Fatigue, Social Reintegration, and Quality of Life after Stroke in Sialkot: Beyond Mobility

Abstract

Background: Post-stroke fatigue is a pervasive and disabling symptom that significantly affects quality of life (QoL) and social reintegration, yet it often remains underrecognized in rehabilitation programs focused primarily on physical recovery. Its impact may be particularly profound in low-resource settings where structured post-stroke care is limited. Objective: This study aimed to examine the relationship between fatigue severity and reintegration to normal living among stroke survivors in Sialkot, Pakistan, while assessing whether this association is independent of gait performance measures. Methods: A cross-sectional study was conducted among 100 post-stroke survivors and 100 age- and sex-matched community controls recruited from five tertiary hospitals. Fatigue was assessed using the Fatigue Severity Scale (FSS), reintegration using the Reintegration to Normal Living Index (RNLI), and gait performance using the Timed Up and Go (TUG) test, gait speed, and cadence. Data were analyzed using Pearson correlation and multivariate regression to identify independent predictors of reintegration, with adjustments for demographic and clinical confounders. Results: Stroke survivors exhibited significantly higher fatigue (FSS 5.78 ± 1.28 vs. 3.58 ± 0.95; p < 0.001) and lower reintegration (RNLI 28.35 ± 16.39 vs. 75.73 ± 11.88; p < 0.001). Fatigue severity independently predicted poorer reintegration (β = −0.29, p = 0.003) after adjusting for mobility and socioeconomic factors. Conclusion: Fatigue exerts a substantial, independent influence on post-stroke reintegration and QoL, underscoring the need for fatigue-focused rehabilitation strategies that extend beyond gait recovery.