Post stroke fatigue--where is the evidence to guide practice?

A significant proportion of stroke survivors suffer from persistent and significant fatigue which is linked to reduced independence and case fatality. Despite its high prevalence and detrimental effects, studies of post-stroke fatigue (PSF) interventions are scarce. Only one randomised controlled trial of post-stroke fatigue treatment (i.e. fluoxetine) was identified, and though improving post-stroke emotional incontinence and depression in patients with fatigue this did not improve PSF itself. Despite there being no literature on its efficacy, patient and family education/counselling has been identified as an important rehabilitation intervention for the management of stroke-related fatigue, which has been found effective in other patient groups (i.e. cancer, multiple sclerosis, and those with traumatic brain injury). Factors contributing to the lack of evidence for PSF management are identified and it is concluded that there is a need to better differentiate those most likely to suffer PSF, to validate existing assessments of fatigue, and to evaluate the efficacy of fatigue management and treatment strategies in stroke survivors.