Five-year study finds post-stroke fatigue follows four distinct trajectories, not a uniform decline

A Norwegian multicentre cohort of 693 stroke patients, recruited from acute stroke units and followed for five years, examined how post-stroke fatigue evolves over time Primary Study. Overall fatigue prevalence remained broadly stable, between 24% and 30%, from three months to five years after stroke. However, latent trajectory modelling identified four distinct subgroups within that average — low, emerging, improving and high fatigue — showing that the apparently stable population-level figure conceals substantial individual variability.

This is one of the longest longitudinal follow-ups of post-stroke fatigue trajectories published to date, and the strongest currently available evidence on how fatigue actually evolves at the individual level rather than the population level. As a Norwegian cohort, the specific proportion of patients in each trajectory subgroup should be read with some caution before assuming direct transfer to other health systems.

The trajectory-based approach implies that psychology and therapy follow-up after stroke could be more effectively targeted at the minority of patients following an emerging or high-fatigue trajectory, rather than applying uniform blanket review to the whole stroke survivor population — an approach that would use scarce follow-up capacity more efficiently, provided local services can identify which trajectory a given patient is likely to be on.