Effects of Physiotherapy Interventions for Poststroke Fatigue: A Systematic Review.

Background: Poststroke fatigue affects half of global patients with stroke, causing early exhaustion, weariness, and dependence. Physiotherapy interventions like exercise and aerobic training are recommended to alleviate symptoms, but their effectiveness is not well supported. This review evaluates physiotherapy's effectiveness in treating poststroke fatigue in adults.

Methods: We conducted a systematic review using a comprehensive search across multiple databases, including ClinicalTrials.gov, PubMed, PEDro, CINAHL, Embase, Cochrane Library, MEDLINE, and WHO ICTRP. We searched for English-language articles using various keywords, without any restrictions on date, document type, or publication status, and included only randomized controlled trials. After removing duplicates through EndNote X7, 2 independent reviewers screened and reviewed the remaining articles. The Cochrane Risk of Bias Tool was applied to assess the quality of included studies.

Results: A total of 712 articles were reviewed, and after removing duplicates, 450 articles were left, then only 34 articles passed the title screening and 29 were excluded due to various reasons. Therefore, only 4 randomized controlled trials were found relevant after screening out 416 irrelevant ones. The average percentage of participants across all 4 randomized controlled trials was 44.65% men and 55.35% women, with an average age of 59.1 years. The review assessed a range of physiotherapy treatments, such as caregiver-mediated exercise with e-health support, graded activity training with cognitive therapy, and circuit training exercises. Graded activity training with cognitive therapy approach has effectively reduced poststroke fatigue (<0.001) and improved endurance levels (η=0.20; <0.001). On the contrary, circuit training is not effective. Caregiver-mediated exercises and e-health supported exercises have been shown to impact functional recovery positively.

Conclusions: Among all the studies evaluated, only 1 intervention, the graded activity training with cognitive therapy, significantly reduced fatigue after stroke. However, more research is needed to study the effect of physiotherapy interventions.

Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42017075196.