Cognitive and Graded Activity Training Can Alleviate Persistent Fatigue After Stroke

Abstract

Background and Purpose-Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention. Methods-This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (Ͼ4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength-subscale Fatigue (CIS-f); self-observation list-fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up). Results-The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: p

Neuropsychiatric outcomes of stroke

“…56 A Cochrane review of 3 small randomised trials (142 people) which included fatigue as an outcome measure found no effective preventative or treatment strategies . 57 One subsequent trial (n=83) without a control arm showed that treadmill aerobic training and cognitive behavioural therapy (CBT) together was better than CBT alone to treat post-stroke fatigue, 58 A small trial (n=19) demonstrated that group education was a feasible treatment. 59 Screening for fatigue is not currently recommended in guidelines.…”

Inflammation and the Silent Sequelae of Stroke

“…Modafinil, which is approved for the treatment of fatigue in shift workers and patients with MS, failed to improve the Multi-dimensional Fatigue Inventory-20 score in a relatively small randomized controlled trial of patients with stroke, although it did have an effect on some secondary endpoints [123]. Cognitive therapy with graded activity training, however, was associated with a decrease in PSF [124]. (As mentioned previously, exercise and fitness training lead to a reduction in circulating proinflammatory cytokines [125][126][127].)…”

Poststroke Fatigue Is Still a Neglected Issue: Findings from an Internet-Based Study on the Need for Information and Treatment in The Netherlands

“…Furthermore, PSF has been found to have a negative effect on quality of life [2,10], rehabilitation outcomes [11], and even mortality [12][13][14]. However, PSF is often misdiagnosed [11,15,16] and evidence-based clinical guidelines for dealing with PSF are scarce [17,18].…”

“…Although no uniform definition of PSF exists, it is generally defined as "a subjective experience of extreme and persistent tiredness, weakness, or exhaustion after stroke, which can present itself mentally, physically or both and which is unrelated to previous exertion levels" [18,27]. Since this definition is intrinsically subjective and no derivative assessment tools have been specifically constructed for patients with stroke, a large variety of fatigue rating scales have been used in research and clinical practice [20,28].…”

“…They want to understand their experience of fatigue and have it diagnosed or explained so that they are less overwhelmed by it and know what to do about it [15]. Studies on the treatment of fatigue in patients with stroke and in patients with other neurological disease suggest that patient education, teaching energy conservation strategies, and graded activity training can be helpful in the management of fatigue [18,32,33].…”