Monitoring Post-Stroke Fatigue, Sleep Quality and Therapy Participation during in-Patient Rehabilitation: A Feasibility Study

ABSTRACT

Background: Despite similar motor recovery of limbs in research, clinically the lower limb is observed to demonstrate greater recovery than the upper limb (UL). Understanding the relation between the post-stroke rehabilitation experience in the hospital environment and neuroplasticity and motor recovery of the UL may provide insight into how to optimize the hospital and promote recovery. Aim(s) This feasibility study aimed to collect cross-sectional data from inpatients who were clinically receiving UL motor training within a rehabilitation hospital to determine the feasibility of our protocol as well as describe the factors and potential associations between motor performance and therapy participation, fatigue, stress and sleep. Method(s) Inpatients were recruited across two rehabilitation wards;inclusion criteria were broad (stroke diagnosis and clinically identified UL motor impairment). Therapy session duration and frequencies were recorded prior to assessing sleep quality and amount over one night (Actiwatch, Phillips Respironics, USA)). Participants rated their perceived fatigue (Fatigue Severity Scale-FSS) and sleep quality (Leeds Sleep Evaluation Questionnaire-LSEQ), and overnight nursing documentation of sleep was extracted from the medical record. Motor performance was assessed via the box and block test. All data were collected across a 24h period. Result(s) N=14 participants participated (age 71+/-11y) at a mean+/-SD 32+/-23 days post-stroke and 22+/-21 days since admission to rehabilitation. Participants received motor training 10+/-3 times per week, and sessions were 51+/-18min in length. Mean+/-SD sleep duration was 9.5+/-1.9h with 1.1+/-0.7h awake-time during the night. All participants reported fatigue, with mean FSS (37+/-16), and identified issues with respect to getting to sleep as well as quality of sleep on the LSEQ. All data were feasible to collect, however COVID restrictions and bed-numbers influenced recruitment rate. Conclusion(s) Findings provide key feasibility data to better understand targetable factors to optimise the post-stroke rehabilitation experience, neuroplasticity and UL motor recovery after stroke.