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Review

Is there evidence for a relationship between cognitive impairment and fatigue after acquired brain injury: a systematic review and meta-analysis

, ORCID Icon, , ORCID Icon, ORCID Icon & ORCID Icon
Pages 4359-4372 | Received 24 Aug 2022, Accepted 20 Nov 2022, Published online: 10 Dec 2022

Figures & data

Table 1. Demographic characteristics, clinical variables in ABI, study participants (n = 1,745), and risk of bias.

Figure 1. Preferred reporting item for systematic review and meta – analysis flow chart study selection.

A PRISMA flow diagram to represent the flow of information through the four phases of this Systematic Review: Identification, Screening, Eligibility and Included studies. The name of each phase is listed in the left columns. The middle columns illustrate the results of each phase. The right column shows the reason for exclusion throughout each round. Phase one shows 421 papers were identified, once exclusion and duplicates were removed. Papers were then screened by title and abstract in phase two. Phase three shows how 74 full-text papers were assessed for eligibility. Phase four shows that 16 papers met the inclusion criteria.
Figure 1. Preferred reporting item for systematic review and meta – analysis flow chart study selection.

Table 2. Study details and overall findings.

Table 3. Fatigue scales and dimensions assessed.

Figure 2. Forest plot displaying reaction time scores in Pearson’s r and relationship between cognitive measures/fatigue scales.

A forest plot, graphical displaying the results of meta-analysis from five studies. The left column shows the reaction-time based cognitive measure/fatigue measure used when investigating for a relationship. The most frequently used cognitive assessment was the Go/No/Go and associations were found with fatigue in all instances. Associations were found with all comparisons made with Multi-Dimensional fatigue scales. The middle column are the associated findings for each comparison made, and are displayed in a hierarchal manner. Though, wide confidence intervals are used in certain instances, which are shown in the right column.
Figure 2. Forest plot displaying reaction time scores in Pearson’s r and relationship between cognitive measures/fatigue scales.

Table 4. Summary of domain specific comparisons made, associations found, rate of positivity (%).

Figure 3. Meta-analysis effect size in Pearson’s r.

Figure 2 &3, Abbreviations of cognitive assessments: SMDT: Symbol Digit Modalities Test; PASAT: Paced Auditory Serial Addition Test; CPT II: Continuous Performance Test II; PVT: Psychomotor Vigilance Task; SRT: simple reaction time; CRT: choice reaction time; ANT: Attention Network Test. Abbreviations of fatigue measures: FSMC – C: Fatigue Scale of Motor and Cognition – cognitive subscale; MFIS – C: Modified Fatigue Impact Scale, cognitive subscale; VAS: Visual Analog Scale; FSS: Fatigue Severity Scale. : Positive threshold target (yellow vertical line), 0.2.

The findings from meta-analysis of the included five studies is presented across 4 columns. The reaction-time based cognitive measure/fatigue measure and study references are listed in column one. The number of participants in each study is presented in column two. The effect size found from each comparison is shown in a hierarchal manner in column three. Higher effect sizes are observed with multi-dimensional fatigue scales, though wide confidence were used in certain instances, as shown in the right column. The final row of the figure presents a significant though overall low random effect size of this meta-analysis as r = 0.234.
Figure 3. Meta-analysis effect size in Pearson’s r.Figure 2 &3, Abbreviations of cognitive assessments: SMDT: Symbol Digit Modalities Test; PASAT: Paced Auditory Serial Addition Test; CPT II: Continuous Performance Test II; PVT: Psychomotor Vigilance Task; SRT: simple reaction time; CRT: choice reaction time; ANT: Attention Network Test. Abbreviations of fatigue measures: FSMC – C: Fatigue Scale of Motor and Cognition – cognitive subscale; MFIS – C: Modified Fatigue Impact Scale, cognitive subscale; VAS: Visual Analog Scale; FSS: Fatigue Severity Scale. Figure 2: Positive threshold target (yellow vertical line), 0.2.
Supplemental material