Survivors don't care about useless predictions. They want fatigue solved. GET THERE!
At least half of all stroke survivors experience fatigue
Or is it 70%?
Or is it 40%?
Whom is solving that problem?
Prevalence of fatigue after stroke: A systematic review and meta-analysis
Abstract
Background and Purpose
Post-stroke fatigue is a debilitating and long-lasting condition. However, there are uncertainties regarding its prevalence and variability between studies. This review aims to estimate the prevalence of fatigue and determine the factors responsible for its variation in the literature.
Methods
A systematic review was conducted for all published studies (search to November 2020) using AMED, CINAHL, EMBASE, MEDLINE, PsycINFO, SCOPUS and Web of Science. Papers were included if they recruited participants with stroke, used a validated scale to measure fatigue and were in English. Two reviewers screened and assessed the relevant studies for eligibility (n = 96). The included papers were appraised using the Joanna Briggs Institute (JBI) tool for prevalence studies, and data were extracted by one reviewer. To understand the variation in PSF prevalence between papers, data were pooled and analysed based on relevant methodological (e.g. time of assessment) or clinical factors (e.g. depression) using Review Manager 5.4 software.
Results
While 48 studies were included and summarised (N = 9004), only 35 were appropriate for the meta-analysis (N = 6851). The most frequently used tool to measure fatigue was the Fatigue Severity Scale (FSS) (n = 31). The prevalence was calculated with a cut-off point of four or more using FSS and resulted in an estimate of 48% (95% CI 42–53%). Time of assessment (<6 vs ≥6 months), stroke type (ischaemic vs haemorrhagic/subarachnoid haemorrhage) and geographical location (East Asia vs Europe) could explain the prevalence variation between studies.
Conclusions
Fatigue is prevalent among stroke survivors. This condition varies in terms of occurrence between studies; however, time of assessment, stroke type and geographical location might explain this variation. As this review estimates the overall burden of fatigue after stroke, it provides a useful indicator to inform policy, planning and healthcare professionals. Further efforts are required to investigate the mechanisms that lead to PSF, particularly in the groups that show high prevalence, in order to prevent or alleviate it.
Introduction
Stroke has many complications, one of which is fatigue. A recent scoping review reported that fatigue is one of the commonest secondary conditions among stroke survivors.1 It has also been ranked as one of the top research priorities in the United Kingdom.2 Although there is no consensus on its definition, a practical one is ‘a sensation of exhaustion during or after usual activities, or a feeling of inadequate energy to begin these activities’.3,4 Since defining the condition is open to personal interpretations, this has reflected on the methods that are been used to measure it. These methods are usually subjective and consist of a self-reported questionnaire. Some of the frequently employed tools are the Fatigue Severity Scale (FSS) and Multi-dimensional Fatigue Inventory (MFI).5,6
Post-stroke fatigue has a negative impact on patients’ quality of life and independence, and the evidence of its association with high morbidity and mortality rates is well-established.7–10 This condition has been reported to affect around 29–68% of stroke survivors.11 However, there is a noticeable variability in this range. This variation has been suggested to be due to multiple reasons, broadly the methodological and clinical differences between studies. One factor that has been claimed to play a role is the selection of a scale to measure fatigue, which might be influenced by the fact that there is neither a clear definition of PSF nor a standardised tool to assess it.12 Nevertheless, even in studies that used the same scale and cut-off point, there was still a considerable variation between their estimates. Moreover, it has been proposed that the time of assessment might affect the occurrence, resulting in more patients reporting fatigue in later months as they start resuming their normal activities. But the evidence around this factor was conflicting for some cohorts showed an increasing trend in PSF prevalence, while others a downward or stable one.4 Finally, it has been proposed that other methodological factors such as geographical locations or eligibility criteria, specifically related to depression, disability or cognitive impairment, are somehow related. However, there is still a lack of comprehensive, systematic evidence to support that.13–16
Post-stroke fatigue has increasingly drawn researchers’ attention, particularly for the last decade, but there is still a scarcity of extensive evidence to estimate its prevalence and determine the factors of its variability. Since this condition has multiple implications on stroke survivors and their families’ lives, and there is a need for evidence synthesis regarding its occurrence and the causes of its variation between studies, we aim to address this gap by conducting a systematic review of the literature.
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