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Review
. 2021 Dec;6(4):319-332.
doi: 10.1177/23969873211047681. Epub 2021 Oct 7.

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

Ibraheem Alghamdi  1 , Cono Ariti  2 , Adam Williams  2 , Emma Wood  3 , Jonathan Hewitt  4
Affiliations
Review

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

Ibraheem Alghamdi et al. Eur Stroke J. 2021 Dec.

Erratum in

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.

Keywords: fatigue; frequency; review; stroke.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMAs) flow diagram.
Figure 2.
Figure 2.
Critical appraisal of the included studies.
Figure 3.
Figure 3.
Random effects meta-analysis of post-stroke fatigue prevalence in studies that used FSS and MFI to measure fatigue. FSS: Fatigue Severity Scale; MFI: Multi-dimensional Fatigue Inventory.
Figure 4.
Figure 4.
Random effects meta-analysis of post-stroke fatigue prevalence stratified according to time of assessment, stroke type and location.
See this image and copyright information in PMC

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References

    1. Baylor C, Yorkston KM, Jensen MP, et al. Scoping review of common secondary conditions after stroke and their associations with age and time post stroke. Top Stroke Rehabil 2014; 21: 371–382. DOI: 10.1310/tsr2105-371. - DOI - PubMed
    1. Rowat A, Pollock A, St George B, et al. Top 10 research priorities relating to stroke nursing: a rigorous approach to establish a national nurse-led research agenda. J Adv Nurs 2016; 72: 2831–2843. DOI: 10.1111/jan.13048. - DOI - PubMed
    1. Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med 1986; 15: 74–81. DOI: 10.1016/0091-7435(86)90037-x. - DOI - PubMed
    1. Aarnes R, Stubberud J, Lerdal A. A literature review of factors associated with fatigue after stroke and a proposal for a framework for clinical utility. Neuropsychol Rehabil 2020; 30: 1449–1476. DOI: 10.1080/09602011.2019.1589530. - DOI - PubMed
    1. Krupp LB, LaRocca NG, Muir-Nash J, et al. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46: 1121–1123. DOI: 10.1001/archneur.1989.00520460115022. - DOI - PubMed