WHAT FUCKING STUPIDITY! We've known of post stroke fatigue a long time. SOLVE THE FUCKING PROBLEM! Instead of this waste of time. And your mentors and senior researchers were so incompetent, they didn't know of all this earlier research?
This
did absolutely nothing to help survivors recover. I'd fire the mentors
and senior researchers involved! A lot of dead wood needs to be removed
in stroke so we can actually get around to solving stroke to 100%
recovery!
At
least half of all stroke survivors experience fatigue Known since March 2017
Or is it 70%? Known since March 2015.
Or is it 40%? Known since September 2017.
Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis
Jibrin S. Usman
Thomson W. L. Wong
Shamay S. M. Ng- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
Background: Effective post-stroke mobility, recovery, performance, and participation are key goals for stroke survivors. However, these outcomes may be hindered by post-stroke fatigue (PSF), which can affect numerous aspects of post-stroke mobility, recovery, performance, functioning, community participation, and return to work. This review aimed to assess the scientific evidence on the relationship between PSF and mobility function, functional recovery, functional performance, and participation-related outcomes among stroke survivors.
Method: A comprehensive search of Cochrane Central, PubMed, Embase, and Web of Science (WoS) databases was conducted from inception to December 2023. Observational, cross-sectional, and longitudinal studies were included. The methodological quality of the included studies was assessed using the National Institute of Health’s quality assessment tool, while the risk of bias was assessed using the Quality in Prognostic Studies tool. A total of 28 studies (n = 2,495 participants, 1,626 men, mean age ranging from 52.5 ± 9.5 to 71.1 ± 9.9 years) were included. The data analysis was conducted using narrative and quantitative synthesis. Fixed and random effects meta-analyses were conducted to explore the relationships between PSF and relevant outcomes.
Results: Chronic PSF was found to have significant negative correlations with mobility (meta r = −0.106, p < 0.001), balance performance (meta r = −0.172; 95%; p = 0.004), and quality of life (meta r = −0.647; p < 0.001). It also showed significant positive correlations with stroke impairment (meta r = 0.144, p < 0.001) and disability (meta r = 0.480, p < 0.001). Additionally, exertion/acute PSF had significantly negative correlations with walking economy (meta r = −0.627, p < 0.001) and walking endurance (meta r = −0.421, p = 0.022). The certainty of evidence was deemed moderate for these relationships.
Conclusion: Our findings indicate that higher levels of PSF are associated with poorer mobility, balance, and participation, as well as greater disability and stroke impairment. Future studies, especially prospective longitudinal and randomized controlled trials, are warranted to substantiate our findings.
Systematic review registration: PROSPERO, identifier: CRD42023492045.
Introduction
Stroke survivors experience a range of impairments and functional limitations that manifest in various combinations (1). In addition to this, they may experience various post-stroke symptoms, such as fatigue, pain, and spasticity, which often occur concurrently and can significantly influence mobility, motor function, physical function, and activities of daily living (ADLs), adding to the overall burden and hindering recovery (2). Fatigue in stroke survivors can be classified as either chronic or acute (exertion related), with two distinct characteristics (3). Exertion/state fatigue is characterized by its immediate onset and recovery time (3), while chronic fatigue is caused by long periods of accumulation of acute fatigue (4) or the gradual progression of mental fatigue, potentially triggered by daily tasks (4, 5). Post-stroke exertion fatigue is typically experienced after intense physical or mental exertion (5). Additionally, fatigue can be categorized as mental or peripheral (physical), with underlying mechanisms often associated with autonomic diseases (4).
PSF is associated with feelings of mental, physical, and overall exhaustion, with a variation in fatigue levels and activity (6). Its characteristics vary from general fatigue to a certain degree, and it can occur without any specific exertion (7). PSF is a common post-stroke deficit typified by complex multifactorial phenomena (8) and is a frequent, incapacitating health issue due to the complex interactions of numerous factors (9). Fatigue and sleepiness commonly exist together due to lack of sleep and are usually combined under the concept of tiredness by patients. However, they are two separate but interrelated terms (10). The two terms fatigue and sleepy are different, with the suggestion that clinicians and researchers should be cautious when using these terms interchangeably (11). Fatigue is an overwhelming feeling of tiredness, lacking energy, and a sense of exhaustion related to diminished physical and/or cognitive performance, whereas sleepiness is a pervasive phenomenon felt not just as a symptom in various disorders but as a normal state of physiology in most persons during any given 24-h duration (10). Additionally, disorder is inferred both when sleepiness becomes pervasively present or when it is absent, and abnormality is considered when it does not happen when needed or happens at unsuitable periods (10).
Post-stroke fatigue (PSF) is prevalent in stroke survivors (12–15) and affects their daily functioning, and quality of life is a commonly disregarded problem (3). It affects participation, emotions, cognitive performance, and ADLs and can diminish the ability to carry out the expected ADLs (6). PSF, which can have numerous adverse consequences (16), is significantly associated with functional impairments, disability, and diminished quality of life among stroke survivors in several areas (1, 14). It has also been shown to have a negative influence on the survivors’ cardiopulmonary function (13), and fatigue hinders their community integration (12). Thus, fatigue is a major symptom that affects numerous physical functions, such as ADLs and mobility, in stroke survivors.
The effects of fatigue can be lifelong (17, 18) and may impact post-stroke functional recovery and outcomes (2, 18). Moreover, PSF is associated with dual-task performance (19), both cognitive and motor performances (8), lower extremity mobility (20), and lower limb motor tasks, including balance and gait, with more challenges to navigating in complex settings likely to be observed in those with higher fatigue (8). Other studies have found that fatigue is weakly related to post-stroke gait performance (19), inextricably related to affective disorders (21), and also related to poor functional outcomes in young stroke survivors (18).
The summary above shows that most of the studies reporting the relationships or associations between PSF and variables of interest have not expounded the strength, direction, or extent of the relationships. This precludes the drawing of definite conclusions regarding the relationships. Therefore, there is a need to synthesize the scientific evidence of how and to what extent PSF influences the mobility, recovery, performance, and participation of stroke survivors. Such evidence will guide stroke rehabilitation professionals in formulating better rehabilitation strategies by targeting PSF, mobility, recovery, functioning, and participation. Despite the known importance of these outcomes in stroke survivors, to the best of our knowledge, this will be the first systematic review and meta-analysis that determine the scientific evidence on how and to what extent PSF influences these outcomes in stroke survivors.
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