Post-stroke fatigue: a treatment protocol that is being evaluated

Abstract

COGRAT is currently being evaluated in outpatients with severe post-stroke fatigue in a multicentre randomized controlled trial. Preliminary data suggest both positive short- and long-term effects. Adaptations for other neurological patient groups suffering from fatigue are suggested.

Cognitive and Graded Activity Training Can Alleviate Persistent Fatigue After Stroke

“…13 In addition, a GRAT protocol was designed including walking on a treadmill, strength training, and home work assignments. Maximum heart rate and strength were slowly increased from 40% at the beginning of the training to a maximum of 70% at the end of the 12-week program, based on recommendations by the American Heart Association.…”

“…Maximum heart rate and strength were slowly increased from 40% at the beginning of the training to a maximum of 70% at the end of the 12-week program, based on recommendations by the American Heart Association. 13,22 GRAT was given in groups of maximally 4 patients as well. The CO group received weekly 2-hour sessions of cognitive therapy for 12 weeks, In addition to group CO, the COGRAT group received 24, 2-hour sessions of GRAT twice a week for 12 weeks.…”

“…19 The HADS has been validated in patients with stroke, and it consists of 14 items scored on a 4-point Likert scale (0 -3): 7 items on the depression subscale (HADS-D) and 7 items on the anxiety subscale (HADS-A). 26 Subscale sum scores are categorized as normal (0 -7), mild (8 -10), moderate (11)(12)(13)(14), or severe (15)(16)(17)(18)(19)(20)(21). 27 Functional health status was assessed with the well-validated Stroke-Adapted Sickness Impact Profile 30 (SA-SIP 30).…”

“…Against this background, we developed a 12-week group cognitive treatment (CO) tailored to the stroke population, including elements of cognitive behavioral therapy (CBT) and teaching compensation strategies aimed at pacing and relaxation. 13 A Graded Activity Training (GRAT) was offered alongside the cognitive treatment. GRAT consisted of walking on a treadmill, strength training, and physical fitness home work assignments.…”

“…A full description of these interventions has been published previously. 13 The aim of this study was to compare the effectiveness of a combined intervention (COGRAT) with that of CO alone on fatigue and associated psychological and physical variables. Because the long-term beneficial effects of physical fitness training after stroke are still subject to debate and because functional benefits of physical training tend to taper off at a later stage, 14 we did not include a separate GRAT group.…”