A Preliminary Analysis of Fatigue and Depressive Symptoms in Relation to Physical Activity Among Chronic Stroke Survivors
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Published:
Dec 24, 2025
Keywords:
Brunnstorm, Chronic, Depression, Fatigue, GPAQ, Physical, Rehabilitation, Stroke
Main Article Content
Abstract
ABSTRACT
Introduction: Depression and fatigue are common sequelae among chronic stroke survivors and may influence their physical activity levels. This preliminary study analyzed associations between depressive symptoms, physical fatigue, and physical activity in chronic stroke patients.
Methods: A preliminary cross-sectional study was conducted from January to May 2025 involving chronic stroke outpatients (?6 months) with Brunnstrom stage IV–V and MoCA-Ina ?24. Depression was assessed using the Indonesian-validated DASS-21, fatigue using the Fatigue Severity Scale (FSS), and physical activity using the Global Physical Activity Questionnaire (GPAQ). Mann–Whitney U tests compared low versus moderate activity groups, and Spearman’s rho evaluated correlations (?=0.05).
Results: Fatigue scores were higher in the low-activity group (34.8 ± 13.10) compared with the moderate-activity group (20.2 ± 6.64), showing a trend toward significance (p = 0.057). Depression scores did not differ between groups (p = 0.532). Spearman’s analysis showed a moderate negative trend between fatigue and activity (rho = -0.592, p = 0.071), while depression demonstrated a weak non-significant association (rho=-0.073, p=0.841).
Conclusions: Physical fatigue showed a stronger trend toward lower activity levels than depressive symptoms, although associations were not statistically significant. Larger, adequately powered studies are needed to clarify these relationships.
Keywords : Brunnstorm, Chronic, Depression, Fatigue, GPAQ, Physical, Rehabilitation, Stroke
Introduction: Depression and fatigue are common sequelae among chronic stroke survivors and may influence their physical activity levels. This preliminary study analyzed associations between depressive symptoms, physical fatigue, and physical activity in chronic stroke patients.
Methods: A preliminary cross-sectional study was conducted from January to May 2025 involving chronic stroke outpatients (?6 months) with Brunnstrom stage IV–V and MoCA-Ina ?24. Depression was assessed using the Indonesian-validated DASS-21, fatigue using the Fatigue Severity Scale (FSS), and physical activity using the Global Physical Activity Questionnaire (GPAQ). Mann–Whitney U tests compared low versus moderate activity groups, and Spearman’s rho evaluated correlations (?=0.05).
Results: Fatigue scores were higher in the low-activity group (34.8 ± 13.10) compared with the moderate-activity group (20.2 ± 6.64), showing a trend toward significance (p = 0.057). Depression scores did not differ between groups (p = 0.532). Spearman’s analysis showed a moderate negative trend between fatigue and activity (rho = -0.592, p = 0.071), while depression demonstrated a weak non-significant association (rho=-0.073, p=0.841).
Conclusions: Physical fatigue showed a stronger trend toward lower activity levels than depressive symptoms, although associations were not statistically significant. Larger, adequately powered studies are needed to clarify these relationships.
Keywords : Brunnstorm, Chronic, Depression, Fatigue, GPAQ, Physical, Rehabilitation, Stroke
Article Details
How to Cite
Saraswati, D., Novitri, Farida , A., Sungkar, E., & Prananta, M. S. (2025). A Preliminary Analysis of Fatigue and Depressive Symptoms in Relation to Physical Activity Among Chronic Stroke Survivors. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 203 - 207. https://doi.org/10.36803/indojpmr.v14i2.528
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Original Article
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References
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2. Ghosh PA, Chaudhury S, Rohatgi S. Assessment of Depression, Anxiety, Stress, Quality of Life, and Fatigue in Patients After a Cerebrovascular Accident. Cureus. 2024;16(10):e71845.
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5. van der Zee CH, Visser-Meily JM, Lindeman E, et al. Post-stroke fatigue and its impact on activities of daily living. Disabil Rehabil. 2013;35(8):676-81.
6. Douven E, Schieveen J, Staals J, et al. Fatigue, depression, and apathy after stroke: A longitudinal study. J Psychosom Res. 2017;96:83-9.
7. Alghamdi I, et al. Prevalence of fatigue after stroke: a systematic review and meta-analysis. Eur Stroke J. 2021;6(6):XX-XX. PMCID: PMC8948505.
8. Usman JS, Gbiri CAO, Mogaji EO, et al. Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis. Front Neurol. 2024;15:1420443.
9. Juárez-Belaúnde A, Soto-León V, Dileone M, et al. Early post-stroke clinically significant fatigue predicts functional independence: a prospective longitudinal study. Front Neurol. 2024;15:XX-XX. PMCID: PMC11197430.
10. Kuppuswamy A, Billinger S, Coupland K, et al. Mechanisms of post-stroke fatigue: follow-up from the 3rd Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2024;38(1):52-61.
11. Widjaja J, Musrifah A, Santoso D. Hubungan kualitas tidur dengan kelelahan pasca-stroke di Makassar. J Kesehat Masyarakat. 2022;10(2):45-52
12. Thilarajah S, Mentiplay BF, Bower KJ, et al. Factors associated with physical activity levels in chronic stroke survivors. Stroke. 2018;49(6):1438-45.
13. Pratiwi A, Susanti R, Hidayati N. Beban pengasuh dan dampaknya terhadap depresi pasca-stroke di Indonesia. J Keperawatan Indones. 2021;14(1):23-30.
14. Kusec A, Milosevic J, Murphy KJ, et al. Impact of sample size on detecting statistical significance in post-stroke fatigue studies. Brain Impair. 2020;21(2):165-73.
15. Kaloeti DVS, Ifdil I, et al. Validation and psychometric properties of the Indonesian DASS-21. BMC Psychiatry. 2021;21:XX-XX. PMCID: PMC8197682.
16. de Diego-Alonso C, et al. Validity and stability of the IPAQ in stroke survivors. Top Stroke Rehabil. 2025;Epub ahead of print. PMID: 39436814.
17. Ribeiro M, et al. Reliability and validity of the Global Physical Activity Questionnaire (GPAQ) for MVPA and sedentary behavior. Percept Mot Skills. 2024; Epub ahead of print.
18. Li Y, Zhang X, Chen G. Sample size considerations in stroke rehabilitation studies: A meta-analysis. Arch Phys Med Rehabil. 2021;102(4):765-72.
19. Ymer L, Gard G, et al. Cognitive-behavioural therapy for post-stroke fatigue and sleep disturbance: a pilot randomized controlled trial. J Rehabil Med. 2025;Epub ahead of print.
20. Sari N, Dewi R, Santoso A. Pentingnya skrining kelelahan pasca-stroke dalam manajemen rehabilitasi. J Rehabilitasi Medik Indones. 2022;11(1):34-41.
21. Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009;6(6):790-804.
22. Duncan F, Wu S, Mead GE. Frequency and natural history of fatigue after stroke: A systematic review of longitudinal studies. J Psychosom Res. 2012;73(6):18-27.
23. Tang WK, Chen YK, Lam WW, et al. Cerebral metabolic correlates of poststroke fatigue. J Neurol. 2022;269(3):1456-64.
24. Jones K, et al. Fatigue After Stroke Educational Recovery (FASTER): a group-based educational intervention for PSF. J Am Heart Assoc. 2025;Epub ahead of print.
25. Yudhi P, Rahayu S, Pratama D. Program rehabilitasi berbasis komunitas untuk pasien stroke kronis di Indonesia. J Kesehat Komunitas. 2023;8(2):89-97.
2. Ghosh PA, Chaudhury S, Rohatgi S. Assessment of Depression, Anxiety, Stress, Quality of Life, and Fatigue in Patients After a Cerebrovascular Accident. Cureus. 2024;16(10):e71845.
3. Feigin VL, et al. Global, regional, and national burden of stroke, 1990–2021. Lancet Neurol. 2024;23(1):34-45.
4. Sari R, Nugroho DA, Pratama Y. Prevalensi depresi pada pasien stroke di rumah sakit umum: Studi observasional di Indonesia. J Kedokteran Indones. 2023;12(3):112-9.
5. van der Zee CH, Visser-Meily JM, Lindeman E, et al. Post-stroke fatigue and its impact on activities of daily living. Disabil Rehabil. 2013;35(8):676-81.
6. Douven E, Schieveen J, Staals J, et al. Fatigue, depression, and apathy after stroke: A longitudinal study. J Psychosom Res. 2017;96:83-9.
7. Alghamdi I, et al. Prevalence of fatigue after stroke: a systematic review and meta-analysis. Eur Stroke J. 2021;6(6):XX-XX. PMCID: PMC8948505.
8. Usman JS, Gbiri CAO, Mogaji EO, et al. Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis. Front Neurol. 2024;15:1420443.
9. Juárez-Belaúnde A, Soto-León V, Dileone M, et al. Early post-stroke clinically significant fatigue predicts functional independence: a prospective longitudinal study. Front Neurol. 2024;15:XX-XX. PMCID: PMC11197430.
10. Kuppuswamy A, Billinger S, Coupland K, et al. Mechanisms of post-stroke fatigue: follow-up from the 3rd Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2024;38(1):52-61.
11. Widjaja J, Musrifah A, Santoso D. Hubungan kualitas tidur dengan kelelahan pasca-stroke di Makassar. J Kesehat Masyarakat. 2022;10(2):45-52
12. Thilarajah S, Mentiplay BF, Bower KJ, et al. Factors associated with physical activity levels in chronic stroke survivors. Stroke. 2018;49(6):1438-45.
13. Pratiwi A, Susanti R, Hidayati N. Beban pengasuh dan dampaknya terhadap depresi pasca-stroke di Indonesia. J Keperawatan Indones. 2021;14(1):23-30.
14. Kusec A, Milosevic J, Murphy KJ, et al. Impact of sample size on detecting statistical significance in post-stroke fatigue studies. Brain Impair. 2020;21(2):165-73.
15. Kaloeti DVS, Ifdil I, et al. Validation and psychometric properties of the Indonesian DASS-21. BMC Psychiatry. 2021;21:XX-XX. PMCID: PMC8197682.
16. de Diego-Alonso C, et al. Validity and stability of the IPAQ in stroke survivors. Top Stroke Rehabil. 2025;Epub ahead of print. PMID: 39436814.
17. Ribeiro M, et al. Reliability and validity of the Global Physical Activity Questionnaire (GPAQ) for MVPA and sedentary behavior. Percept Mot Skills. 2024; Epub ahead of print.
18. Li Y, Zhang X, Chen G. Sample size considerations in stroke rehabilitation studies: A meta-analysis. Arch Phys Med Rehabil. 2021;102(4):765-72.
19. Ymer L, Gard G, et al. Cognitive-behavioural therapy for post-stroke fatigue and sleep disturbance: a pilot randomized controlled trial. J Rehabil Med. 2025;Epub ahead of print.
20. Sari N, Dewi R, Santoso A. Pentingnya skrining kelelahan pasca-stroke dalam manajemen rehabilitasi. J Rehabilitasi Medik Indones. 2022;11(1):34-41.
21. Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009;6(6):790-804.
22. Duncan F, Wu S, Mead GE. Frequency and natural history of fatigue after stroke: A systematic review of longitudinal studies. J Psychosom Res. 2012;73(6):18-27.
23. Tang WK, Chen YK, Lam WW, et al. Cerebral metabolic correlates of poststroke fatigue. J Neurol. 2022;269(3):1456-64.
24. Jones K, et al. Fatigue After Stroke Educational Recovery (FASTER): a group-based educational intervention for PSF. J Am Heart Assoc. 2025;Epub ahead of print.
25. Yudhi P, Rahayu S, Pratama D. Program rehabilitasi berbasis komunitas untuk pasien stroke kronis di Indonesia. J Kesehat Komunitas. 2023;8(2):89-97.