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Poststroke Fatigue Is Related to Motor and Cognitive Performance

A Secondary Analysis

Goh, Hui-Ting PT, PhD; Stewart, Jill C. PT, PhD

Journal of Neurologic Physical Therapy: October 2019 - Volume 43 - Issue 4 - p 233–239
doi: 10.1097/NPT.0000000000000290
Research Articles

Background and Purpose: Poststroke fatigue (PSF) is a common debilitating and persistent symptom after stroke. The relationship between PSF and motor and cognitive function remains inconclusive partly due to lack of control for effects of depression and use of insensitive measures. We examined the relationship between PSF and motor and cognitive performance using a comprehensive set of behavioral measures and excluding individuals with depression.

Methods: Fifty-three individuals poststroke (16 female) were included (median age: 63 years, median months poststroke: 20 months). Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and cognitive performance was measured with the Montreal Cognitive Assessment, simple and choice reaction time (SRT and CRT) tasks. Lower extremity motor performance included Fugl-Meyer Motor Assessment, 5 times sit-to-stand test (5 × STS), Berg Balance Scale, Functional Ambulation Category, and gait speed. Upper extremity motor performance was indexed with Fugl-Meyer, grip strength, and Box and Block test. Spearman correlation and stepwise linear regression analyses were performed to examine relationships.

Results: Two motor performance measures, Berg Balance Scale and Functional Ambulation Category, were significantly correlated with FSS (ρ = −0.31 and −0.27, respectively) while all cognitive measures were significantly correlated with FSS (ρ = −0.28 for Montreal Cognitive Assessment, 0.29 for SRT, and 0.29 for CRT). Regression analysis showed that Berg Balance Scale was the only significant determinant for FSS (R2 = 0.11).

Discussion and Conclusions: Functional gait, balance, and cognitive performance are associated with PSF. Fatigue should be considered when planning and delivering interventions for individuals with stroke. Future studies are needed to explore the potential efficacy of balance and cognitive training in PSF management.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at:

School of Physical Therapy, Texas Woman's University, Dallas (H.-T.G.); and Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia (J.C.S.).

Correspondence: Hui-Ting Goh, PT, PhD, School of Physical Therapy, Texas Woman's University, 5500 Southwestern Medical Ave, Dallas, Texas 75235 (

This study was funded by the University of Malaya UMRG 496-HTM and the American Heart Association 15SDG24970011.

This article was presented, in part, as a poster presentation at the American Congress of Rehabilitation Medicine Conference 2018 in October 2018, Dallas, Texas.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA