Treatment of severe fatigue after stroke. A study of cognitive therapy and physical exercise training in eight rehabilitation centres in the Netherlands.

N/A

Stroke patients frequently complain of excessive fatigue, both in post-acute and in the chronic stage of their illness. The prevalence of severe fatigue is estimated between 28-73%, even in patients who seem to recover well. This may lead to impairments in daily functioning. Although clinicians are aware that a treatmnet for PSF is urgently needed, there are no evidence-based treatments available. On the basis of positive outcomes of a pilot-study of a cognitive and physical treatment in the Maartenskliniek, the protocol was adapted and a multi-center randomised waiting-list controlled study proposed. This cognitive and graded activity training (COGRAT) is offered to stroke patients in the chronic phase (> 4 mnts post stroke), and compared to the Cognitive therapy alone, and waiting list condition.


The hypotheses are: Cognitive and Graded Activity Training (COGRAT) will be helpfull in decreasing chronic fatigue after stroke. Furthermore the addition of a Graded activity programme will enhance the effectiveness of the treatment.

All questionaires and tests are performed at all testing points (T1-T4).
T1: 3 months prior to randomisation and treatment;

T2: Prior to randomisation and treatment;

Randomisation;

Treatment (COGRAT, or Cognitive treatment alone);

T3: After treatment;

T4: 6 months post treatment follow-up.

COGRAT consist of 2 arms given alongside during 12 weeks.



1. Cognitive strategy training: Frequency; 1x week for 2 hours (& homework) in small groups (max 4 patients). It consists of:

A. Patient education on fatigue after stroke and sleep hygiene;

B. Gaining insight into the individual activity and fatigability pattern by logging activities and fatigue;

C. Cognitive strategy training in order to prevent fatigue and manage existing fatigue. These strategies are: modification of activity patterns, improvement of planning abilities and the use of relaxation and leisure activities;

D. Cognitive behavioural Therapy (CBT) to enhance behavioural change and to assist in managing existing fatigue.



2. Graded Activity Training: Frequency: 2x week, for 2 hours & homework assignments.

A. Walking on a treadmill (with increasing inclination);

B. Strength training;

C. Stretching;

Maximum heart rate and strength are increased from 40% at the beginning of the training and increased during the treatment to a maximum of 70% at the end of the 12 weeks.