Behavioral and Neural correlates of Post- STROKE Fatigue: A randomized controlled trial protocol

YOU'RE FIRED! Post stroke fatigue has been known forever, solve the problem! YOUR INCOMPETENT? DOCTOR AND HOSPITAL NEEDS TO SOLVE THE FUCKING PROBLEM!

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015

Or is it 40%? Known since September 2017

The latest here: 

 Behavioral and Neural correlates of Post-STROKE Fatigue: A randomized controlled trial protocol

PLOS One | https://doi.org/10.1371/journal.pone.0324591 June 6, 2025 1 / 12
OPEN ACCESS
Citation: Liao K-C, Christian I, Stewart J,
Trudelle-Jackson E, Wang W, Shang T, et al.
(2025) Behavioral and Neural correlates of
Post-stroke fatigue: A randomized controlled
trial protocol. PLoS One 20(6): e0324591.
https://doi.org/10.1371/journal.pone.0324591
Editor: Jennifer Tucker, PLOS: Public Library
of Science, UNITED KINGDOM OF GREAT
BRITAIN AND NORTHERN IRELAND
Received: April 7, 2025
Accepted: April 14, 2025
Published: June 6, 2025
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication
of all of the content of peer review and
author responses alongside final, published
articles. The editorial history of this article is
available here: https://doi.org/10.1371/journal.
pone.0324591
Copyright: © 2025 Liao et al
. This is an open
access article distributed under the terms of
the Creative Commons Attribution License,
which permits unrestricted use, distribution,
STUDY PROTOCOL
Behavioral and Neural correlates of Post-
STROKE Fatigue: A randomized controlled trial
protocol
Kuan-Chun Liao1, Isabelle Christian1, Jill Stewart2, Elaine Trudelle-Jackson1,
Wanyi Wang3, Ty Shang4, Hui-Ting Goh 1*,
1 School of Physical Therapy, Texas Woman’s University, Dallas, Texas, United States of America,
2 Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbus,
South Carolina, United States of America, 3 Center for Research Design and Analysis, Texas Woman’s
University, Houston, Texas, United States of America, 4

Abstract

Introduction
Post-stroke fatigue (PSF) is highly prevalent and lacks of effective management.
Recent evidence suggest the use of transcranial direct current stimulation (tDCS) to
reduce PSF. However, the effect was not lasting and the working mechanisms was
unclear. The purpose of this study is to determine the behavioral and neurophysiolog-
ical effects of five daily sessions of tDCS on PSF.

Methods and analysis

This will be a double-blind randomized controlled trial targeting an enrollment of 32
participants with subacute-chronic stroke and significant fatigue (average Fatigue
Severity Scale (FSS) > 4). Participants will be equally randomized to either anodal
tDCS or sham tDCS groups. The anodal tDCS group will receive 20 minutes of 2-mA
anodal tDCS applied to the ipsilesional primary motor cortex (M1) for five consecu-
tive days. The sham tDCS group will receive the same protocol except there will be
to randomization), immediately after the intervention, and at one-month follow-up. The primary behavioral outcome will be the FSS and the primary neurophysiological outcome will be an input-output curve of motor cortex excitability derived using tran-
scranial magnetic stimulation. Secondary behavioral outcomes will include Fatigue
Scale for Motor and Cognitive Function, Visual Analog Scale-Fatigue, Borg Rating
of Perceived Exertion, and Paas Mental Effort Rating Scale. Secondary neurophys-
iological outcome will be the functional connectivity of the fronto-striato-thalamic
network acquired using resting state functional Magnetic Resonance Imaging (MRI).PLOS One | https://doi.org/10.1371/journal.pone.0324591 June 6, 2025 2 / 12
Repeated measure ANOVA or ANCOVA will be conducted for all outcomes to com-
pare the change between groups.

Discussion

Little is known about effective treatments for PSF and the underlying mechanisms of PSF. tDCS is a promising tool to provide targeted intervention to reduce PSF. The results of this clinical trial will offer critical information for PSF management and investigation. 

Trial registration This trial was registered in February 1 2024 with ClinicalTrials.gov under the registra

More Than Half of Mini-Stroke Patients Battle Long-Term Fatigue: Study Highlights

 

Post stroke fatigue has been known forever. YOUR DOCTOR NEEDS TO SOLVE THE FUCKING PROBLEM!

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015

Or is it 40%? Known since September 2017

The latest here: 

More Than Half of Mini-Stroke Patients Battle Long-Term Fatigue: Study Highlights

Digital self-management programme to support stroke survivors to manage fatigue

 WRONG! Survivors want fatigue cured; NOT MANAGED! We've known of this problem forever, why the fuck haven't you solved it?  I'd fire everyone involved in this crapola!

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015.

Or is it 40%? Known since September 2017.

The latest useless shit here:

Digital self-management programme to support stroke survivors to manage fatigue

Researchers from Bournemouth University will help develop and evaluate a new self-management programme designed to support stroke survivors to manage fatigue.

Funded by a £2.1 million grant from the National Institute for Health and Care Research (NIHR) and the Stroke Association, COMbAT Fatigue is being developed by the Universities of Birmingham, Cambridge, and Bournemouth, in partnership with Cognitant Group, a healthcare technology company.

Post-stroke fatigue affects approximately half of all stroke survivors and can be one of the most challenging and distressing symptoms people face, making everyday activities difficult.

Despite its prevalence, many people do not receive adequate support or information on how to manage it. COMbAT Fatigue seeks to address this by co-creating a self-management programme that will be delivered digitally, empowering stroke survivors to optimise energy and improve their quality of life.

COMbAT Fatigue builds upon an existing programme called FACETS, which was developed at BU with support from University Hospitals Dorset (UHD) and was originally designed to help people with multiple sclerosis (MS) manage their fatigue through a combination of cognitive behavioural therapy (CBT), education, and energy management techniques.

The research team – co-led by Dr Grace Turner from the University of Birmingham and Professor Jonathan Mant from the University of Cambridge - will adapt FACETS to suit the needs of stroke survivors, ensuring it is accessible through a web-based platform and inclusive of under-represented groups, such as people from ethnic minority backgrounds and those with stroke-related impairments.

Bournemouth University will play a key role in the project, with experts including Dr Sarah Thomas, a research psychologist specialising in fatigue who led the development of the original FACETS programme, and Professor Huseyin Dogan, who specialises in human computer interaction, digital health and assistive technology.

Dr Thomas said: “It’s exciting to see FACETS, an evidence-based, group fatigue management programme developed originally for people with multiple sclerosis (MS) by researchers at Bournemouth University in partnership with the Dorset Multiple Sclerosis Service, being adapted for digital delivery to people following stroke.

“There is currently very little support available for people experiencing fatigue after stroke so we hope the adapted digital programme led by Universities of Birmingham and Cambridge in partnership with Cognitant Group and co-created with stroke survivors, caregivers, clinicians, and other experts will extend the benefits of FACETS to people experiencing this highly debilitating symptom following stroke.”

Over the course of five years, the COMbAT Fatigue programme will co-create and trial a digital self-management programme, working with stroke survivors to assess its impact on fatigue and quality of life.

Professor in Human Computer Interaction at BU Huseyin Dogan added: "We are excited to be working with the University of Birmingham, Cognitant Group and University of Cambridge to co-create and test a digital therapy for people with post stroke fatigue. We are enhancing our capability in developing intelligent digital solutions in the healthcare domain through utilising techniques such as cognitive behavioural therapy, participatory design, usability evaluations and user acceptance tests.

“We would like to make a difference by helping people to better manage their fatigue level through a digital programme provision."

Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis

 

WHAT FUCKING STUPIDITY! We've known of post stroke fatigue a long time. SOLVE THE FUCKING PROBLEM! Instead of this waste of time. And your mentors and senior researchers were so incompetent, they didn't know of all this earlier research?

This did absolutely nothing to help survivors recover. I'd fire the mentors and senior researchers involved!  A lot of dead wood needs to be removed in stroke so we can actually get around to solving stroke to 100% recovery!

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015.

Or is it 40%? Known since September 2017.

Relationships of post-stroke fatigue with mobility, recovery, performance, and participation-related outcomes: a systematic review and meta-analysis

Jibrin S. UsmanThomson W. L. WongShamay S. M. Ng^*

• Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China

Background: Effective post-stroke mobility, recovery, performance, and participation are key goals for stroke survivors. However, these outcomes may be hindered by post-stroke fatigue (PSF), which can affect numerous aspects of post-stroke mobility, recovery, performance, functioning, community participation, and return to work. This review aimed to assess the scientific evidence on the relationship between PSF and mobility function, functional recovery, functional performance, and participation-related outcomes among stroke survivors.

Method: A comprehensive search of Cochrane Central, PubMed, Embase, and Web of Science (WoS) databases was conducted from inception to December 2023. Observational, cross-sectional, and longitudinal studies were included. The methodological quality of the included studies was assessed using the National Institute of Health’s quality assessment tool, while the risk of bias was assessed using the Quality in Prognostic Studies tool. A total of 28 studies (n = 2,495 participants, 1,626 men, mean age ranging from 52.5 ± 9.5 to 71.1 ± 9.9 years) were included. The data analysis was conducted using narrative and quantitative synthesis. Fixed and random effects meta-analyses were conducted to explore the relationships between PSF and relevant outcomes.

Results: Chronic PSF was found to have significant negative correlations with mobility (meta r = −0.106, p < 0.001), balance performance (meta r = −0.172; 95%; p = 0.004), and quality of life (meta r = −0.647; p < 0.001). It also showed significant positive correlations with stroke impairment (meta r = 0.144, p < 0.001) and disability (meta r = 0.480, p < 0.001). Additionally, exertion/acute PSF had significantly negative correlations with walking economy (meta r = −0.627, p < 0.001) and walking endurance (meta r = −0.421, p = 0.022). The certainty of evidence was deemed moderate for these relationships.

Conclusion: Our findings indicate that higher levels of PSF are associated with poorer mobility, balance, and participation, as well as greater disability and stroke impairment. Future studies, especially prospective longitudinal and randomized controlled trials, are warranted to substantiate our findings.

Systematic review registration: PROSPERO, identifier: CRD42023492045.

Introduction

Stroke survivors experience a range of impairments and functional limitations that manifest in various combinations (1). In addition to this, they may experience various post-stroke symptoms, such as fatigue, pain, and spasticity, which often occur concurrently and can significantly influence mobility, motor function, physical function, and activities of daily living (ADLs), adding to the overall burden and hindering recovery (2). Fatigue in stroke survivors can be classified as either chronic or acute (exertion related), with two distinct characteristics (3). Exertion/state fatigue is characterized by its immediate onset and recovery time (3), while chronic fatigue is caused by long periods of accumulation of acute fatigue (4) or the gradual progression of mental fatigue, potentially triggered by daily tasks (4, 5). Post-stroke exertion fatigue is typically experienced after intense physical or mental exertion (5). Additionally, fatigue can be categorized as mental or peripheral (physical), with underlying mechanisms often associated with autonomic diseases (4).

PSF is associated with feelings of mental, physical, and overall exhaustion, with a variation in fatigue levels and activity (6). Its characteristics vary from general fatigue to a certain degree, and it can occur without any specific exertion (7). PSF is a common post-stroke deficit typified by complex multifactorial phenomena (8) and is a frequent, incapacitating health issue due to the complex interactions of numerous factors (9). Fatigue and sleepiness commonly exist together due to lack of sleep and are usually combined under the concept of tiredness by patients. However, they are two separate but interrelated terms (10). The two terms fatigue and sleepy are different, with the suggestion that clinicians and researchers should be cautious when using these terms interchangeably (11). Fatigue is an overwhelming feeling of tiredness, lacking energy, and a sense of exhaustion related to diminished physical and/or cognitive performance, whereas sleepiness is a pervasive phenomenon felt not just as a symptom in various disorders but as a normal state of physiology in most persons during any given 24-h duration (10). Additionally, disorder is inferred both when sleepiness becomes pervasively present or when it is absent, and abnormality is considered when it does not happen when needed or happens at unsuitable periods (10).

Post-stroke fatigue (PSF) is prevalent in stroke survivors (12–15) and affects their daily functioning, and quality of life is a commonly disregarded problem (3). It affects participation, emotions, cognitive performance, and ADLs and can diminish the ability to carry out the expected ADLs (6). PSF, which can have numerous adverse consequences (16), is significantly associated with functional impairments, disability, and diminished quality of life among stroke survivors in several areas (1, 14). It has also been shown to have a negative influence on the survivors’ cardiopulmonary function (13), and fatigue hinders their community integration (12). Thus, fatigue is a major symptom that affects numerous physical functions, such as ADLs and mobility, in stroke survivors.

The effects of fatigue can be lifelong (17, 18) and may impact post-stroke functional recovery and outcomes (2, 18). Moreover, PSF is associated with dual-task performance (19), both cognitive and motor performances (8), lower extremity mobility (20), and lower limb motor tasks, including balance and gait, with more challenges to navigating in complex settings likely to be observed in those with higher fatigue (8). Other studies have found that fatigue is weakly related to post-stroke gait performance (19), inextricably related to affective disorders (21), and also related to poor functional outcomes in young stroke survivors (18).

The summary above shows that most of the studies reporting the relationships or associations between PSF and variables of interest have not expounded the strength, direction, or extent of the relationships. This precludes the drawing of definite conclusions regarding the relationships. Therefore, there is a need to synthesize the scientific evidence of how and to what extent PSF influences the mobility, recovery, performance, and participation of stroke survivors. Such evidence will guide stroke rehabilitation professionals in formulating better rehabilitation strategies by targeting PSF, mobility, recovery, functioning, and participation. Despite the known importance of these outcomes in stroke survivors, to the best of our knowledge, this will be the first systematic review and meta-analysis that determine the scientific evidence on how and to what extent PSF influences these outcomes in stroke survivors.

More at link.

A systematic review of post-stroke fatigue measurement scale based on COSMIN guidelines

We've known of post stroke fatigue a long time. WHY THE FUCK AREN'T YOU SOLVING IT?

This did absolutely nothing to help survivors recover. I'd fire the mentors and senior researchers involved!  A lot of dead wood needs to be removed in stroke so we can actually get around to solving stroke to 100% recovery!

At least half of all stroke survivors experience fatigue Known since March 2017

Or is it 70%? Known since March 2015.

Or is it 40%? Known since September 2017.

A systematic review of post-stroke fatigue measurement scale based on COSMIN guidelines

Lingsha Wu^*Haiqin Jin

• The Second Hospital of Jiaxing, Jiaxing, China

Objective: This study aimed to evaluate the methodological quality and measurement attribute quality of the post-stroke fatigue measurement scale, so as to provide some basis for the clinical application and promotion of related scales.

Methods: The Chinese National Knowledge Infrastructure, the Wanfang Data Knowledge Service Platform, the China Science and Technology Journal Database, the Chinese Medical Journal Full-text Database, the Chinese Biology Medicine, PubMed, Embase, Medline, the Cochrane Library, the Web of Science, CINAHL, and PsycINFO databases were searched for literature on the post-stroke fatigue measurement scale up to June 2022. Literature screening and data extraction were carried out independently by two researchers, and in the case of disagreement, discussions were held with a third investigator to reach an agreement, and the COSMIN checklist and criteria were used to systematically evaluate the attributes of the measurement scale.

Results: A total of 17 studies were included, involving 10 post-stroke fatigue measurement scales. The content validity of FSS-7, FACIT-F, NRS-FRS, and MFI-20 was “not mentioned,” and the remaining scales were “uncertain.” In terms of construct validity, MFS was “adequate”; FSS-7, FACIT-F, and NRS-FRS were “not mentioned”; and the remaining scales were “uncertain.” In terms of internal consistency, NRS-FRS was “not mentioned”; FSS and MFS were “adequate”; and the remaining scales were “uncertain.” In terms of hypothesis testing, CIS and FACIT-F were “not mentioned,” NRS-FRS was “adequate,” and the remaining scales were “uncertain.” The stability of FSS-7, CIS, FACIT-F, and MFI-20 was “not mentioned,” and the remaining scales were “adequate.” The cross-cultural validity of FSS-7 was “adequate,” and the remaining scales were “not mentioned.” All 10 scales were given a recommendation grade of “B”.

Conclusion: For the time being, the FSS can be recommended to measure post-stroke fatigue, but it still needs to be tested for more relevant measurement properties in order to gain more support from high-quality evidence. For a more comprehensive assessment of post-stroke fatigue, the FIS, FAS, and NFI-stroke should perhaps be considered, as the FSS is a one-dimensional scale that can only measure physical fatigue in patients; however, these scales also need to be tested for more relevant measurement properties to verify their clinical applicability.

1 Introduction

Post-stroke fatigue is not related to tension and is a subjective feeling of stroke survivors about weakness and tiredness (1, 2). PSF arises not only from physical activities but also from mental or social activities. As one of the common complications after stroke, it has a high incidence, which will make it difficult or impossible for patients to maintain daily activities, thus causing a certain degree of adverse effects on their quality of life (3, 4). Accurate measurement of PSF is the premise and basis for the timely and effective treatment of the disease. There are many scales used to measure PSF, such as the fatigue severity scale (FSS) (5), fatigue impact scale (FIS) (6), and fatigue assessment scale (FAS) (7). Kjeverud et al. (8) explored the frequency and overlap of PSF by using scales, such as FSS, and the results showed that different scales produced different results. Blackwell et al. (9) noted that there are currently no corresponding guidelines to assess fatigue management in patients with PSF in fatigue management and that there are no established guidelines yet. Thus it can be seen different measurement focus of different scales, it has not been able to determine whether these scales have good measurement properties, and few studies to systematically evaluate these measurement properties. The guidelines for the selection criteria for health measurement tools (COSMIN) (10) can assess the methodological quality and measurement attribute quality of the scale, and the best scale for the purpose of the study can be selected. In this study, a systematic evaluation of PSF measurement scales using COSMIN quality standards was carried out to clarify the methodological quality and measurement attribute quality of relevant scales. It aimed to comprehensively evaluate the evidence level of each measurement attribute, leading to the final recommendation and providing certain evidence-based support for the application and promotion of relevant scales in clinical practice.