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Efficacy of cognitive behavioral therapy for post-stroke fatigue: A systematic review and meta-analysis
Fusen Sun1, Yan Li1, Fengli Liu2
1Clinical Medical College, Hebei University of Engineering, Handan, China.
Objective:
This systematic review and meta-analysis evaluates the efficacy of Cognitive Behavioral Therapy (CBT) for post-stroke fatigue (PSF), focusing on its multidimensional impact on fatigue severity, sleep quality, depressive symptoms, and overall quality of life, while also exploring the reporting of safety outcomes.
Methodology:
Following PRISMA guidelines (PROSPERO: CRD420251181798), a comprehensive literature search spanned seven major electronic databases (including PubMed, Web of Science, and Cochrane Library, Embase, CNKI, and Wanfang) up to November 2025. Randomized controlled trials (RCTs) comparing CBT against routine care or active interventions in adult stroke survivors were included. Two reviewers independently performed data extraction and quality assessment. Statistical synthesis was executed using a random-effects model to account for clinical heterogeneity.
Results:
Nine RCTs involving 778 participants met the inclusion criteria. Pooled analysis suggested that CBT was associated with a reduction in fatigue severity (SMD = -0.72, 95% CI:1.06 to -0.38, P < 0.0001), although significant heterogeneity was observed. Furthermore, CBT showed potential in improving sleep quality (SMD = -1.07, P = 0.003) and enhancing overall quality of life (SMD = 0.67, P = 0.01). Subgroup analyses indicated a distinct duration-dependent effect: interventions exceeding six weeks demonstrated potential efficacy, whereas shorter protocols did not yield statistically significant benefits. Safety data were critically underpowered, with only one study explicitly reporting adverse events.
Conclusions:
Current low-certainty evidence suggests CBT is a promising and scalable intervention that shows potential in managing PSF, alleviating fatigue, and improving sleep and quality of life. To maximize potential therapeutic benefits, clinical programs might consider protocols lasting more than six weeks. However, due to high statistical heterogeneity and a pervasive lack of safety reporting, these findings should be interpreted cautiously. Future trials must mandate rigorous adverse event monitoring to establish a comprehensive risk-benefit profile.
