(34) Symptom Clusters Predict Community Life in People with Stroke

Ms. Lily Yuen-Wah HO¹, Prof. Claudia Kam-Yuk LAI¹ Prof. Shamay Sheung-Mei NG^2
1School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, ²Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, , Hong Kong SAR

Background
Fatigue, sleep disturbances and depressive symptoms are common in stroke populations, which hinder survivors returning to community life. Current care focuses on management of individual symptoms rather than symptoms as a cluster. This study aimed to examine the proportion of people with stroke experiencing the symptoms and determine the association between symptom clusters and community life of people with stroke.

Methods
A cross-sectional design was adopted. The Chinese versions of the Fatigue Assessment Scale, Pittsburgh Sleep Quality Index, Geriatric Depression Scale, Frenchay Activities Index (FAI), and Community Integration Measure (CIM) were used to assess fatigue, sleep disturbances, depressive symptoms, participation in daily activities, and community integration among 115 people with stroke. It was hypothesized that in people with stroke, clusters of fatigue, sleep disturbances, and depressive symptoms could predict community life, with FAI and CIM scores as indicators. The hypothesis was tested with a structural equation modelling.

Results
Single symptom, fatigue was reported by 16.5%, sleep disturbances by 16.5%, and depressive symptoms by 0.9% of the people with stroke. Co-existence of symptoms, fatigue and sleep disturbances was reported by 27.0%, fatigue and depressive symptoms by 5.2%, and sleep disturbances and depressive symptoms by 0.9% of the people with stroke. Co-existence of all three symptoms was report by 20.9% of the people with stroke. The path coefficient of symptom clusters was greater than that of individual symptoms on community life. Symptom clusters strongly predicted community life with a good model fit (X²=1.813, df=4, p=0.770, standardized root mean square residual=0.022, comparative fit index=1.0).

Conclusion
Symptom clusters were common in people with stroke and were a determinant of returning to community life. The findings support management of symptom clusters rather than a single symptom for promoting community participation of people with stroke.

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