Oral Presentation Asia Pacific Stroke Conference 2024

Fatigue after stroke – future national and international directions (106992)

Coralie English 1 , Dawn Simpson 1 , Sandra Billinger 2 , Leonid Churilov 3 , Kirsten Coupland 1 , Avril Drummond 4 , Anna Kuppaswamy 5 , Mansur kutlubaev 6 , Anners Lerdal 7 , Amreen Mahmood 8 , Lorimer Moseley 9 , Quentin Pittman 10 , Ellyn Riley 11 , Brad Sutherland 12 , Connie Wong 13 , Dale Corbett 14 , Gillian Mead 15
  1. University of Newcastle, Wickham, NSW, Australia
  2. Department of Neurology, , University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre,, Kansas, USA
  3. Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
  4. School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
  5. School of Biomedical Sciences, University of Leeds , Leeds, United Kingdom
  6. Department of Neurology, Bashkir State Medical University, Ufa, Russia
  7. Department of Interdisciplinary Health Sciences, , Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
  8. Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
  9. IIMPACT in Health, University of South Australia, , Adelaide, South Australia, Australia
  10. Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  11. Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, USA
  12. Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
  13. Centre for Inflammatory Diseases, Department of Medicine School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  14. Dept Cellular & Molecular Medicine, Roger Guindon Hall, University of Ottawa, Ontario, Canada
  15. Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom

Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. The Stroke Recovery and Rehabilitation Roundtables (SRRR) bring together leading international experts and deliver consensus recommendations for stroke rehabilitation and recovery research, and are endorsed by the World Stroke Organisation.

Methods: Following the methodology of the SRRRs, we convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We focused on four priority areas: (1) best measurement tools for post-stroke fatigue research, (2) clinical identification of post-stroke fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials and (4) possible biological mechanisms of post-stroke fatigue.

Results: We developed and published1 20 recommendations. These include recommendations for outcome measures for future trials, and how to interpret results of past trials based on the measures used. We developed the Stroke Fatigue Clinical Assessment Tool for identifying potential modifiable contributors to post-stroke fatigue. The most promising interventions that warrant further research include psycho-educational interventions, exercise, dopamine re-uptake inhibitors and neuromodulation therapies. The potential biological mechanisms of fatigue are likely multifactorial and could include systemic inflammation, gut dysbiosis, genetics, post-stroke alteration of cellular energy stores and/or dysfunction in sensorimotor processing. Our work1 is already highly influential (>2,700 downloads, altmetric score 138 and field-weighted citation impact = 29).

Conclusions: By synthesising current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research.

  1. English C, Simpson D, Billinger S, Churilov L, Coupland K, Drummond A, Kuppuswamy A, Kutlubaev M, Lerdal A, Mahmood A, Moseley GL, Pittman Q, Riley E, Sutherland B, Wong C, Corbett D, Mead G (2024) "19 fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable" Int J Stroke 2024, Vol. 19(2) 133 - 144