The course of fatigue and physical activity from discharge up to 5-7 years post stroke rehabilitation and the role of activity pacing behaviour: a longitudinal mixed-methods study.

Purposes: The course of fatigue and physical activity (PA) from discharge up to 5-7 years post stroke rehabilitation may be influenced by activity pacing behaviour (how people divide their energy and daily PA during the day). This study aims (1) to explore how people after stroke perceive their course of fatigue and PA post rehabilitation and (2) to explore participants’ experience of activity pacing behaviour, and its barriers and facilitators. Methods: People after stroke (N=303) were followed from 3-6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after rehabilitation in the longitudinal cohort study Rehabilitation, Sports and Active lifestyle (ReSpAct 1.0). Latent Class analyses were used to characterize diversity in the course of fatigue and PA (trajectories from T0-T3), based on questionnaire data. Based on these trajectories and participants’ characteristics (gender and age), a heterogeneous subsample of the ReSpAct 1.0 study (N=20) will be invited, around 5-7 years post stroke rehabilitation, to fill in a short questionnaire and to participate in a semi-structured interview on how they experience their course of fatigue and PA and how they divide their energy and daily PA during the day. The qualitative data will be combined with individual fatigue and PA trajectories and data on activity pacing behaviour into a longitudinal mixed-methods study. Audiotapes of the interviews will be transcribed verbatim. Both a thematic inductive and a deductive analysis (based on the Behaviour Change Wheel Taxonomy, centred on activity pacing behaviour) will be performed.Results: Three fatigue trajectories were identified: (1) stable high (N=163), (2) stable low (N=41) and (3) recovery (N=2). Three PA trajectories were identified: (1) moderately active (N=196), (2) active (N=35) and (3) strongly improved PA (N=4). Further results will be presented during the ISBNPA2020 conference.Discussion: We found a large diversity in fatigue and PA trajectories post stroke rehabilitation (T0-T3). Further findings of this study will provide a deeper understanding of the diversity in perceived fatigue in people after stroke and the role of activity pacing behaviour to obtain/maintain a physically active lifestyle