Fatigue, Sleep Disturbance, and Depression Symptom Cluster Among Sub-Acute Stroke Patients: A Correlational Study

Abstract This study aimed to investigate the correlation between fatigue, sleep disturbance, and depressive symptoms as a symptom cluster, and their association with mobility limitations in subacute stroke patients. These symptoms often co-exist and may interact synergistically, worsening functional outcomes. Early identification and comprehensive management of this psychoneurological symptom cluster are essential to improve mobility outcomes and enhance active participation in rehabilitation. A cross-sectional correlational study was conducted on 35 subacute stroke patients aged 35 to 65 years, using purposive sampling at MGM Physiotherapy and Rehabilitation Centre and other hospitals in Chhatrapati Sambhajinagar. Standardized tools including the Fatigue Assessment Scale, Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, Modified Barthel Index, and Timed Up and Go test were used. Statistical analysis was performed using Pearson/Spearman correlation, selected based on data normality, and mediation and moderation analysis via SPSS version 23.0. The study revealed a strong positive correlation between fatigue, sleep disturbance, and depression. Fatigue showed a significant negative correlation with mobility (r = − 0.64, p < 0.001), while sleep disturbance and depression also demonstrated strong negative associations with mobility. Mediation analysis revealed that depression significantly mediated the relationship between fatigue and mobility (indirect effect: β = − 1.46, 95% confidence interval: − 2.40 to − 0.78), indicating that fatigue may influence mobility limitations through depressive symptoms. On the other hand, moderation analysis found no significant influence of age, gender, stroke severity, comorbidities, or occupation. The study found a strong, statistically significant association between the symptom cluster of fatigue, sleep disturbance, and depression as a whole with mobility limitations in subacute stroke patients. Sleep disturbance and depression showed the strongest association with reduced mobility. The current study findings underscore the significance of routine screening for this symptom cluster as a whole and incorporating integrated psychosocial interventions into Indian stroke rehabilitation to optimize mobility outcomes.