Adjuvant therapy with Astragalus membranaceus for post-stroke fatigue: a systematic review

Xu, Li; Xu, Xiaoyan; Hou, Xian‐Geng; Wang, Fugang; Gao, Shan; Zhang, Han‐Ting

doi:10.1007/s11011-019-00483-4

Cited by 11 publications

(5 citation statements)

References 23 publications

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“…This review concluded that there was insufficient evidence of the efficacy of the tested interventions in trials, and more robust research with adequate sample sizes was required 42 , 43 . Since then, more recent systematic reviews until 2019 have attempted to summarise the evidence of effectiveness of Modafinil, mindfulness training, a traditional Chinese medicine, and smart technologies, but still came to a similar conclusion to that of the Cochrane review in 2015 44 – 47 .…”

Section: Introductionmentioning

confidence: 92%

Post-stroke fatigue: a scoping review

et al. 2020

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Background: Post-stroke fatigue (PSF) is one of the most common and frustrating outcomes of stroke. It has a high prevalence and it can persist for many years after stroke. PSF itself contributes to a wider range of undesirable outcomes that affect all aspects of daily life. The aim of this review was to identify and summarise the most recent research on PSF, in order to update the evidence base. Methods: We updated an existing review (Hinkle et al. 2017) systematically searching CINAHL, MEDLINE, PsycINFO, and PubMed to cover new research studies between 1st March 2016 and the search date (19th January 2020). We included interventional and observational research, and clinical practice guidelines that were not covered in the original review. After duplicate removal in EndNote, two reviewers screened the search results in Rayyan, and data from eligible full texts were extracted onto an Excel spreadsheet. Finally, we used RobotReviewer and a human reviewer to assess the risk of bias of randomised trials for this scoping review. Results: We identified 45 records for 30 studies (14 observational, 10 interventional studies, and 6 guidelines). Apart from one, the interventional studies were single-centred, had high risk of bias and small sample size (median 50). They investigated exercise, pharmacotherapy, psychotherapy, education, and light therapy. Observational studies mainly reported the factors related to PSF including co-morbidities, depression and anxiety, quality of life, activities of daily living, stroke severity, medication use and polypharmacy, polymorphism, pain, apathy, limb heaviness, neuroticism, mobility, and thyroid-stimulating hormone. Guidelines either did not report on PSF or, when reported, their recommendations were supported by little or low level of evidence. Conclusion: Although we identified a number of recent studies which have added to our current knowledge on PSF, none are robust enough to change current clinical practice.

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Section: Introductionmentioning

confidence: 92%

Post-stroke fatigue: a scoping review

et al. 2020

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“…44 Links between microglial activation and post-stroke fatigue are yet to be directly investigated. While a few small studies have investigated the effect of anti-inflammatory agents on post-stroke fatigue, 45,46 further definitive trials are needed.…”

Section: Resultsmentioning

confidence: 99%

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

English,

Simpson,

Billinger

et al. 2023

Neurorehabil Neural Repair

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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. Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. Conclusions: By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

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“…Second, there is a lack of evidence and understanding of which ingredient(s) or components are associated with any observed clinical benefits or adverse effects, as decoctions often contain a complex composition and lack of standardization of the quantity of each ingredient in the decoction. 11 Third, the overall methodological quality of all 10 studies was low. All 10 studies had some concerns in reporting bias, and none of the studies was at low risk of bias overall.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews have examined the evidence on PSF interventions, focusing on studies published in English-language databases, 6 , 9 , 10 or a single Chinese herbal medicine. 11 , 12 This review examined completed trials not exclusively published in the English-language databases, thus addressing the language bias of previous reviews and extended geographical location to search and include trials from Chinese databases. This allows a more comprehensive investigation of PSF treatment and provides insights into different Chinese herbal medicines that are used in Asia and Asian populations.…”

Section: Discussionmentioning

confidence: 99%

“…Hinkle et al 6 included trials from 2000 to 2016, which was updated by Aali et al 10 to include published trials until January 2020, but these two reviews included only trials published in English. There are two reviews of individual Chinese herbal medicine interventions: Xu et al 11 reviewed trials of Astragalus membranaceus interventions up to November 2016 and Jin et al 12 reviewed randomized controlled trials (RCTs) of Buyang Huanwu Tang interventions up to October 2021, but there is no review of all Chinese herbal medicines. Furthermore, these reviews are now out-of-date.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue

Chu,

Zhao,

Komber

et al. 2023

International Journal of Stroke

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Background: Post-stroke fatigue (PSF) affects around 50% of stroke survivors. Previous systematic reviews of randomized controlled trials found insufficient evidence to guide practice, but most excluded Chinese studies. Furthermore, their searches are now out-of-date. Aims: To systematically review and perform a meta-analysis of randomized placebo-controlled trials of pharmacological interventions for treating PSF. Methods: We screened Airitri, CNKI, VIP, CINAHL, ClinicalTrials.gov, CENTRAL, Cochrane Stroke Group Trial Register, EMBASE, EU Clinical Trial Register, ISRCTN, MEDLINE, PsycINFO, Wanfang, and WHO ICTRP up to 11 November 2022. Our primary outcome was fatigue severity. We conducted subgroup analysis by drug type and sensitivity analysis after excluding the trials at high risk of bias. Secondary outcomes included mood and quality of life. Results: We screened 33,297 citations and identified 10 published completed trials, 6 unpublished completed trials, and 6 ongoing trials. Pharmacological treatments were associated with lower fatigue severity at the end of treatment (10 published completed trials, 600 participants, pooled standardized mean difference (SMD) = −0.80, 95% confidence interval (CI): −1.29 to −0.31; I2 = 86%, p < 0.00001), but not at follow-up (265 participants, pooled SMD = −0.14, 95% CI: −0.38 to 0.10; I2 = 0, p = 0.51). However, these trials were small and had considerable risk of bias. Beneficial effects were seen in trials with low risk of bias on randomization, missing outcome data, and reporting bias. There were insufficient data on secondary outcomes for meta-analysis, but six trials reported improved quality of life. Conclusion: There is insufficient evidence to support a particular pharmacological treatment for PSF, thus current clinical guidelines do not require amendment.

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Adjuvant therapy with Astragalus membranaceus for post-stroke fatigue: a systematic review

Cited by 11 publications

References 23 publications

Post-stroke fatigue: a scoping review

Post-stroke fatigue: a scoping review

A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue

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