The prevalence of fatigue after stroke: A systematic review and meta-analysis

Abstract

Background: Fatigue is a common and debilitating symptom after stroke. The last decade has seen rapid expansion of the research literature on post-stroke fatigue, but prevalence remains unclear.

Aims: To estimate post-stroke fatigue prevalence and to identify the contributing factors to fatigue, by conducting a systematic review and meta-analysis.

Summary of review: We included all studies of adult stroke survivors that used a recognized assessment scale for fatigue (search date September 2014). Two reviewers independently reviewed all full texts for inclusion. Data were extracted by one reviewer and independently cross-checked by a second. Risk of bias was evaluated using a critical appraisal tool. From an overall yield of 921 studies, 101 full text papers were screened, and 49 of these met inclusion criteria. The most widely used measure of fatigue was the Fatigue Severity Scale (n = 24 studies). Prevalence estimates at a cut-off score of > or ≥ 4 were available for 22 of these 24 studies (total n = 3491), and ranged from 25 to 85%. In random effects meta-analysis, the pooled prevalence estimate was 50% (95% CI 43-57%), with substantial heterogeneity (I² = 94%). Neither depression status nor time point post-stroke explained the heterogeneity between studies. In post-hoc analysis, fatigue prevalence was found to be lower in the four Asian studies (35%; 95% CI 20-50; I² = 96%).

Conclusions: Our results confirm that fatigue is a widespread issue for stroke survivors, although it may be less prevalent in Asia. Further research is needed to explain the wide variability in prevalence estimates between studies.

Keywords: Stroke; depression; fatigue; meta-analysis; prevalence; systematic review.