Fatigue

Fatigue is common for people with a neurological condition and includes lack of energy or an increased need to rest every day, however, fatigue is characteristically not relieved by rest or sleep.

The National Clinical Guideline for Stroke (2023) recommends:

Healthcare professionals should anticipate post-stroke fatigue, and ask people with stroke (or their family/ carers) if they experience fatigue and how it impacts on their life.

Healthcare professionals should use a validated measure in their assessment of post-stroke fatigue, with a clear rationale for its selection, and should also consider physical and psychological fatigue, personality style, context demands and coping styles.

People with stroke should be assessed and periodically reviewed for post-stroke fatigue, including for factors that might precipitate or exacerbate fatigue (e.g. depression and anxiety, sleep disorders, pain) and these factors should be addressed accordingly. Appropriate time points for review are at discharge from hospital and then at regular intervals, including at 6 months and annually thereafter.

People with stroke should be provided with information and education regarding fatigue being a common post-stroke problem, and with reassurance and support as early as possible, including how to prevent and manage it, and signposting to peer support and voluntary sector organisations. Information should be provided in appropriate and accessible formats.

People with post-stroke fatigue should be involved in decision making about strategies to prevent and manage it that are tailored to their individual needs, goals and circumstances.

People with post-stroke fatigue should be referred to appropriately skilled and experienced clinicians as required, and should be considered for the following approaches, whilst being aware that no single measure will be effective for everyone:
- building acceptance and adjustment to post-stroke fatigue and recognising the need to manage it;
- education on post-stroke fatigue for the person with stroke, and their family/ and carers;
- using a diary to record activities and fatigue;
- predicting situations that may precipitate or exacerbate fatigue;
- pacing and prioritising activities;
- relaxation and meditation;
- rest;
- setting small goals and gradually expanding activities;
- changing diet and/or exercise (applied with caution and tailored to individual needs);
- seeking peer support and/or professional advice;
- coping methods including compensatory techniques, equipment and environmental adaptations.

Healthcare professionals working with people affected by post-stroke fatigue should be provided with education and training on post-stroke fatigue, including its multi-factorial nature and impact, potential causes and triggers, validated assessment tools and the importance of involving people affected by post-stroke fatigue in designing strategies to prevent and manage it.

Healthcare professionals working with people with post-stroke fatigue should consider the impact of fatigue on their day-to-day ability to engage with assessment and rehabilitation, and tailor the scheduling and length of such activities accordingly.

Service planners and managers should consider people with stroke whose ability to engage in rehabilitation is affected by post-stroke fatigue, and provide access to alternative solutions to ensure that they are still able to benefit from personalised rehabilitation input as required.

In April 2019, the network ran a workshop to improve clinical management and you can view the presentation on sleep and presentation on post stroke fatigue as well as other resources.