Effects of non-pharmacological interventions on fatigue in people with stroke: a systematic review and meta-analysis

ABSTRACT

Background

Fatigue, a common problem following a stroke, can have negative effects on a person’s daily life. There are no good interventions thus far for alleviating fatigue among those affected.

Objective

This review aimed to evaluate the effects of non-pharmacological interventions on fatigue among people with stroke.

Methods

A search was conducted for articles in seven databases, clinical trial registry, and backward and forward citations of included publications. Randomized controlled trials, including feasibility and pilot trials, of non-pharmacological interventions for managing fatigue or promoting sleep or both in people with stroke were included. The standardized mean difference in scores for fatigue was analyzed using random effects models.

Results

Ten studies, with 806 participants, were analyzed. The identified interventions included physical interventions, cognitive interventions, a combination of physical and cognitive interventions, oxygen therapy, and complementary interventions. Non-pharmacological interventions had no significant immediate, short-term and medium-term effects on fatigue. The adverse effects of falls and arrhythmia were each found in one participant in circuit training. The risk of bias was high in all studies. The certainty of the evidence ranged from very low to low.

Conclusions

The evidence in support of any non-pharmacological interventions for alleviating fatigue is still inconclusive in people with stroke. In view of the inadequacies of existing interventions and study designs, addressing the multidimensional characteristics of fatigue may be a possible direction in developing interventions. A robust study design with a larger sample size of people with stroke experiencing fatigue is required to evaluate the effects of interventions.

KEYWORDS:

• Fatigue
• meta-analysis
• non-pharmacological interventions
• stroke
• systematic review

Acknowledgement

The authors would like to thank Dr. Peiming Chen for his assistance with the literature review.

Disclosure statement

The authors declare that they have no conflicts of interest.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.