title: A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke: protocol paper.
abstract: BACKGROUND
  Approximately 20,000 people have a transient ischemic attack (TIA) and 23,375 have a minor stroke in England each year. Fatigue, psychological and cognitive impairments are well documented post-stroke. Evidence suggests that TIA and minor stroke patients also experience these impairments; however, they are not routinely offered relevant treatment. This systematic review aims to: (1) establish the prevalence of fatigue, anxiety, depression, post-traumatic stress disorder (PTSD) and cognitive impairment following TIA and minor stroke and to investigate the temporal course of these impairments; (2) explore impact on quality of life (QoL), change in emotions and return to work; (3) identify where further research is required and to potentially inform an intervention study.
  
  
  METHODS
  A systematic review of MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane libraries and grey literature between January 1993 and April 2013 will be undertaken. Two reviewers will conduct screening search results, study selection, data extraction and quality assessment. Studies of adult TIA and minor stroke participants containing any of the outcomes of interest; fatigue, anxiety, depression, PTSD or cognitive impairment will be included. Studies at any time period after TIA/minor stroke, including those with any length of follow-up, will be included to investigate the temporal course of impairments. QoL, change in emotions and return to work will also be documented. The proportion of TIA or minor stroke participants experiencing each outcome will be reported.If appropriate, a meta-analysis will pool results of individual outcomes. Studies will be grouped and analyzed according to their follow-up timeframe into short-term (< 3 months after TIA/minor stroke), medium-term (3 to 12 months) and long term (> 12 months). Sub-analysis of studies with a suitable control group will be conducted. Exploratory sub-analysis of memory and attention domains of cognitive impairment will be conducted.
  
  
  CONCLUSIONS
  The current treatment goal for TIA and minor stroke patients is secondary stroke prevention. If these patients do experience fatigue, psychological or cognitive impairments then this treatment alone is unlikely to be sufficient. The results of this comprehensive review will increase understanding of treatment needs for this patient group, identify where further research is required and potentially inform an intervention trial.
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, England. gxt513@bham.ac.uk.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Moran
authors.forename: Benjamin
authors.initials: B
authors.lastname: Fletcher
authors.forename: Melanie
authors.initials: M
authors.lastname: Calvert
authors.forename: Max G
authors.initials: MG
authors.lastname: Feltham
authors.forename: Catherine
authors.initials: C
authors.lastname: Sackley
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D016206:Databases, Bibliographic; D003863:Depression / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012107:Research Design; D062707:Return to Work / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D020521:Stroke / Q000523:psychology*; D000078202:Systematic Reviews as Topic