Prevalence of Swallowing-Related Fatigue and Its Association With Self-Perceived Swallowing Impairments Across Phases of Stroke, Site of Lesion, and Stroke Severity

PURPOSE: This study examined the prevalence of swallowing-related fatigue in individuals with stroke and its association with self-perceived swallowing difficulties. It also explored differences across stroke phases, lesion sites, and severity levels, and examined the association between the Swallowing and Eating-Related Fatigue Scale (SERF) scores and self-reported dysphagia risk (Eating Assessment Tool [EAT-10], Dysphagia Handicap Index [DHI]). METHOD: A cross-sectional study was conducted with 170 poststroke adults (120 men, 50 women) recruited at a tertiary care hospital. Participants were categorized into early subacute, late subacute, and chronic phases. Stroke severity was measured using the National Institutes of Health Stroke Scale, and lesion site was determined from radiological reports. Swallowing fatigue was assessed using the SERF scale, general fatigue with the Fatigue Severity Scale, and self-reported swallowing difficulties with the EAT-10 and DHI. Analyses included chi-square test, Spearman correlations, Kruskal-Wallis with post hoc comparisons, and logistic regression. RESULTS: Swallowing-related fatigue was most prevalent in the early subacute phase (92%), among individuals with brainstem lesions (84%), and in those with greater stroke severity (72.7%). SERF scores strongly correlated with EAT-10 and DHI, indicating an association with both functional swallowing impairments and psychosocial handicap. Logistic regression identified stroke phase as a significant predictor, with lower prevalence in later phases. CONCLUSIONS: Swallowing-related fatigue emerges as a notable and unique complication of stroke, especially prominent in early recovery and among individuals with brainstem involvement. Incorporating the SERF scale into routine assessment may enable early identification of patients at risk of reduced mealtime endurance and guide targeted rehabilitation.