Fatigue is a problem for many of those who survive a stroke and effective interventions would bring benefits to millions of people around the world. An updated Cochrane Review in July 2015 looks at the research that has been done and Simiao Wu, from the West China Hospital at Chengdu in China, who is currently at the Centre for Clinical Brain Sciences in the University of Edinburgh in Scotland, tells us what they found.
John: Fatigue is a problem for many of those who survive a stroke and effective interventions would bring benefits to millions of people around the world. An updated Cochrane Review in July 2015 looks at the research that has been done and Simiao Wu, from the West China Hospital at Chengdu in China, who is currently at the Centre for Clinical Brain Sciences in the University of Edinburgh in Scotland, tells us what they found.
Simiao: Post-stroke fatigue is a common and serious problem that affects more than one third of stroke survivors. It often persists for some time even after other symptoms have resolved. Fatigue impedes patients’ participation in daily activities and has negative impacts on their quality of life. However, for a long time, there was almost no evidence to inform its treatment. The previous version of our Cochrane Review, in 2009, was only able to include three trials, none of which was specifically designed for post-stroke fatigue. However, over the last decade, more researchers and clinicians became interested in this topic and we were aware that several new interventions had been tested. So, we conducted this update in the hope of providing some new evidence; and although we have been able to do so, many uncertainties remain.
We used broad searches with the aim of identifying any intervention that might prevent or improve post-stroke fatigue, even if fatigue was not the primary target of the intervention. We found nine new studies. Of the 12 trials now in the review, none was aimed to prevent fatigue after stroke. Four trials were primarily intended to treat symptoms other than fatigue, but reported fatigue as an outcome. They tested anti-depressants, tirilazad mesylate, continuous positive airway pressure for sleep apnoea, and a self-management programme for stroke recovery; none of these interventions showed any benefit on post-stroke fatigue.
The other eight trials were specifically designed to treat post-stroke fatigue, and each tested a different intervention. These included anti-depressants and psychostimulants, psychological interventions, physical training, traditional Chinese medicine, and vitamin B supplementation. Of these interventions, only Chinese herbs and vitamin B supplementation showed a significant benefit for post-stroke fatigue, but both of these had been studied in small trials that had some methodological limitations. Therefore, larger randomised trials are needed to confirm whether these interventions are really effective. None of the other six trials showed any evidence of efficacy, but this does not mean that these interventions are useless. This is because all the trials were very small, with the largest having only 128 participants.
In conclusion, we are not surprised that there is still insufficient evidence to inform the clinical management of post-stroke fatigue, because the research is still in its infancy but is becoming more common. For example, we have identified nine ongoing trials, testing psychostimulants, psychological interventions, physical training, and Chinese herbs. The diversity of interventions reflects the multidimensional nature of post-stroke fatigue, which may involve interactions of various biological, psychological and behavioural factors. It will take a few more years before we have clear answers on how best to prevent and treat post-stroke fatigue.
John: If you would like to read more about the interventions that could be included in this new Cochrane Review and to see details of the ongoing trials, simply visit Cochrane library dot com and search 'post stroke fatigue'.