A roadmap for research in post-stroke fatigue: consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. Conclusions: By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue

Deficiency of dietary fiber modulates gut microbiota composition, neutrophil recruitment and worsens experimental colitis

Ulcerative colitis is an inflammatory disease of the colon that is associated with colonic neutrophil accumulation. Recent evidence indicates that diet alters the composition of the gut microbiota and influences host–pathogen interactions. Specifically, bacterial fermentation of dietary fiber produces metabolites called short-chain fatty acids (SCFAs), which have been shown to protect against various inflammatory diseases. However, the effect of fiber deficiency on the key initial steps of inflammation, such as leukocyte–endothelial cell interactions, is unknown. Moreover, the impact of fiber deficiency on neutrophil recruitment under basal conditions and during inflammation in vivo is unknown. Herein, we hypothesized that a fiber-deficient diet promotes an inflammatory state in the colon at baseline and predisposes the host to more severe colitis pathology. Mice fed a no-fiber diet for 14 days showed significant changes in the gut microbiota and exhibited increased neutrophil-endothelial interactions in the colonic microvasculature. Although mice fed a no-fiber diet alone did not have observable colitis-associated symptoms, these animals were highly susceptible to low dose (0.5%) dextran sodium sulphate (DSS)-induced model of colitis. Supplementation of the most abundant SCFA, acetate, prevented no-fiber diet-mediated enrichment of colonic neutrophils and colitis pathology. Therefore, dietary fiber, possibly through the actions of acetate, plays an important role in regulating neutrophil recruitment and host protection against inflammatory colonic damage in an experimental model of colitis

sj-docx-3-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-3-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p

sj-docx-4-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-4-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p

sj-docx-5-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-5-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p

sj-docx-2-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-2-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p

sj-docx-1-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-docx-1-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p

sj-pptx-6-wso-10.1177_17474930231189135 – Supplemental material for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable

Supplemental material, sj-pptx-6-wso-10.1177_17474930231189135 for A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable by Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie HY Wong, Dale Corbett and Gillian Mead in International Journal of Stroke</p