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NON-PHARMACOLOGICAL INTERVENTIONS FOR ALLEVIATING FATIGUE AND PROMOTING SLEEP IN PEOPLE WITH STROKE: A META-ANALYSIS
Background and Aims
Treating predisposing factors of fatigue such as sleep quality may help reduce fatigue in people with stroke. In the last decade, more interventions have been developed for stroke survivors having fatigue, but the effects of non-pharmacological interventions on fatigue and sleep quality among this population remains unclear. This review aimed to evaluate the effects of non-pharmacological interventions on fatigue and sleep quality among people with stroke.
We searched the randomized controlled trials about non-pharmacological interventions for alleviating fatigue and promoting sleep in seven databases. The search included the clinical trial registries, reference lists and the forward citations of the included publications. The standardized mean difference (SMD) or mean difference (MD) of fatigue and/or sleep variables at different time points post-intervention were/was estimated using random effects models.
Seventeen studies (n=1,079) were analyzed. Non-pharmacological interventions were summarized into four types: physical intervention, cognitive intervention, oxygen therapy, and traditional Chinese medicine. Compared to the control groups, non-pharmacological interventions significantly improved sleep quality (SMD= -0.76, 95% CI= -1.27 to -0.25) and insomnia (MD= -4.19, 95% CI= -5.77 to -2.60) but not fatigue, sleep apnea, and sleepiness immediately post-intervention. Non-pharmacological interventions had insignificant short and medium-term effects on fatigue, but their longer-term effects on sleep quality, insomnia, and sleepiness were inconclusive.
Non-pharmacological interventions could improve sleep quality and insomnia immediately post-intervention among people with stroke. Further robust studies are needed to determine their immediate and longer-term effects on fatigue and sleep.
EFFECT OF THE TOOL ‘BEFAST’ ON STROKE IDENTIFICATION: A SCOPING REVIEW
Background and Aims
FAST(Facial weakness,Arm droop,Slurry Speech and Time) which is used for identifying acute strokes mostly recognize signs which are related to anterior circulation stroke.Several medical institutions are now applying BEFAST with two components added to FAST(B-Balance disturbances /E-Eye issues) for identifying common posterior circulation stroke signs also.We aim to review and synthesize relevant knowledge on the effect of adding BE with FAST for stroke identification.
The review followed scoping methodological framework outlined by Arskey and O’Malley(2005).An extensive literature search with electronic databases like Embase,PubMed,Medline,CINAHL, APA PsycINFO,Google scholar and grey literature was undertaken.Study selection was conducted according to inclusion criteria with the help of PRISMA flowchart.Study design wasn't restricted for conducting an extensive search and date range from 2015 onwards was considered for reviewing recent research in the field.
Out of 56 articles,18 articles were included in the review upon meeting the criteria.BEFAST was found to be effective in many of the included papers,even though there were few studies with no significant difference in adding'BE’to the current existing FAST.Additionally, the review pointed out BEFAST to be taking the role of a screening tool among the clinicians more than a public awareness tool.
The BEFAST was found to be effective as a screening tool for identification, particularly those belonging to posterior circulation.Therefore,revision of the existing tool to BE FAST may be recommended while attempting to avoid missed strokes which could manifest with posterior circulation. However,further research over larger population and variety settings are required to confirm its effect as a public awareness tool.