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Post-stroke fatigue: a scoping review

Aali, Ghazaleh; Drummond, Avril; das Nair, Roshan; Shokraneh, Farhad


Ghazaleh Aali

Professor of Healthcare Research

Professor of Clinical Psychology and Neuropsychology

Farhad Shokraneh


Background: Post-stroke fatigue (PSF) is one of the most common and frustrating outcomes of stroke. It has a high prevalence and it can persist for many years after stroke. PSF itself contributes to a wider range of undesirable outcomes that affect all aspects of daily life. The aim of this review was to identify and summarise the most recent research on PSF, in order to update the evidence base.

Methods: We updated an existing review (Hinkle et al. 2017) systematically searching CINAHL, MEDLINE, PsycINFO, and PubMed to cover new research studies between 1st March 2016 and the search date (19th January 2020). We included interventional and observational research, and clinical practice guidelines that were not covered in the original review. After duplicate removal in EndNote, two reviewers screened the search results in Rayyan, and data from eligible full texts were extracted onto an Excel spreadsheet. Finally, we used RobotReviewer and a human reviewer to assess the risk of bias of randomised trials for this scoping review.

Results: We identified 45 records for 30 studies (14 observational, 10 interventional studies, and 6 guidelines). Apart from one, the interventional studies were single-centred, had high risk of bias and small sample size (median 50). They investigated exercise, pharmacotherapy, psychotherapy, education, and light therapy. Observational studies mainly reported the factors related to PSF including co-morbidities, depression and anxiety, quality of life, activities of daily living, stroke severity, medication use and polypharmacy, polymorphism, pain, apathy, limb heaviness, neuroticism, mobility, and thyroid-stimulating hormone. Guidelines either did not report on PSF or, when reported, their recommendations were supported by little or low level of evidence.

Conclusion: Although we identified a number of recent studies which have added to our current knowledge on PSF, none are robust enough to change current clinical practice.


Aali, G., Drummond, A., das Nair, R., & Shokraneh, F. (2020). Post-stroke fatigue: a scoping review. F1000Research, 9, Article 242.

Journal Article Type Article
Acceptance Date Apr 1, 2020
Online Publication Date Apr 7, 2020
Publication Date Apr 7, 2020
Deposit Date Apr 7, 2020
Publicly Available Date Apr 8, 2020
Journal F1000Research
Print ISSN 2046-1402
Publisher F1000Research
Peer Reviewed Not Peer Reviewed
Volume 9
Article Number 242
Public URL
Publisher URL
Additional Information Referee status: Awaiting Peer Review; Grant Information: Drummond A, Thomas S, Jones F, dasNair R, Sprigg N, Jones A. Nottingham Fatigue Study-Developing a Fatigue Programme: NotFAST2. Stroke Association. Research ID: SA PG 19\100060; 20 Months (1st Dec 2019 – 31st July 2021). URL:
This scoping review reports independent research funded by the UK Stroke Association. The views expressed are those of the author(s) and not necessarily those of the UK Stroke Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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