{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:23:21Z","timestamp":1792113801417,"version":"4.4.0"},"reference-count":70,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neurorehabil Neural Repair"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Fatigue affects 50% to 90% of patients with multiple sclerosis, Parkinson\u2019s disease, stroke, ME\/CFS, and long COVID and represents a primary barrier to rehabilitation participation yet remains poorly understood despite decades of research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>The Problem:<\/jats:title>\n                    <jats:p>Systematic examination of recent comprehensive reviews reveals a dual diversity failure. Brain diversity is underexamined: fatigue, fundamentally a central nervous system symptom, is assessed predominantly through questionnaires (95%-100% of studies) and peripheral biomarkers, while functional neuroimaging appears in fewer than 15% of studies. Population diversity is neglected: reviews consistently document a predominance of Western European and North American cohorts, with racial and ethnic composition inconsistently reported and demographic stratification virtually absent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>The Solution:<\/jats:title>\n                    <jats:p>Identical fatigue scores reflect heterogeneous brain mechanisms, basal ganglia hypometabolism, frontal dysfunction, inflammatory network disruption, and differentially distributed across populations. Five testable predictions distinguish this framework: (1) neuroimaging reveals distinct subtypes; (2) subtypes show different clinical phenotypes; (3) treatment responses vary by subtype; (4) populations differ in subtype distribution; and (5) stratification resolves apparently inconsistent findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recommendations:<\/jats:title>\n                    <jats:p>Fatigue rehabilitation research should (1) incorporate multimodal neuroimaging as standard, with a tiered protocol accommodating participant burden; (2) intentionally recruit demographically diverse populations; (3) employ data-driven clustering to identify brain-based subtypes; and (4) conduct mechanism-stratified treatment trials. An illustrative study design incorporating multimodal neuroimaging, comprehensive clinical and biological assessment, and diverse population sampling can test core predictions within existing research infrastructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact:<\/jats:title>\n                    <jats:p>Mechanism-based patient stratification enables precision rehabilitation, reducing required trial sample sizes while identifying effective interventions and preventing harm in vulnerable subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15459683261481762","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:33:46Z","timestamp":1788172426000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Fatigue in Neurological Rehabilitation: Why Brain Diversity and Population Diversity Matter"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2057-7793","authenticated-orcid":false,"given":"Thorsten","family":"Rudroff","sequence":"first","affiliation":[{"name":"Turku PET Centre, Department of Clinical Medicine, University of Turku and Turku University Hospital, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31827f07be"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15794-2"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-022-00846-2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909113494748"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1747493019847334"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2015.00052"},{"issue":"9","key":"e_1_3_2_8_2","article-title":"Exercise therapy for fatigue in multiple sclerosis","volume":"2015","author":"Elbers RG","year":"2015","unstructured":"Elbers RG, Rietberg MB, van Wegen EE, et al. 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