Development of the Fatigue Interference and Severity Scale for Aphasia.

Purpose: Poststroke fatigue, which is characterized by an overwhelming feeling of exhaustion that affects daily life, is prevalent among stroke survivors and can negatively affect cognition, motor function, employment, life participation, and quality of life. However, individuals with aphasia are often excluded from fatigue studies because of communication barriers, leading to underdiagnosis and an inaccurate picture of the occurrence and impact of poststroke fatigue in persons with aphasia.

Method: This study aimed to develop a more aphasia-accessible tool that would be similar to the Fatigue Severity Scale (FSS), a self-reported fatigue measure commonly used to identify significant poststroke fatigue. The Fatigue Interference and Severity Scale for Aphasia (FISS-A) was developed using a modified nominal group technique involving two focus groups: individuals with aphasia and speech-language pathologists. The groups provided feedback on the format, wording, administration, and response methods of the FSS. Focus group feedback led to several key recommendations, including simplifying language, increasing text spacing and font size, incorporating images, and enabling nonverbal responses.

Results: The FISS-A retains the original nine items of the FSS but presents them with lexical and syntactic modifications to enhance clarity and comprehensibility for individuals with aphasia. Visual aids and explicit instructions for providers were added to ensure an accurate administration and response collection. An additional open-ended item was included to capture any fatigue-related symptoms that were not covered by the standard items, and two visual analog scales were added to collect additional ratings of general fatigue severity and its impact on language ability.

Conclusions: This study highlights the importance of creating accessible assessment tools for clinical and research purposes. Future research will focus on validating the FISS-A across diverse populations and exploring its integration into clinical practice.