A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable.
Coralie English, Dawn B Simpson, Sandra A Billinger and 14 others
PMID 37837346WHAT IT FOUND
Experts recommend assessing every stroke survivor for fatigue using a structured interview tool to identify modifiable causes like sleep, mood, or medication side effects.
For research, they propose a specific 7-item scale, noting current evidence for treatments is conflicting and insufficient to guide practice.
Key findings
01The consensus group recommends that every stroke survivor be assessed for fatigue using the Stroke Fatigue Clinical Assessment Tool (SF-CAT), which is designed to identify potentially modifiable causes.
02For research purposes, the Fatigue Severity Scale-7 (FSS-7) is recommended as the primary outcome measure, supplemented by visual analogue scales for severity and communication impact.
03There is currently very limited evidence for any interventions to treat or manage post-stroke fatigue, with conflicting results from trials of modafinil, psychoeducation, and neuromodulation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The taskforce did not conduct rigorous systematic reviews due to time and resource constraints, so some relevant studies may have been missed. The SF-CAT identifies modifiable factors but does not provide specific treatment pathways or recommendations for addressing them. Evidence for interventions is weak, with many trials being underpowered and showing conflicting results, so no clinical recommendations for treatment efficacy can be made. The minimum clinically important difference for the recommended FSS-7 measure has not been established in stroke, requiring extrapolation from other conditions.
Declared interests
The authors declared no potential conflicts of interest. Funding was provided by the Canadian Partnership for Stroke Recovery, an NHMRC Centre of Research Excellence, and unrestricted educational grants from Ipsen Pharma and Moleac.
The easy way to misread this
Do not interpret the SF-CAT or the FSS-7 recommendations as evidence that a specific treatment for post-stroke fatigue exists or is effective. The consensus explicitly states there is very limited evidence for any interventions, and the tools are for assessment and research standardization, not for prescribing therapy.