ABSTRACT NUMBER: ESOC2026A83 INVISIBLE BURDEN, CRITICAL GAPS: A GLOBAL SCOPING REVIEW OF POST-STROKE FATIGUE ASSESSMENT DISPARITIES IN SOUTH ASIA

Abstract Background and aims Post-stroke fatigue (PSF) affects ~50% of survivors, ranking among their most distressing concerns. South Asia bears 25% of global stroke burden yet has sparse research, creating a critical evidence gap. This review systematically assesses international PSF data to understand methodological challenges and identify priorities for equitable research. Methods Per PRISMA-ScR guidelines, we searched six databases and grey literature (2000-2025) for studies on adult stroke survivors examining PSF prevalence, assessment, mechanisms, or management. Results From 2,944 records, 97 studies (31 countries) were included. Global PSF prevalence was 50%, varying threefold (12-85%) by assessment method. South Asian studies reported lower prevalence (12-15%) versus Europe/North America (52-55%). Sixteen assessment tools were identified; the dominant Fatigue Severity Scale showed 8-12% depression confounding. Four factors consistently associated with PSF: functional disability (aOR 2.4-8.7), depression (aOR 1.8-6.3), poor sleep quality (aOR 2.8-4.9), and pre-stroke fatigue (OR=4.2). Neuroinflammatory markers showed mechanistic potential. No medication proved consistently effective, while small trials of CBT+graded activity showed promise. Notably, no intervention trials have been conducted in India. Conclusions Regional differences seen may reflect measurement challenges and research gaps, not epidemiology. The lack of culturally appropriate tools and interventions in South Asia is an equity issue. We recommend developing culturally validated instruments, implementing routine screening, promoting self-management strategies, and building research capacity in underrepresented regions. Addressing PSF systematically in stroke guidelines could improve outcomes worldwide. Conflict of interest Nothing to disclose