Background: Post-stroke fatigue affects one in two stroke survivors. Effective treatments are lacking. Fatigue education is a consensus recommendation in stroke clinical guidelines, but we have limited evidence for the effect of education. With limited knowledge in stroke, exploring the effect of education programs in people with neurological conditions may inform the development of education for post-stroke fatigue.
Aim: To determine the effect of education programs on fatigue in people with stroke and other neurological conditions.
Methods: Two independent reviewers followed a systematic review protocol (PROSPERO CRD42023466070]. Reviewers completed screening, full-text selection, data extraction and investigation of risk of bias. Post-intervention scores were pooled for meta-analysis to yield an overall standard mean difference (SMD).
Results: We identified 18 clinical trials (n=1870) of education for fatigue, across four neurological conditions. Intervention duration ranged from 4-12 weeks. While 2/18 trials included people with stroke, 14/8 included people with Multiple Sclerosis. Most education programs (10/18) were delivered in a group setting. We found a small-moderate level of effect for education programs compared with usual care in reducing fatigue (SMD -0.31, 95%CI [-0.48 to -0.13]). Greater benefits for fatigue were observed in individually delivered sessions (SMD -0.4, 95%CI [-0.69 to -0.12]) than group sessions (SMD -0.22, 95%CI [-0.43 to -0.01]). Mode of delivery (in-person versus telehealth) appeared comparable.
Conclusion: Tailored education programs may improve fatigue for people living with post-stroke fatigue. Individually delivered sessions may have a greater impact than group programs, and remote delivery could improve accessibility to education for stroke survivors.