Simiao Wu

Psychological Associations of Poststroke Fatigue A Systematic Review and Meta-Analysis

Background and Purpose— Fatigue is common after stroke but has no effective treatments. Psychological interventions improve fatigue in other conditions by targeting psychological factors such as mood. If psychological factors correlate with fatigue in stroke, this would justify the development of similar interventions for poststroke fatigue (PSF). We used systematic review and meta-analysis to determine psychological associations of PSF. Methods— We systematically searched for studies that reported psychological associations of PSF. We used odds ratios (ORs) to estimate the strength of associations and random-effects modeling to calculate summary estimates of ORs. We used stratified meta-analysis to investigate the impact of study design and conducted sensitivity analyses limited to studies that excluded patients with clinical depression and to studies that used depression scales without fatigue items. Results— Thirty-five studies (n=9268) reported the association between PSF and ≥1 psychological factor. For PSF and depressive symptoms, we identified 19 studies (n=6712; pooled OR=4.14; 95% confidence interval, 2.73–6.27); this association existed in patients without clinical depression (pooled OR=1.39; 95% confidence interval, 1.27–1.53) and in studies using depression scales without fatigue items (pooled OR=5.41; 95% confidence interval, 1.54–18.93). For PSF and anxiety, we identified 4 studies (n=3884; pooled OR=2.34; 95% confidence interval, 0.98–5.58). Two studies (n=123) found an association with poor coping styles and 1 study (n=167) with loss of control. Six studies (n=1978) reported other emotional or behavioral associations. Conclusions— PSF is associated with depressive symptoms, anxiety, poor coping, loss of control, emotional, and behavioral symptoms. These factors are potential targets for treatment of PSF.

Model of Understanding Fatigue After Stroke

Fatigue is ubiquitous but it is more common and more severe in patients with acute and chronic conditions, including stroke. The reported proportion of people with fatigue after stroke ranges from 23% to 75%.1 The variation in proportion between studies reflects the heterogeneity in the studied populations, time since stroke, and assessment methods for fatigue. Fatigue is common immediately after stroke, and it tends to persist in most but not all patients. It contributes to lower quality of life and a higher risk of death.2,3 How to manage and prevent fatigue is ranked by stroke survivors and health professionals among the top 10 research priorities relating to life after stroke.4 However, there is no effective treatment, which is partly because of our lack of knowledge of its mechanisms. Fatigue after stroke may share some common underlying mechanisms with other conditions. For example, Zedlitz and colleagues found that the psychosocial profiles of stroke patients with fatigue were similar to those reported in patients with cancer, multiple sclerosis, and chronic fatigue syndrome.5 Several fatigue models have been developed for patients with other conditions; a myriad of biological,6,7 psychosocial,8,9 and behavioral factors,9 as well as other symptoms, such as pain and sleep problems,10 are involved. In this review, we explored whether these factors contribute to fatigue after stroke. We systematically reviewed studies of post-stroke fatigue (PSF) and discussed the definition of PSF, its natural history, and its associations. By drawing on literature of fatigue in other conditions alongside evidence from stroke studies, we propose a conceptual model of PSF. This model is potentially useful in understanding the mechanisms of PSF and informing the development of its treatment. In stroke studies, PSF is usually defined by cut-off scores on fatigue …

Edaravone improves functional and structural outcomes in animal models of focal cerebral ischemia: A systematic review

Edaravone has been used in patients with acute ischemic stroke in Japan for over 10 years but does not have marketing authorization in Europe or America. Either patients in Europe and America are not receiving an effective treatment, or those in Asia are being given a treatment which is not effective. Finding out which of these is true will require further clinical trials, and a better understanding of its efficacy in animal models may help inform the design of those trials so that it might be tested under conditions where there is the greatest prospect of success. We systematically reviewed the efficacy of edaravone in animal models of focal ischemia and summarized data using weighted mean difference DerSimonian and Laird random-effects modeling. We used stratified meta-analysis and metaregression to assess the influence of study design and methodological quality. We identified 49 experiments describing outcome in 814 animals; 30 experiments (519 animals) reported functional and 35 experiments (503 animals) reported structural outcome. Edaravone improved functional and structural outcome by 30.3% (95% confidence interval 23.4–37.2%) and 25.5% (95% confidence interval, 21.1–29.9%), respectively. For functional outcome, there was an inverse relationship between study quality and effect size (P < 0.0017). Effect sizes were larger in studies where randomization or blinded assessment was not reported. There was no evidence of publication bias. Edaravone is a promising treatment for stroke. However, because of the methodological weakness in current animal studies, no sufficient preclinical evidence is available to optimize the study design of clinical trials. Higher quality animal studies are expected to inform further clinical study.

Factors Associated with Poststroke Anxiety: A Systematic Review and Meta-Analysis

Background and Purpose. Anxiety affects 25% of stroke survivors. There are no effective treatments. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. We systematically reviewed the literature and performed a meta-analysis to identify associations with these factors. Methods. We searched electronic databases from January 2014 to July 2015 to complement a literature search performed from inception to May 2014. Study quality was assessed using an internationally endorsed checklist. We used odds ratios (ORs) to estimate the strength of associations and random-effects modelling to calculate summary effect sizes. Results. There were 24 studies recruiting 15448 patients. Quality of reporting was satisfactory. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR = 4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. No studies reported on locus of control, coping, or confidence. Conclusion. Poststroke anxiety was associated with depression but there are limited data on other modifiable associations. Further research is needed to identify potential targets for treatment.

Exploratory Cohort Study of Associations between Serum C - Reactive Protein and Fatigue after Stroke.

Background and Aim Post-stroke fatigue is a common and distressing problem but little is known about its biological mechanisms. This cohort study was to investigate associations between C-reactive protein (CRP) and fatigue after stroke. Methods Patients were assessed at one, six and 12 months after their stroke onset, with the Fatigue Assessment Scale, a case definition of post-stroke fatigue, Hospital Anxiety and Depression Scale, and daily step counts. Blood samples were collected at each assessment and the CRP level was determined by a standard CRP immunoassay. Cross-sectional associations between CRP and fatigue at each time point were determined by Pearson correlation coefficient and independent-samples t-test. Whether CRP levels at one month predict fatigue scores at six and 12 months was explored by multiple linear regression, with anxiety, depression, and daily step counts as covariates. Results Sixty-five patients (mean age 67 years, 65% men) were included: 61 at one month, 49 at six months, and 41 at 12 months. CRP levels and fatigue scores were not associated at one month (p = 0.88) or 12 months (p = 0.56), but weakly associated at six months (r = 0.27, p = 0.04); however, this association was no longer significant (p = 0.14) after controlling for the effects of covariates. The CRP level was not associated with the fulfilment of case definition of post-stroke fatigue at any time points (all p > 0.05). The CRP level at one month was not a significant predictor for fatigue levels at either six months (p = 0.93) or 12 months (p = 0.78). Conclusions There is insufficient evidence for the association between CRP and PSF in stroke patients. Future studies with larger sample sizes and controlling for potential confounders are needed to investigate whether this association exists.

Factors associated with post-stroke anxiety: A systematic review and meta-analysis

Background and Purpose. Anxiety affects 25% of stroke survivors. There are no effective treatments. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. We systematically reviewed the literature and performed a meta-analysis to identify associations with these factors. Methods. We searched electronic databases from January 2014 to July 2015 to complement a literature search performed from inception to May 2014. Study quality was assessed using an internationally endorsed checklist. We used odds ratios (ORs) to estimate the strength of associations and random-effects modelling to calculate summary effect sizes. Results. There were 24 studies recruiting 15448 patients. Quality of reporting was satisfactory. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR = 4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. No studies reported on locus of control, coping, or confidence. Conclusion. Poststroke anxiety was associated with depression but there are limited data on other modifiable associations. Further research is needed to identify potential targets for treatment.

Factors Associated with Poststroke Anxiety

Background and Purpose. Anxiety affects 25% of stroke survivors. There are no effective treatments. Poststroke depression, prestroke anxiety and depression, locus of control, coping, confidence, fatigue, and sleep are factors that may be associated with poststroke anxiety and can potentially be targeted by therapy. We systematically reviewed the literature and performed a meta-analysis to identify associations with these factors. Methods. We searched electronic databases from January 2014 to July 2015 to complement a literature search performed from inception to May 2014. Study quality was assessed using an internationally endorsed checklist. We used odds ratios (ORs) to estimate the strength of associations and random-effects modelling to calculate summary effect sizes. Results. There were 24 studies recruiting 15448 patients. Quality of reporting was satisfactory. 13 studies with 2408 patients reported associations between poststroke anxiety and poststroke depression (OR = 4.66, 95% confidence interval: 2.23, 9.74). One study reported association with prestroke anxiety, three with prestroke depression, one with fatigue, and two with sleep. No studies reported on locus of control, coping, or confidence. Conclusion. Poststroke anxiety was associated with depression but there are limited data on other modifiable associations. Further research is needed to identify potential targets for treatment.