Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Surgical Department, Lovisenberg Diaconal Hospital, Oslo, Norway.
Int J Stroke. 2023 Oct;18(9):1063-1070. doi: 10.1177/17474930231152132. Epub 2023 Feb 3.
It has been hypothesized that post-stroke fatigue (PSF) is associated with reduced physical activity (PA) and impaired physical fitness (fitness). Understanding associations between PSF and PA, and/or fitness could help guide the development of targeted exercise interventions to treat PSF.
Our systematic review and meta-analysis aimed to investigate PSF's associations with PA and fitness.
Following a registered protocol, we included studies with cross-sectional or prospective observational designs, published in English or a Scandinavian language, which reported an association of PSF with PA and/or fitness in adult stroke survivors. We searched MEDLINE, Embase, AMED, CINAHL, PsycINFO, ClinicalTrials.gov, and World Health Organization's International Clinical Trials Registry Platform from inception to November 30, 2022. Risk of bias was assessed using Quality in Prognosis Studies. Thirty-two unique studies (total n = 4721 participants, 55% male), and three study protocols were included. We used random-effects meta-analysis to pool data for PA and fitness outcomes, and vote-counting of direction of association to synthesize data that could not be meta-analyzed. We found moderate-certainty evidence of a weak association between higher PSF and impaired fitness (meta = -0.24; 95% confidence interval (CI) = -0.33, -0.15; n = 905, 7 studies), and very low-certainty evidence of no association between PSF and PA (meta = -0.09; 95% CI = -0.34, 0.161; n = 430, 3 studies). Vote-counting showed a higher proportion of studies with associations between higher PSF and impaired fitness (pˆ = 0.83; 95% CI = 0.44, 0.97; p = 0.22, n = 298, 6 studies), and with associations between higher PSF and lower PA (pˆ = 0.75; 95% CI = 0.51, 0.90; p = 0.08, n = 2566, 16 studies). Very low- to moderate-certainty evidence reflects small study sample sizes, high risk of bias, and inconsistent results.
The meta-analysis showed moderate-certainty evidence of an association between higher PSF and impaired fitness. These results indicate that fitness might protect against PSF. Larger prospective studies and randomized controlled trials evaluating the effect of exercise on PSF are needed to confirm these findings.
据推测，卒中后疲劳（PSF）与体力活动（PA）减少和身体适应性（fitness）受损有关。了解 PSF 与 PA 和适应性之间的关联可以帮助指导针对 PSF 的靶向运动干预措施的制定。
我们的系统评价和荟萃分析旨在调查 PSF 与 PA 和适应性的关联。
根据已注册的方案，我们纳入了具有横断面或前瞻性观察设计的研究，这些研究发表于英文或斯堪的纳维亚语，报告了成年卒中幸存者 PSF 与 PA 和/或适应性之间的关联。我们检索了 MEDLINE、Embase、AMED、CINAHL、PsycINFO、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台，检索时间截至 2022 年 11 月 30 日。使用预后研究质量评估工具评估偏倚风险。共纳入 32 项独特的研究（总计 4721 名参与者，55%为男性）和 3 项研究方案。我们使用随机效应荟萃分析汇总 PA 和适应性结果的数据，并对无法进行荟萃分析的数据进行关联方向的票数计数合成。我们发现，PSF 较高与身体适应性较差之间存在中等确定性证据的弱关联（meta = -0.24；95%置信区间（CI）=-0.33，-0.15；n = 905，7 项研究），而 PSF 与 PA 之间不存在关联的证据非常低（meta = -0.09；95% CI = -0.34，0.161；n = 430，3 项研究）。票数计数显示，PSF 较高与身体适应性较差之间存在关联的研究比例更高（pˆ=0.83；95% CI = 0.44，0.97；p=0.22，n=298，6 项研究），而 PSF 较高与 PA 较低之间存在关联的研究比例更高（pˆ=0.75；95% CI = 0.51，0.90；p=0.08，n=2566，16 项研究）。非常低至中等确定性证据反映了研究样本量小、偏倚风险高和结果不一致的情况。
荟萃分析显示，PSF 较高与身体适应性较差之间存在中等确定性证据的关联。这些结果表明，适应性可能有助于预防 PSF。需要更大规模的前瞻性研究和随机对照试验来评估运动对 PSF 的影响，以证实这些发现。
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