Fatigue is a multidimensional symptom composed of subjective, motor and cognitive components. Subjective fatigue relates to feelings of exhaustion and lack of energy and has been identified as a debilitating consequence of neurosurgical conditions including traumatic brain injury (Beaulieu–Bonnaeu & Ouellet, 2016) and brain tumours (Boele et al, 2014). No research has looked at the consequence of fatigue in a population of general neurosurgical patients, with varied diagnosis.
Objective: To identify the impact of subjective fatigue on an acute population of neurosurgical patients with varied diagnoses.
Methods: All neurosurgical patients admitted to an acute neurosurgical department, over a four week period and were referred for physiotherapy were included in the study, once consent was obtained. Ethical approval was obtained for the study. A cooling off period was provided prior to written consent being obtained. Participants that provided consent and met the inclusion criteria were provided with validated fatigue outcome measures, The Fatigue Severity Scale (FSS), Fatigue VAS (FVAS) and the Piper Fatigue Scale (PFS). The outcome measures were completed pre-operatively (T1) to determine baseline fatigue data and post-operatively (T2) during the inpatient stay. Pre-determined baseline demographics including age, sex and mobility status were also gathered. Post-operatively the patient’s medical chart was accessed to gather data relating to the surgical intervention and the condition for which the participant was receiving treatment.
Results: 79 participants were recruited; 35 females and 44 males with a mean age of 44 years. Of the 73 participants who completed the pre-operative outcome measures, 55 underwent surgery. 50 participants completed post-operative outcome measures.
51% (P = 27) of participants had surgery for a brain tumour, 24% (P = 13) spinal surgery, 18% (P = 10) surgery due to a cerebral bleed, 3% (P = 2) for hydrocephalus and 3% (P = 2) epilepsy surgery.
The FVAS at T1 measured 6.5 and 5.82 at T2, demonstrating a borderline significantly meaningful change (P = 0.0497). No significant difference was detected on the FSS between T1 and T2. The PFS demonstrated a mean increase of 0.78 at T2, but is not statistically significant.
Discussion: A borderline significant increase in post-operative fatigue levels was noted, only on one outcome measure (FVAS), at T2. The quick succession of testing and the general post-operative recovery process may have impacted on fatigue levels experienced. Qualitative elements of the PFS gave interesting insight into the impact of fatigue experienced:
“…fatigue is the most distressing symptom…..I feel miserable and crap…” .
Investigation of fatigue levels experienced in this population at longer post-operative time-frames would provide a more robust insight into the longer-term impact of fatigue post neurosurgery.
Conclusion: This pilot study shows limited change in fatigue levels in a mixed neurosurgical population in the acute management phase. Long-term follow-up is required to provide more robust data.
Ethical Approval: Ethical approval was obtained from Beaumont Hospital and RCSI
Funding: This project was funded by the Royal College of Surgeon's Summer Research School
References:
Beaulieu-Bonneau S & Ouellet MC (2016). Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates. Neuropsychological Rehabilitation, Apr 1:1-19
Boele et al (2014). Symptom management and quality of life in glioma patients. CNS Oncology, Jan;3(1):37-47
