Hindawi Publishing Corporation Stroke Research and Treatment Volume 2012, Article ID 126275, 8 pages doi:10.1155/2012/126275 Research Article The Course of Fatigue during the First 18 Months after First-Ever Stroke: A Longitudinal Study Anners Lerdal, 1, 2 Kathryn A. Lee, 3 Linda N. Bakken, 4, 5 Arnstein Finset, 5 and Hesook Suzie Kim 4 1 Department of Research, Lovisenberg Diakonale Hospital, Lovisenberggt. 17, 0440 Oslo, Norway 2 Division of Medicine, Department of Gastroenterology, Oslo University Hospital, PB 4956 Nydalen, 0424 Oslo, Norway 3 Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA 94143, USA 4 Department of Health Sciences, Buskerud University College, PB 7053, 3007 Drammen, Norway 5 Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, PB 1111, Blindern, 0316 Oslo, Norway Correspondence should be addressed to Anners Lerdal, anners.lerdal@lds.no Received 7 June 2011; Revised 22 July 2011; Accepted 22 July 2011 Academic Editor: Gillian Mead Copyright © 2012 Anners Lerdal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Little is known about the course of poststroke fatigue. Objectives. To describe the course of poststroke fatigue in relation to the patient’s level of physical functioning, depressive symptoms, and self-reported history of prestroke fatigue. Methods. A longitudinal study using structured face-to-face interviews, questionnaires, and patients’ medical records. Data were collected from 95 patients in Norway with first-ever stroke. Fatigue was measured with the Fatigue Severity Scale 7 item version and assessed for change between the acute phase, six, 12, and 18 months after stroke using 2-way ANOVA repeated-measures analyses. Results. The patients’ level of fatigue did not change over time. However, those who reported prestroke fatigue showed a relatively high level of fatigue over time in the poststroke period, while patients with no history of pre-stroke fatigue showed a stable course of relatively low fatigue over time. Conclusion. Studies on poststroke fatigue should control for the patient’s pre-stroke fatigue level. 1. Introduction Fatigue is one of the most common complaints after stroke [1, 2]. Despite this, little is known about the development of poststroke fatigue, its development over time and how this development is related to other clinical factors. A few longitudinal studies have been conducted, but to our know- ledge, no longitudinal studies have considered that patients with poststroke fatigue may have experienced fatigue for a long time before stroke. In fact, epidemiological studies report that approximately 20–25% of the general population experience current fatigue [3, 4]. A relationship between pre- stroke fatigue and poststroke fatigue has previously been reported in a cross-sectional study [5] 15 months after stroke (mean time after stroke) and in a study of stroke patients in the acute phase [6]. Thus, prestroke fatigue may confound the clinical covariates associated with poststroke fatigue reported in previous studies. Fatigue can be defined as a sense of exhaustion, lack of perceived energy, or tiredness [7, 8] distinct from sadness or weakness [7]. Because of the subjective character of fatigue and the fact that no objective signs of the condition have been identified, self-report is seen as the most valid way to assess fatigue [9]. Although fatigue is understood as multidimen- sional with mental, physical, and motivational aspects [8], the Fatigue Severity Scale (FSS) is a one-dimensional self- report measure frequently used to assess fatigue in stroke populations [9]. In a previous published review of poststroke studies [9], poststroke fatigue was more common among women [10– 12] and in those reporting a history of fatigue prior to their stroke [5]. Furthermore, poststroke fatigue was related to higher levels of depression [5, 13–19], sleep disturbance [5, 17], and dependency [5, 17, 18]. Some researchers have also observed a significant relationship between a patient’s