22. European Stroke Conference 2043 Stroke care problems Fatigue and the Energy Expenditure of Gait Post-Stroke H. Kavanagh1, N. Murphy2, J.A. Harbison3, J.M. Hussey4 St. James’ Hospital & Trinity College Dublin, Dublin, IRELAND1, St. James’ Hospital, Dublin, IRELAND2, Trinity College Dublin & St. James’ Hospital, Dublin, IRELAND3, Trinity College Dublin, Dublin, IRELAND4 Background: Fatigue is a common and distressing symptom of stroke1. It has been demonstrated that many stroke survivors are profoundly deconditioned and have an inefficient, energy-consuming gait2. This study aimed to compare fatigue levels and the energy expenditure (EE) of gait in a co-hort of subjects with stroke with matched healthy controls and to determine if there was a relation-ship between fatigue and EE in subjects with stroke. Methods: A sample of independently mobile subjects with stroke participated. Matched controls were recruited for those who completed treadmill testing. Fatigue was measured using the Fatigue Assessment Scale (FAS) and Fatigue Severity Scale (FSS). EE was determined by measuring oxy-gen consumption (VO2) and heart rate (HR) with a portable gas analyser during two treadmill tests at standardised speeds. Results: Of fourteen subjects with stroke, 11 completed at least one treadmill test (mean age 65.0±10.9 years, mean time since stroke 13.2±7.3 months). Mean FAS and FSS scores for these subjects were 23.4±5.1 and 4.0±1.7 respectively. Subjects with stroke had significantly higher fa-tigue scores compared with controls (FAS p<0.001, FSS p=0.003). Only 50% of subjects with stroke were able to complete both treadmill tests. VO2 and HR were high in both groups (see Table 1). There was no significant difference in EE between groups during either treadmill test. No rela-tionship was found between fatigue scores and EE. Conclusion: This study provides support for the concept of a primary post-stroke fatigue (PSF) which can occur even in those who have made a good functional recovery. However, no relation-ship was found between PSF and the EE of gait. Further research is required to understand the fac-tors which are associated with PSF before targeted interventions can be developed. 1. Lerdal A, Bakken LN, Kouwenhoven SE, Pedersen G, Kirkevold M, Finset A, et al. Poststroke fa-tigue-- a review. J Pain Symptom Manage. 2009;38(6):928-49. 2. Ivey FM, Macko RF, Ryan AS, Hafer-Macko CE. Cardiovascular health and fitness after stroke. Top Stroke Rehabil. 2005;12(1):1-16. Fatigue and the Energy Expenditure of Gait Post-Stroke Table 1: Energy Expenditure Results Treadmill Test A (1.5km/ hr) Treadmill Test B (3.0km/ 218 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting hr) Subjects with stroke (n=11) Matched controls Subjects with stroke (n=7) Matched controls VO2, ml/kg/ min 11.5±3.1 10.3±2.6 13.4±3.4 13.8±3.7 % HR Max-imum 62.8%±11.2 54.0%±9.0 60.9%±15.5 62.7%±12.1 2044 Management of diabetes, hypertension and inflammation Best feet forward: improving foot care of stroke patients with diabetes I. De Sousa1, A. Amorim2, J. Slark3 Imperial College Healthcare NHS Trust, London, UNITED KINGDOM1, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM2, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM3 Background: Diabetes is a condition in crescendo and a major risk factor for stroke. Impairment caused by stroke can put patients with diabetes at increased risk of developing foot problems. The aim of this study is to understand how HASU (Hyper-Acute Stroke Unit) nurses perceive the impor-tance of foot care and its key care aspects. Methods: All stroke patients with diabetes admitted in our institution during the months of October and November 2012 were included in a retrospective audit of medical notes of patients, using an audit tool produced for this purpose. We excluded those who had received care from any of the re-searchers. Results: Seventeen patients were included. Foot inspection was documented in 2 of 17 patients (11,8%) but not from a HASU nurse. No data could be found on foot education provided to the stroke patient. Four of 17 patients (23,5%) were referred to the Diabetes Specialist Nurse using the diabetes assessment tool, all due to persistent hyperglycaemia. However, analysis showed that 13 of 17 patients (76,5%) should have been referred for the same reason. Lesion of stroke and ability of patient to self-care was never documented by HASU nurses. Never-theless, in 1 of the 4 referrals (25%) made, the assessment also highlighted a significant education needed for that patient. Conclusion: Foot care for the stroke patient with diabetes is not taken into consideration in the ini-tial assessment done by HASU nurses. Glycaemic control takes over the more holistic care approach that is needed to prevent amputations, reduce costs and improve quality of life for these patients. However, hyperglycaemia in acute stroke is still challenging.
Karger_ESC London_2013
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