A roadmap for research in post-stroke fatigue: consensus-based core recommendations from the third stroke recovery and rehabilitation roundtable.

Abstract

Background/Aims: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. The Stroke Recovery and Rehabilitation Roundtables (SRRR) bring together leading international experts and deliver consensus recommendations for stroke rehabilitation and recovery research, and are endorsed by the World Stroke Organisation. Method(s): Following the methodology of the SRRRs, we convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We focused on four priority areas: (1) best measurement tools for post-stroke fatigue research, (2) clinical identification of post-stroke fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials and (4) possible biological mechanisms of post-stroke fatigue. Result(s): We developed and published 20 recommendations. These include recommendations for outcome measures for future trials, and how to interpret results of past trials based on the measures used. We developed the Stroke Fatigue Clinical Assessment Tool for identifying potential modifiable contributors to post-stroke fatigue. The most promising interventions that warrant further research include psychoeducational interventions, exercise, dopamine re-uptake inhibitors and neuromodulation therapies. The potential biological mechanisms of fatigue are likely multifactorial and could include systemic inflammation, gut dysbiosis, genetics, post-stroke alteration of cellular energy stores and/or dysfunction in sensorimotor processing. Our work1 is already highly influential (>2,700 downloads, altmetric score 138 and field-weighted citation impact = 29). Conclusion(s): By synthesising current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research.