Interventions for post-stroke fatigue

Interventions for post-stroke fatigue (Review)
McGeough E, Pollock A, Smith LN, Dennis M, Sharpe M, Lewis S, Mead GE
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library2009, Issue 3 Interventions for post-stroke fatigue (Review)
Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Interventions for post-stroke fatigue
Elizabeth McGeough2, Alex Pollock3, Lorraine N Smith4, Martin Dennis5, Michael Sharpe6, Susan Lewis1, Gillian E Mead1 1School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK. 2Care of the Elderly Department,Edinburgh Royal Infirmary, Edinburgh, UK. 3Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow CaledonianUniversity, Glasgow, UK. 4Nursing and Health Care, Faculty of Medicine, University of Glasgow, Glasgow, UK. 5Division of ClinicalNeurosciences, University of Edinburgh, Edinburgh, UK. 6School of Molecular & Clinical Medicine, University of Edinburgh,Edinburgh, UK Contact address: Gillian E Mead, School of Clinical Sciences and Community Health, University of Edinburgh, Room F1424, RoyalInfirmary, Little France Crescent, Edinburgh, EH16 4SA, UK. . Editorial group: Cochrane Stroke Group.
Publication status and date: New, published in Issue 3, 2009.
Review content assessed as up-to-date: 6 October 2008.
Citation: McGeough E, Pollock A, Smith LN, Dennis M, Sharpe M, Lewis S, Mead GE. Interventions for post-stroke fatigue. Cochrane
Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007030. DOI: 10.1002/14651858.CD007030.pub2.
Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Fatigue after stroke is common and distressing to patients. The best way to treat this fatigue is uncertain. Theoretically, several differentinterventions may be of benefit.
Objectives
To determine whether any treatment for fatigue after stroke reduces the proportion of patients with fatigue, or fatigue severity, or both,and to determine the effect of treatment on health-related quality of life, disability, dependency and death, and whether such treatmentsare cost effective.
Search strategy
We searched the Cochrane Stroke Group Trials Register (last searched January 2008), the Cochrane Central Register of ControlledTrials (The Cochrane Library Issue 1, 2008), MEDLINE (1950 to February 2008), EMBASE (1980 to February 2008), CINAHL(1982 to February 2008), AMED (1985 to February 2008), PsycINFO (1967 to February 2008), Digital Dissertations (1861 to March2008), PsycBITE (searched March 2008), PEDro (searched March 2008), and British Nursing Index (1985 to March 2008). We alsosearched four trials registries, scanned reference lists, performed citation tracking of included trials, and contacted experts.
Selection criteria
The review author who performed the searches scrutinised all titles and abstracts, excluded irrelevant references, and obtained referencesfor potentially relevant studies. A second review author independently scrutinised potentially relevant studies to determine whetherthey fulfilled inclusion criteria. We included randomised controlled trials of any intervention in patients with stroke where fatigue wasa primary or secondary endpoint.
Data collection and analysis
The two review authors who scrutinised references independently extracted data. We performed a narrative review; we had intendedto perform a meta-analysis but this was not possible as the interventions were too diverse for data to be combined.
Interventions for post-stroke fatigue (Review)
Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Main results
We identified three trials. One randomised 83 patients with emotional disturbance after stroke to fluoxetine or placebo. After correctingfor differences in fatigue severity at baseline, there was no significant difference in fatigue between groups at follow up. The second trialrandomised 31 women with subarachnoid haemorrhage to tirilazad or placebo, of whom 18 were available for follow up. There wasno difference in fatigue between the two groups. The third trial investigated a chronic disease self-management programme in 1150patients with chronic diseases, of whom 125 had had a stroke. There was no difference in fatigue at follow up between the treatmentand control in the subgroup with stroke.
Authors’ conclusions
There is insufficient evidence available to guide the management of fatigue after stroke. Further trials are required.
P L A I N L A N G U A G E S U M M A R Y
Interventions for post-stroke fatigue
Fatigue is common and distressing after stroke. This review found three small, randomised controlled trials that recruited a total of239 people who had had a stroke to three different treatments (two different drug treatments and one chronic disease self-managementprogramme). At follow up, there was no difference in fatigue levels between the patients who received the active treatments and thosewho received usual care or placebo. However, the trials were too small to provide firm conclusions and further trials are required.
Interventions for post-stroke fatigue (Review)
Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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