The relationship between post-stroke fatigue and trunk impairment in the subacute phase: a cross-sectional study.

Twenty people at a single hospital: small numbers and one setting, so the size and even the presence of these links could change in a different sample. People with severe aphasia were excluded, and they made up 46% of those screened out. The paper itself notes that people with aphasia are at higher risk of fatigue and depression, so a group that is hard to assess and may be more fatigued is missing. It is a single snapshot taken at admission, so it cannot say whether poor trunk control leads to fatigue or fatigue limits how much people use their trunk. The authors say the causal direction remains unclear. Only one factor at a time was analysed. Age, sex, stroke site, pain, sleep problems and depression are all named by the authors as things that could be involved, and none was adjusted for. The participants were relatively able (median FIM total 110 of 126, median trunk score 18.5 of 23), and static sitting balance scores were bunched at the top of the scale (median 7 of 7), so the findings may not carry across to patients with severe trunk impairment. Fatigue was measured by self-report questionnaire only, and for anyone who could not read or write clearly the first author read the questions aloud.

The study received no external funding, and the authors declare no conflicts of interest.

Do not read this as evidence that improving trunk control will reduce fatigue. The study took a single snapshot of 20 people, so it shows that trunk impairment and fatigue go together, not that one causes the other, and the authors say the direction of the relationship is unclear. Nothing in this paper tested whether treating the trunk changes fatigue.