Cognitive and graded activity training can alleviate persistent fatigue after stroke: a randomized, controlled trial

Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms....

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Vydáno v:Stroke (1970) Ročník 43; číslo 4; s. 1046
Hlavní autoři: Zedlitz, Aglaia M E E, Rietveld, Toni C M, Geurts, Alexander C, Fasotti, Luciano
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.04.2012
Témata:
Adolescent
Adult
Aged
Cognitive Therapy - methods
Female
Follow-Up Studies
Humans
Male
Mental Fatigue - etiology
Mental Fatigue - therapy
Middle Aged
Stroke - complications
Stroke Rehabilitation
Time Factors
ISSN:1524-4628, 1524-4628
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Shrnutí:Fatigue is a common, persistent consequence of stroke, and no evidence-based treatments are currently available to alleviate fatigue. A new treatment combining cognitive therapy (CO) with graded activity training (GRAT), called COGRAT, was developed to alleviate fatigue and fatigue-related symptoms. This study compared the effectiveness of the COGRAT intervention with a CO-only intervention after a 3-month qualification period without intervention. This randomized, controlled, assessor-blind clinical trial was conducted in 8 rehabilitation centers. Eighty-three stroke patients (>4 months after stroke) were randomly assigned to 12 weeks of CO or COGRAT after qualification. Seventy-three patients completed treatment and 68 were available at follow-up. Primary outcomes (Checklist Individual Strength-subscale Fatigue (CIS-f); self-observation list-fatigue (SOL-f)) and secondary outcomes (Hospital Anxiety and Depression Scale, Stroke-Adapted Sickness Impact Profile, SOL-pain, SOL-sleep-D, 6-minute walk test) were collected at baseline (before and after qualification period) and after treatment (immediate and 6-month follow-up). The qualification period showed stable outcome measures. Both treatments showed significant beneficial effects on fatigue (CIS-f: η(p)(2)=0.48, P<0.001) and other outcomes (except pain and anxiety) with intention-to-treat analyses. Gains for the COGRAT group exceeded those in the CO group on number of individuals showing clinical improvement on the CIS-f (≥8 points: 58% versus 24%) and on physical endurance (η(p)(2)=0.20, P<0.001). A 12-week cognitive therapy program can alleviate persistent fatigue after stroke. The best results are obtained when cognitive therapy is augmented with graded activity training. Clinical Trial Registration- URL: http://www.trialregister.nl. Unique identifier: NTR2704.
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ISSN:1524-4628
1524-4628
DOI:10.1161/STROKEAHA.111.632117