Efficacy of cognitive behavioral therapy for post-stroke fatigue: A systematic review and meta-analysis

Area of Science:

• Neurology
• Psychiatry
• Rehabilitation Medicine

Background:

• Post-stroke fatigue (PSF) significantly impacts survivors' recovery and quality of life.
• Current management strategies for PSF often yield suboptimal results.
• Cognitive Behavioral Therapy (CBT) is a potential intervention for addressing the multifaceted nature of PSF.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of CBT for managing post-stroke fatigue (PSF).
• To evaluate CBT's impact on fatigue severity, sleep quality, depressive symptoms, and quality of life in stroke survivors.
• To explore the safety outcomes associated with CBT interventions for PSF.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Inclusion of randomized controlled trials (RCTs) comparing CBT with control groups in adult stroke survivors.
• Data extraction and quality assessment by two independent reviewers, with statistical synthesis using a random-effects model.

Main Results:

• Nine RCTs with 778 participants were included.
• CBT demonstrated a significant reduction in fatigue severity (SMD = -0.72, P < 0.0001), improved sleep quality (SMD = -1.07, P = 0.003), and enhanced quality of life (SMD = 0.67, P = 0.01).
• Interventions exceeding six weeks showed greater efficacy; safety data were limited and underpowered.

Conclusions:

• CBT is a promising, scalable intervention for managing PSF, fatigue, sleep, and quality of life in stroke survivors.
• Clinical programs should consider CBT protocols longer than six weeks for optimal benefits.
• High heterogeneity and insufficient safety reporting necessitate cautious interpretation and future rigorous monitoring of adverse events.