WSO - February 2024 - 139

English et al.
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Table 3. Stroke Fatigue Clinical Assessment Tool (SF-CAT).
The purpose of the tool is twofold; to ensure (1) fatigue is not missed as an unmet need (simple acknowledgment of fatigue as an issue
for people with stroke can greatly reduce distress) and (2) potentially modifiable causes are identified. It is designed for any health care
professional to administer via interview, using the questions in each of the categories. Modifiable factors should be addressed where
possible, with referral to other health professionals as needed.
Ask your patient/client if they:
Assess whether fatigue is an issue
Feel tired all the time or get tired quickly since your stroke?
Need additional help and support for this?
Consider mood disorders
Feel sad or depressed?
Feel anxious or stressed?
Consider sleep quality
Have difficulty falling or staying asleep?
Wake up frequently, or wake feeling unrefreshed?
Fall asleep unintentionally during the day?
Consider new/uncontrolled conditions
Have any new pain that bothers you?
Have hypotension?
Have chronic conditions (diabetes, hypothyroidism, anemia,
etc.) that are not optimally controlled?
Consider physical/nutrition status
Exercise regularly? Keep active?
Regularly miss meals?
Consider role of medication
Get side effects from your medications (e.g. beta blockers,
benzodiazepines, polypharmacy)?
Drink alcohol?
Consider new/undiagnosed cognitive impairment
Have new problems remembering things or concentrating?
Consider speech and/or language disorder
Do you often feel fatigued after talking or listening to others
talk?
Y: address/refer
Y: how much and how often? address/refer
Y: screen for cognitive impairment (e.g. MoCA)
Y: Screen (e.g. sections 9 and 10 NIH Stroke Scale) refer as
appropriate
FSS-7: Fatigue Severity Scale; PHQ9: Patient Health Questionnaire; GAD7: Generalized Anxiety Disorder; GSAQ: Global Sleep Assessment
Questionnaire; MoCA: Montreal Cognition Assessment; NIH: National Institute of Health Stroke Severity Scale.
Future clinical trials of fatigue management should carefully
consider issues, including participant selection and
combined intervention development and study design. For
participant selection, either the validated case definition for
fatigue34 (noting that this may miss some fatigue cases)35 or
the Greater Manchester Screening tool12 should be used.
Symptoms of depression and anxiety should generally not
be exclusion criteria and should be assessed at baseline and
follow-up. Trial materials and interventions must be accessible
for people with communication disorders.
New fatigue interventions should be co-designed by
people with lived experience of fatigue, clinicians, and
multidisciplinary researchers. Designs should include elucidation
of a theoretical model underpinning the hypothesized
mechanism of action. Models need not focus on
biological mechanisms-for example, interventions aiming
to improve self-management may be based on an assumption
around improving resilience and coping strategies or
reducing anxiety. Theoretical models that reflect mediating/moderating
relationships should guide the choice of
International Journal of Stroke, 19(2)
N: address/refer
Y: address/refer
Y: assess pain
Y: address/refer
Y: address/refer
Y: screen for insomnia, depression, and/or anxiety
Y: screen for sleep apnea/other sleep disorders (e.g. GSAQ)
Y: screen for depression (e.g. PHQ9)
Y: screen for anxiety (e.g. GAD7)
Y: screen for the potential causes and precipitating factors
(below), use FSS-7 for quantitative assessment

WSO - February 2024

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