Effectiveness of cognitive and graded activity training (COGRAT) on post stroke fatigue. A multi-center study
04 / 2007 - 01 / 2011
Excessive fatigue after stroke is a common and chronic complaint with estimated prevalence rates between 28-73% even in stroke patients who seem to recover well. This may lead to impairments in daily functioning. And up to date no evidence based treatments are available. In the Sint Maartenskliniek, a pilot study on a treatment yielded positive results on fatigue and psychological distress after treatment. The purpose if this study was therefore to qualitatively adapt the protocol and evaluate the cognitive treatment with and without Graded Activity Training in a randomized multi-center trial. In a multi-center trial 96 stroke patients will participate in this waiting-list controlled randomized controlled trial. Each patient will be submitted to a first measurement at admission. Then, every patient will be placed on a waiting list for three months (the so-called qualification period) and a second measurement will take place, just before random assignment to one out of two treatment conditions: (a) the full COGRAT training, (b) the cognitive part of COGRAT only. At the end of treatment, and 6 months after the end of treatment (follow-up) every participant will be assessed again. The assessments comprise fatigue complaints lists, registrations of physical activity (with actometers), neuropsychological tests, and psychosocial questionnaires on coping, attributions, self-efficacy, and social support. Of the 231 patients screened, 88 completed the waiting list period. Of these patients 73 finished treatment, and follow-up measurements of 68 patients are available. Both treatments yielded positive results, directly after treatment and at six month follow-up. However, in the COGRAT group significantly more patients attained a clinically significant reduction of fatigue after treatment and follow-up than in the group receiving cognitive therapy alone.