A literature review of factors associated with fatigue after stroke and a proposal for a framework for clinical utility.

OBJECTIVE: Post-stroke fatigue (PSF) is a common and often disabling consequence of stroke, considered to be a complex multidimensional phenomenon. The present review sought to identify studies examining associations between PSF and at least one factor, with the objective of identifying factors that should be investigated in patients with PSF. METHOD: A search for research investigating PSF was conducted through PubMed, CINAHL and Psychinfo databases (19 October 2017), and included studies in English published during the last 15 years, with more than 10 stroke participants (>18 years old), fatigue assessed with quantitative measurements, and reported relationship with one or more associated factor/-s. RESULTS: Overall, 281 papers were identified of which 34 were included in the final review. Demographics (gender, age), emotional health (depression, anxiety, coping strategy, and locus of control), clinical factors (sleep, pain, stroke characteristics, biological and immunological factors), social factors (social support, disabilities and functionality in daily life) and cognitive functions were found to be associated with PSF. A new framework is discussed, incorporating modifiability of PSF-related factors to heighten the clinical utility. CONCLUSIONS: Post-stroke fatigue is multidimensional phenomena with complex aetiology. Further studies are needed to investigate whether treating associated modifiable factors also can decrease PSF.