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Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
Published on: June 6, 2025
Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial
Aglaia M E E Zedlitz1, Toni C M Rietveld, Alexander C Geurts
1Donders Centre for Cognition, Radboud University Nijmegen, Spinozabuilding, Mont 3, B02.09, PO Box 9104, Nijmegen, The Netherlands, 6500. a.zedlitz@donders.ru.nl
Stroke
|February 7, 2012
Summary
Cognitive therapy combined with graded activity training (COGRAT) significantly reduced persistent fatigue in stroke survivors. The COGRAT intervention showed superior improvements in fatigue and physical endurance compared to cognitive therapy alone.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Psychology
Background:
- Post-stroke fatigue is a prevalent and persistent condition lacking effective evidence-based treatments.
- A novel intervention, COGRAT (Cognitive therapy + Graded activity training), was developed to address fatigue and related symptoms post-stroke.
Purpose of the Study:
- To compare the effectiveness of the COGRAT intervention against a cognitive therapy (CO) only intervention in stroke patients experiencing fatigue.
- To evaluate the impact of COGRAT on fatigue, anxiety, depression, pain, sleep, and physical endurance.
Main Methods:
- A randomized, controlled, assessor-blind clinical trial involving 83 stroke patients (>4 months post-stroke) across 8 rehabilitation centers.
- Participants received 12 weeks of either CO or COGRAT intervention following a qualification period.
- Primary outcomes (fatigue measures CIS-f, SOL-f) and secondary outcomes were assessed at baseline, post-treatment, and 6-month follow-up.
Main Results:
- Both interventions demonstrated significant improvements in fatigue and several other outcomes, excluding pain and anxiety.
- The COGRAT group showed a higher percentage of participants achieving clinically significant improvement in fatigue (58% vs. 24% on CIS-f).
- COGRAT also led to greater improvements in physical endurance compared to the CO-only group.
Conclusions:
- A 12-week cognitive therapy program is effective in alleviating persistent fatigue after stroke.
- Augmenting cognitive therapy with graded activity training (COGRAT) yields the best outcomes for post-stroke fatigue and physical endurance.
- The study provides evidence for COGRAT as a superior treatment option for managing fatigue in stroke survivors.
