Abstract 3684: Post-Stroke Fatigue: A Systematic Evidence-Based Critique
Background: Post-stroke fatigue (PSF) is common and manifests as both a physical and mental lack of energy not ameliorated by rest. Studies suggest fatigue has a significant impact on patients’ functioning and dependency, interfering with rehabilitation.
Objectives: to identify (a) gaps in PSF understanding and (b) areas of consensus and recommendations.
Methods: A repetitive search study in PubMed and EMBASE using pre-specified medical subjects heading (MeSH) terms, Boolean logic, and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. All identified publications were screened for inclusion using the following criteria: 1) all relevant randomized controlled trials (RCTs), prospective, retrospective, cross-sectional, cohort and case-control studies; 2) studies providing a pre-specified definition of PSF; and 3) a sample size of at least 10 patients. Additional references were identified from bibliographies of pertinent articles. All languages were included. Uncontrolled case-series were excluded.
Results: 414 publications were retrieved, 221 were duplicates, and 14 related references through bibliographies. A total of 207 abstracts were reviewed by at least 2 independent reviewers for relevance; 63 publications met inclusion criteria and were included. Twenty-four different fatigue scales were used to measure PSF. Only 13 (21%) studies used validated scales and 16 (25%) studies used the non-validated Fatigue Severity Scale (FSS). The prevalence of PSF ranged from 10% to 74%, depending on the fatigue scale used and study population. Independent predictors of PSF included: acute striatal infarct (n=1 study), motor control (n=1), falls efficacy (n=1), peak oxygen uptake (n=1), higher geriatric depression scale score (n=1), depression (n=2), younger age (n=1), infratentorial stroke (n=1), female sex (n=1), and declined mobility (n=1). PSF was an independent predictor of mortality (n=2), long-term morbidity (n=1), reduced health-related quality of life (n=1), institutional placement (n=1), dependency on activities of daily living (n=1), and post-stroke depression (n=1). PSF was associated with the biomarkers C-reactive protein (n=1), and IL-1β, IL1-ra, and IL-9 (n=1). Suggested PSF therapeutic strategies included exercising, assistive technologies, and cognitive behavioral therapy. A RCT found a small benefit from modanifil treatment.
Conclusion: Current research on the predictors of PSF is difficult to interpret because relatively few studies used validated scales combined with a large heterogeneity of PSF definitions. Treating PSF remains a clinical challenge without valid evidence from RCTs. The interplay between PSF and other associated factors as well as specific treatment approaches require further study.
- © 2012 by American Heart Association, Inc.