DAILY PATTERNS OF FATIGUE AFTER SUBARACHNOID HAEMORRHAGE: AN ECOLOGICAL MOMENTARY ASSESSMENT STUDY

OBJECTIVE: To examine the daily course of, and factors associated with, momentary fatigue after subarachnoid haemorrhage, and to explore subgroups of patients with distinct diurnal patterns of fatigue. DESIGN: Observational study using ecological momentary assessment. SUBJECTS: A total of 41 participants with subarachnoid haemorrhage. METHODS: Patients with fatigue were included within one year post-onset. Momentary fatigue (scale 1–7) was assessed with repeated measurements (10–11 times/day) during 7 consecutive days. Multilevel-mixed-model analyses and latent-class trajectory modelling were conducted. RESULTS: Mean (standard deviation; SD) age of the group was 53.9 (13.0) years, 56% female, and mean (SD) time post-subarachnoid haemorrhage onset was 9.3 (3.2) months. Mean (SD) momentary fatigue over all days was 3.22 (1.47). Fatigue increased significantly (p < 0.001) over the day, and experiencing more burden of fatigue and day type (working day vs weekend day) were significantly (p < 0.05) associated with higher momentary fatigue. Three subgroups could be distinguished based on diurnal patterns of fatigue. The largest group (n = 17, 41.5%) showed an increasing daily pattern of fatigue. CONCLUSION: Momentary fatigue in patients with subarachnoid haemorrhage increases over the day, and diurnal patterns of fatigue differ between participants. In addition to conventional measures, momentary measures of fatigue might provide valuable information for physicians to optimize personalized management of fatigue after subarachnoid haemorrhage. LAY ABSTRACT Fatigue is one of the most common symptoms after subarachnoid haemorrhage. Fatigue is usually assessed with a questionnaire, which gives a single score of fatigue over the preceding week(s). However, fatigue in people with subarachnoid haemorrhage may fluctuate over the day. Insight into these daily patterns of fatigue may help in developing adequate rehabilitation strategies to manage fatigue after subarachnoid haemorrhage. Therefore, this study examined the course of fatigue over the day. In addition, the study examined which factors are associated with daily fatigue and whether subgroups with different daily patterns of fatigue can be distinguished. It was found that fatigue increases over the day. In addition, patients who experienced more burden of fatigue in daily life had higher daily fatigue, and fatigue was higher on working days than on weekend days. Three subgroups with different daily patterns of fatigue could be distinguished. Most patients had an increasing pattern of fatigue.