記住我
LETTER TO EDITOR
Year : 2021 | Volume
: 10
| Issue : 2 | Page : 182-183
Severity of fatigue among patients with Guillain–Barre syndrome
Uma Krishnan Namboodhri, Renukadevi Mahadevan, Tejaswini Santhosh
Department of Physiotherapy, JSS College of Physiotherapy, Mysore, Karnataka, India
Correspondence Address:
Dr. Renukadevi Mahadevan
JSS College of Physiotherapy, MG Road, Mysore, Karnataka
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijhas.IJHAS_246_20
Sir,
The management of patient with Guillain–Barre syndrome (GBS) is challenging.[1] Physiotherapists treat patients with GBS starting from intensive care unit (ICU). Management starts from the time the patient is on ventilator support. Most of the patients are conscious even when they have bulbar palsy, and they stay on the weaning mode for prolonged duration. Weaning is challenging, as their work of breathing increases if the muscles have no or less strength. When performing breathing exercises or active exercises, fatigue sets in, and they are unable to do it for more repetitions, this may increase the length of stay in ICU and hospital. After shifting to ward, and once discharged, they have the urge to get better soon and want to improve their functional capacity, but they cannot perform as muscular fatigue sets in and hinder the exercise intervention. Therefore, the management is being modified, and a proper assessment of fatigue seems to be very important to know the extent of fatigue to prescribe the exercises.
Systematic reviews show that the incidence rate of GBS is 1.1–1.8/100,000 in adults, and in children, it is about 0.34–1.34/100,000, and after 50 years of age, the incidence rate increased to 1.7–3.3 per 100,000. The prevalence of fatigue in GBS is well documented (80%). The severity of fatigue may vary[2] at each grade of Hughes disability scale (HDS), which is not clear. Therefore, the purpose of the study is to profile the severity of fatigue among patients with GBS in Grades 2-4 HDS using fatigue severity scale.
It was an observational cross-sectional study design and convenience sampling. Patients who were admitted in JSS hospital with a diagnosis of GBS and who attended physiotherapy outpatient department (OPD) for treatment with the score of 2–4 on HDS were recruited. Complete enumeration of available samples of 4-month duration was included.
The following criteria for inclusion were considered to recruit participants. The inclusion criteria were men and women who were able to understand the questionnaire in Kannada or English, who were diagnosed with GBS with <1-year duration, who were bed/chair bound, and those who were able to walk 5 m with aid or independently (Grades 2-4 of HDS). The exclusion criterion was patients who had comorbidities such as respiratory failure, autonomic dysfunction, thromboembolic disease, pain, and psychiatric disorders.
Ethical approval was obtained and informed consent was taken from patients and patient attenders. Patients were recruited from the records of the hospital and physiotherapy OPD. Fatigue score of more than 36 is considered as more severe and score <36 is less severe. Descriptive statistics is represented below as tables for analysis.
The results showed that the severity of fatigue on Grade 4 of HDS was 67%. The study supported one of the studies done by Mohamed A Alzaidi . which stated that demyelination lesions are scattered and decrease the myelinating fiber density and induce changes in nerve conduction velocity that causes conduction blocks of central axons in Grade 4, which could lead to fatigue in his study.[3],[4]
On Grade 3 of HDS, the patients were using assistive devices for ambulation. The severity of fatigue was 43%. Rekand et al. showed that muscle weakness was present in patients with GBS and resulted in using assistive devices in Grade 3. Muscle weakness influences the risk of fatigue among GBS patients.[5] Systematic review done by Souza, et al. showed that assistive devices can minimize the interface between the human and device, which only requires low energy expenditure. Aids reduce the amount of effort as the person tries. This could be the reason that 57% of the patient had less severity.[6]
The severity of fatigue on Grade 2 of HDS was 25%. Studies documented that in Grade 2 of HDS, patients begin to recover muscle strength and increase in the endurance.[7] Hence, fatigue among patients with GBS at Grade 2 is less severe. Slight fatigue is felt even at Grade 2 HDS. The cause of fatigue is due to axonal damage and previous history of infection.[8] The participants in Grade 2 of HDS in this study were very less, and the duration of their disease was >6 months, which could be the reason for 75% recovery.
From the results, of this study, we can infer that fatigue could be a barrier to rehabilitation and expected outcomes. Hence, assessment of patients with GBS should compulsory include fatigue to plan meaningful interventions.
The patients with Grade 4 of HDS had more severe fatigue than patients with Grades 3 and 2 of HDS. Severity of fatigue was more among patients with 1–3-month duration of disease (89%) and less severe among patients with 4–6-month duration of disease (11%). Therefore, the exercise schedule for the patients with Grade 4 and with duration of disease <3 months has to be implemented with caution, having different work-rest regimen.
Acknowledgment
I thank my colleague Mr Prashanth VM, Hospital Management and the Department of neurology for their support.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
留言 (0)