Donders Centre for Cognition, Radboud University Nijmegen, Spinozabuilding, Mont 3, B02.09, PO Box 9104, Nijmegen, The Netherlands, 6500.
Stroke. 2012 Apr;43(4):1046-51. doi: 10.1161/STROKEAHA.111.632117. Epub 2012 Feb 2.
Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention.
This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (>4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength-subscale Fatigue (CIS-f); self-observation list-fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up).
The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: η(p)(2)=0.48, P<0.001) and other outcomes (except pain and anxiety) with intention-to-treat analyses. Gains for the COGRAT group exceeded those in the CO group on number of individuals showing clinical improvement on the CIS-f (≥8 points: 58% versus 24%) and on physical endurance (η(p)(2)=0.20, P<0.001).
A 12-week cognitive therapy program can alleviate persistent fatigue after stroke. The best results are obtained when cognitive therapy is augmented with graded activity training. Clinical Trial Registration- URL: http://www.trialregister.nl. Unique identifier: NTR2704.
疲劳是中风后的常见且持续的后果，目前尚无缓解疲劳的循证治疗方法。一种新的治疗方法，将认知疗法（CO）与分级活动训练（GRAT）相结合，称为 COGRAT，旨在缓解疲劳和与疲劳相关的症状。本研究比较了 COGRAT 干预与无干预的 3 个月资格期后仅进行 CO 干预的有效性。
这是一项在 8 家康复中心进行的随机、对照、评估者盲法临床试验。83 名中风患者（中风后>4 个月）在资格期后随机分为 12 周的 CO 或 COGRAT。73 名患者完成了治疗，68 名患者可进行随访。主要结局（个体力量检查表疲劳亚量表（CIS-f）；自我观察疲劳清单（SOL-f））和次要结局（医院焦虑和抑郁量表、中风适应影响量表、SOL 疼痛、SOL 睡眠-D、6 分钟步行试验）在基线（资格期前后）和治疗后（即时和 6 个月随访）进行收集。
资格期的结果测量稳定。两种治疗方法对疲劳（CIS-f：η(p)(2)=0.48，P<0.001）和其他结局（疼痛和焦虑除外）均有显著的有益影响，采用意向治疗分析。COGRAT 组的获益超过 CO 组，表现在 CIS-f 上的临床改善（≥8 分：58%对 24%）和身体耐力上（η(p)(2)=0.20，P<0.001）的个体数量增加。
12 周认知疗法方案可缓解中风后的持续性疲劳。当认知疗法与分级活动训练相结合时，可获得最佳效果。临床试验注册-网址：http://www.trialregister.nl。独特标识符：NTR2704。
