a subtype of stroke. In most cases subarachnoid haemorrhage is caused by rupture of an aneurysm, termed aneurysmal subarachnoid haemorrhage. Fatigue is one of the most common symptoms after aneurysmal subarachnoid haemorrhage. Fatigue may reduce participation in activities of daily living. If fatigue and participation are related, focusing on fatigue during rehabilitation might improve participation in activities of daily living after aneurysmal subarachnoid haemorrhage. Therefore, this study examined whether fatigue is associated with participation 4 years after aneurysmal subarachnoid haemorrhage. The results showed that fatigued patients participated less in activities of daily living, were less autonomous regarding their participation, and had more problems with their level of participation than non-fatigued patients. In addition, more severe fatigue was related to worse participation in activities of daily living and more problems with the level of participation. This indicates that treating fatigue during rehabilitation might improve participation in the long-term after aneurysmal subarachnoid haemorrhage.

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