A Three-Point Perspective on Post-Stroke Fatigue: A Grounded Theory Study

Janice Kishi Chow; Noralyn Davel Pickens; Kendall Lin; Lindsey Hammond; Christian Phillips; Veronica Burrola; Madeleine Packer; Hui-Ting Goh

doi:10.1016/j.apmr.2025.06.013

A Three-Point Perspective on Post-Stroke Fatigue: A Grounded Theory Study

Arch Phys Med Rehabil. 2025 Jun 29:S0003-9993(25)00772-5. doi: 10.1016/j.apmr.2025.06.013. Online ahead of print.

Authors

Janice Kishi Chow¹, Noralyn Davel Pickens², Kendall Lin³, Lindsey Hammond⁴, Christian Phillips⁴, Veronica Burrola⁴, Madeleine Packer⁴, Hui-Ting Goh⁵

Affiliations

¹ Physical Medicine and Rehabilitation Services, VA Palo Alto Health Care System, Palo Alto, CA, USA.
² College of Health Science, Texas Woman's University, Denton, TX, USA.
³ Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
⁴ School of Physical Therapy, Texas Woman's University, Dallas, TX, USA.
⁵ School of Physical Therapy, Texas Woman's University, Dallas, TX, USA. Electronic address: hgoh1@twu.edu.

PMID: 40592384
DOI: 10.1016/j.apmr.2025.06.013

Abstract

Objectives: To describe and compare the experiences of post-stroke fatigue (PSF) from the perspectives of stroke survivors, caregivers, and stroke care providers. Secondarily, to develop a model of PSF to explain, predict, and guide advancement of fatigue management.

Design: A constructivist grounded theory approach with one semi-structured interview per participant and a member-check follow-up. Theoretical sampling followed by data analysis resulted in a data-grounded model.

Setting: A clinical setting or via videoconference per the participant's preference or location.

Participants: Stroke survivors with PSF (n=17), caregivers of someone with stroke (n=10), and stroke care providers (n=19).

Interventions: Not applicable.

Main outcome measure: Not applicable.

Results: We developed the Model of Living with Post-Stroke Fatigue, consisting of the causes, perceptions, and triggers of fatigue with constant problem-solving management. All groups described living with PSF as experiencing physical and or cognitive fatigue while incorporating an ongoing, adaptive management process. However, participants occasionally misconstrued fatigue for lack of motivation, reported varying triggers, and noted discrepancies in PSF education provision.

Conclusions: The three participant groups may benefit from opportunities to recognize physical and cognitive fatigue, to define personal causes and triggers of the person with PSF, and to work together through an adaptive strategy process. The Model of Living with PSF may help guide education, structure discussions, and facilitate collaboration for more effective fatigue management. Research is needed to validate the constructs and fatigue management strategies.

Keywords: adaptation; constructivist grounded theory; fatigue management; model development; stroke rehabilitation.