Su Ya, Yuki Michiko, Otsuki Mika
Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812, Japan.
Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido 060-0812, Japan.
J Clin Med. 2020 Feb 25;9(3):621. doi: 10.3390/jcm9030621.
Post-stroke fatigue (PSF) is one of the most serious sequelae, which often interferes with the rehabilitation process and impairs the functional recovery of patients. Due to insufficient evidence, it is unclear which specific pharmacological interventions should be recommended. Therefore, in this paper, we compare the effectiveness of non-pharmacological interventions in PSF. A systematic review and network meta-analysis of randomized controlled trials were performed using EMBASE, MEDLINE, CINAHL, Cochrane library, ClinicalTrials.gov, CNKI, and CQVIP, from inception to January 2018, in the English and Chinese languages. RCTs involving different non-pharmacological interventions for PSF with an outcome of fatigue measured using the Fatigue Severity Scale were included. Multiple intervention comparisons based on a Bayesian network are used to compare the relative effects of all included interventions. Ten RCTs with eight PSF non-pharmacological interventions were identified, comprising 777 participants. For effectiveness, most interventions did not significantly differ from one another. The cumulative probabilities of the best non-pharmacological intervention for fatigue reduction included Community Health Management (CHM), followed by Traditional Chinese Medicine (TCM) and Cognitive Behavioral Therapy (CBT). Network meta-analysis based on data from the selected RCTs indicated that the eight PSF non-pharmacological interventions shared equivalent efficacy, but CHM, TCM, and CBT showed potentially better efficacy. In the future, fatigue needs to be recognized and more accurate assessment methods for PSF are required for diagnosis and to develop more effective clinical interventions.
中风后疲劳（PSF）是最严重的后遗症之一，常常干扰康复进程并损害患者的功能恢复。由于证据不足，尚不清楚应推荐哪些具体的药物干预措施。因此，在本文中，我们比较了非药物干预措施对中风后疲劳的有效性。我们使用EMBASE、MEDLINE、CINAHL、Cochrane图书馆、ClinicalTrials.gov、中国知网和维普资讯，对从创刊至2018年1月以英文和中文发表的随机对照试验进行了系统评价和网状Meta分析。纳入了涉及针对中风后疲劳的不同非药物干预措施且使用疲劳严重程度量表测量疲劳结果的随机对照试验。基于贝叶斯网络的多重干预比较用于比较所有纳入干预措施的相对效果。共识别出10项随机对照试验，涉及8种中风后疲劳非药物干预措施，包括777名参与者。就有效性而言，大多数干预措施之间没有显著差异。减轻疲劳的最佳非药物干预措施的累积概率包括社区健康管理（CHM），其次是中医（TCM）和认知行为疗法（CBT）。基于所选随机对照试验数据的网状Meta分析表明，8种中风后疲劳非药物干预措施具有同等疗效，但社区健康管理、中医和认知行为疗法显示出可能更好的疗效。未来，需要认识到疲劳问题，并且需要更准确的中风后疲劳评估方法用于诊断以及开发更有效的临床干预措施。
