Post-Stroke Fatigue: Common but Poorly Understood

Abstract

Fatigue is experienced by the majority of stroke survivors and often persists even after other symptoms of stroke have resolved. Post-stroke fatigue has important negative effects on a person's quality of life and their social connectedness. The research literature on post-stroke fatigue is still in its infancy, and our understanding of why it develops is based more on potential associates than defi nitive causal explanations. The factors most strongly associated with fatigue after stroke include physical disability and depression, but there are many other potential contributors. Fatigue is multi-dimensional, and any explanatory model must include a wide range of contributing factors, many of which have bi-directional associations with fatigue. Several interventions aimed at reducing post-stroke fatigue have been trialled in small-scale studies, with only limited success. There is great scope for improvements in treatment. Many factors that are relevant to fatigue are modifi able (e.g., sleep quality, physical activity levels), and there are lessons to be learned from approaches used in other models of fatigue (e.g., multiple sclerosis, cancer). Before we can hope to identify effective interventions, however, we need a more detailed understanding of not only why fatigue occurs after stroke, but also why it persists.

Non-pharmacological interventions for the treatment of post-stroke fatigue: A systematic review

“…In total, 13 completed trials (two from pre-2014 and 11 from post-2014) 12 –24 and 13 on-going trials were eligible for inclusion (Figure 1). 25 –37…”

“…28 Three trials aim to deliver psychological interventions, encompassing education, 29 CBT, 30 and communication therapy. 31 Five trials aim to evaluate physical interventions, including standardized physical activity programs, focusing on aerobic, 32 and interval training respectively, 33 or with personalization through motivational interviewing, 34 or using the Stroke Exercise Preference Inventory; 35 one trial aims to evaluate a unique “health extremity” training intervention. 36 Only one trial will investigate a non-pharmacological Chinese medicine, namely, cupping.…”

“…In total, 13 completed trials (two from pre-2014 and 11 from post-2014) [12][13][14][15][16][17][18][19][20][21][22][23][24] and 13 on-going trials were eligible for inclusion (Figure 1). [25][26][27][28][29][30][31][32][33][34][35][36][37]…”

“…Thirteen unpublished trials were found (Appendix 4). [25][26][27][28][29][30][31][32][33][34][35][36][37] All trials are parallel RCTs except one, which is designed as a cluster RCT. 25 Four trials are investigating transcranial stimulation, three using tDCS, [25][26][27] and one using magnetic stimulation.…”