Unpacking the ‘black box’ of a nurse-led stroke support service Expanding the role of the stroke nurse: a pragmatic clinical trial. Controlled Education of patients after Stroke (CEOPS)- nurse-led multimodal and long-term interventional program involving a patient’s caregiver to optimize secondary prevention of stroke: study protocol for a randomized controlled trial Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial A qualitative study of specialist nurse support for stroke patients and care-givers at home The impact of a nurse-led support and education programme for spouses of stroke patients: a randomized controlled trial. A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale Multicenter Randomized Controlled Trial of an Outreach Nursing Support Program for Recently Discharged Stroke Patients The NAILED stroke risk factor trial (Nurse based Age independent Intervention to Limit Evolution of Disease after stroke): study protocol for a randomized controlled trial The impact of stroke nurse specialist input on risk factor modification: a randomised controlled trial. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke. Utility of a Post-Hospitalization Stroke Prevention Program Managed by Nurses Risk Factor Management in Survivors of Stroke: A Double-Blind, Cluster-Randomized, Controlled Trial The Impact of a Web-Based Caregiver Intervention on the Reasons Stroke Survivors Use Health Care Services During the First Year Post Treatment Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke. A randomized trial testing the superiority of a postdischarge care management model for stroke survivors. Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia
Objectives : To describe in detail the nature of the specialist nurse interventions ; to increase underst and ing of the principal problems facing stroke patients and their care-givers in the first year following stroke and to demonstrate how these problems may change over time ; and to investigate the value of qualitative research method ologies within the context of a r and omized trial . Methods :  Specialist nurses providing support in the year following stroke were asked to maintain comprehensive written records of their involvement with all patients and care-givers participating in a r and omized controlled trial .  Qualitative methods were used to examine the problems faced by stroke patients and their care-givers , and the actions taken by nurses in response . Results :  Specialist nurses commenced 120 records . As 19 patients died or left the area during the year-long interventions , we obtained 101 complete records . The problems encountered by stroke patients and their care-givers were numerous , diverse , complex and changed over time . Initially , practical difficulties were noted ; over time , these were accompanied by growing numbers of psychological needs . The nurses responded by providing information , advice , support and monitoring using a flexible , individualized approach . The nurses also collaborated or liaised with 17 other professional groups and provided direct support to care-givers . Conclusion : The need for many stroke patients and their care-givers to be professionally supported during the stages of stroke adjustment , for at least the first year and probably beyond , was emphasized by this study AIMS This paper reports a study evaluating whether exp and ing a specialist nursing role to provide outreach education and support to stroke patients and carers after discharge from hospital is effective in promoting recovery . BACKGROUND Building therapeutic relationships with patients and carers is a key component of the nursing role in stroke rehabilitation , although this is limited by the constraints of service organization . METHODS A pragmatic r and omized controlled trial was undertaken . Patients with a diagnosis of stroke were r and omized to receive continued support from a stroke nurse ( n = 87 ) or usual care and follow-up ( n = 89 ) after discharge from hospital . Patients were recruited from two hospitals in the north-west of Engl and from November 1999 to April 2001 .  Patient dependence ( Barthel Index ) , general health ( Nottingham Health Profile ) , activities of living ( Frenchay Activity of Living Index ) , depression ( Beck Depression Inventory ) and carer strain ( Carer Strain Index ) were assessed at 3 and 12 months after stroke . RESULTS The continued intervention of a stroke nurse after discharge was associated with improved patient perceptions of general health at 12 months ( median difference 42.6 , P = 0.012 ) , and in particular reduced negative emotional reaction ( P = 0.037 ) and perceived social isolation ( P = 0.002 ) . In addition , the intervention reduced carer strain at 3 months ( P = 0.045 ) , and reduced deterioration in physical dependence from 3 to 12 months ( P = 0.049 ) . CONCLUSION The provision of continued intervention from a stroke nurse after discharge from hospital , focusing on education and support , has tangible benefits for patients and carers Background Setting up a follow-up secondary prevention program after stroke is difficult due to motor and cognitive impairment , but necessary to prevent recurrence and improve patients ’ quality of life . To involve a referent nurse and a caregiver from the patient ’s social circle in nurse-led multimodal and long-term management of risk factors after stroke could be an advantage due to their easier access to the patient and family . The aim of this study is to compare the benefit of optimized follow up by nursing personnel from the vascular neurology department including therapeutic follow up , and an interventional program directed to the patient and a caregiving member of their social circle , as compared with typical follow up in order to develop a specific follow-up program of secondary prevention of stroke . Methods / design The design is a r and omized , controlled , clinical trial conducted in the French Stroke Unit of the Strokavenir network . In total , 410 patients will be recruited and r and omized in optimized follow up or usual follow up for 2 years . In both group , patients will be seen by a neurologist at 6 , 12 and 24 months . The optimized follow up will include follow up by a nurse from the vascular neurology department , including therapeutic follow up , and a training program on secondary prevention directed to the patient and a caregiving member of their social circle . After discharge , a monthly telephone interview , in the first year and every 3 months in the second year , will be performed by the nurse . At 6 , 12 and 24 month , the nurse will give the patient and caregiver another training session . Usual follow up is only done by the patient ’s general practitioner , after classical information on secondary prevention of risk factors during hospitalization . The primary outcome measure is blood pressure measured after the first year of follow up . Blood pressure will be measured by nursing personnel who do not know the group into which the patient has been r and omized . Secondary endpoints are associated mortality , morbidity , recurrence , drug side-effects and medico-economic analysis . Discussion The result of this trial is expected to provide the benefit of a nurse-led optimized multimodal and long-term interventional program for management of risk factors after stroke , personalizing the role of the nurse and including the patient ’s caregiver . Trial registration Clinical Trials.gov , NCT 02132364 . Registered on 7 May 2014 . EUDRACT , A 00473 - 40 BACKGROUND AND PURPOSE Limited evidence exists on the benefits of organized care for improving risk factor control in patients with stroke or transient ischaemic attack . The effectiveness of an individualized management programme in reducing absolute cardiovascular disease risk in this high-risk population was determined . METHODS This was a prospect i ve , multicentre , cluster-r and omized controlled trial with blinded assessment of outcomes and intention-to-treat analysis . Patients hospitalized for stroke/transient ischaemic attack and aged ≥18 years were recruited from four hospitals . General practice s treating recruited patients were r and omized to provide either usual care or an individualized management programme comprising nurse-led education and review of care plans by stroke specialists in addition to usual care . The primary outcome was a change in cardiovascular Framingham Risk Score between baseline and 12 months . RESULTS From January 2010 to November 2013 , 156 general practice s ( 280 patients ) were r and omly assigned to usual care ( control ) and 159 ( 283 patients ) to the intervention . The median age was 70.1 years ; 65 % were male . Overall , > 80 % of participants were prescribed recommended secondary prevention therapies at baseline . The primary efficacy analysis comprised 533 participants , with 30 either dying or lost to follow-up . In adjusted analyses , no significant between-group difference was found in the cardiovascular risk score at 12 months ( 0.04 , 95 % confidence interval -1.7 , 1.8 ) . CONCLUSIONS The effectiveness of an organized secondary prevention programme for stroke may be limited in patients from high-performing hospitals with regular post-discharge follow-up and communication with general practice Background : The involvement of  five specialist nurses  in providing a stroke support service  was evaluated quantitatively in a recent r and omized controlled trial . This complementary study used qualitative methods to evaluate trial outcomes more comprehensively . Aims : To identify whether the nurses ' intervention may have influenced the process of stroke recovery . Method : A purpose fully selected sub sample of 30 patients and 15 care-givers were interviewed within 1 - 3 months of their final quantitative assessment ( 12 months after recruitment to the r and omized trial ) . Fifteen of the patients and eight of the care-givers had received visits from a specialist nurse .  A semi- structured interview was design ed to include questions on perceptions of the recovery process and evaluation of services received . Results : Some differences were evident between the accounts of control and intervention group subjects . The less tangible aspects of nurses ' interventions - concern , attention , empathy and interest , when combined with sound professional knowledge , had identifiable value to the patients and care-givers . It appeared that the nurses had employed considerable sensitivity and skill in identifying and responding to particular needs at appropriate times . Conclusion : The qualitative evaluation offers a different picture to the quantitative results of the r and omized controlled trial . In general , the findings of the qualitative study are more positive and encouraging than the quantitative results . The majority of patients and care-givers in the intervention group believed that they had benefited from the specialist nurse 's visits AIMS AND OBJECTIVES The aim of the present study was to determine the impact of a nurse-led support and education programme for improving the spouses ' perceived general quality of life , life situation , general well-being and health state . BACKGROUND Stroke is a disease with great consequences for the patients and their families . The spouses often feel obligated to care for the patient , providing psychological and physical support and having to cope with the patient 's physical and cognitive impairments . This might lead to increased problems , as family members struggle to adapt to their new roles and responsibilities . DESIGN AND METHODS Longitudinal , r and omized controlled trial . One hundred spouses were r and omly assigned to intervention or control groups , 50 in each group . The intervention group participated in a support and education programme , six times during six months , led by stroke specialist nurses . Both groups were followed for 12 months . RESULTS No significant differences were found , between intervention and control groups , over time . In the sub analyses , we found that the group attending 5 - 6 times had a significant decrease in negative well-being and increased quality of life over time , while the group attending fewer times had a significant decrease in positive well-being and health state , similar to the control group , which also had a significant decrease in negative and general well-being . CONCLUSIONS A support and education programme might have a positive effect on  spouses ' well-being , on condition that they attend at least five times . RELEVANCE TO CLINICAL PRACTICE To facilitate the spouses ' role as informal caregivers to the stroke patients , further development of the support and education programme used in the present study is needed , including empowerment approach and implementation of coping strategies Rationale Stroke is the leading cause of death and disability in rural China . For stroke patients residing in re source -limited rural areas , secondary prevention and rehabilitation are largely unavailable , and where present , are far below evidence -based st and ards . Aim This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery , and evaluate its feasibility and effectiveness in rural China . Methods and design This 2-year r and omized controlled trial is being conducted in 2–3 county hospitals located in northwest , northeast , and southwest China . Eligible and consenting stroke in patients ( 200 in total ) have been recruited and r and omized into either a control or intervention group . Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group . They also provide telephone follow-up care three times post discharge . The recruitment , baseline , intervention , follow-up care , and evaluation are guided by the RECOVER mobile phone app specifically design ed for this study . Study outcome The primary outcome is patients ’ Barthel Index ( activities of daily living : mobility , self-care , and toileting ) at 6 months . Process and economic evaluation will also be conducted . Discussion The results of our study will generate initial high- quality evidence to improve stroke care in re source -scarce setting s. If proven effective , this innovative care delivery model has the potential to improve the health and function of stroke patients  , relieve caregiver burden , guide policy-making , and advance translational research in the field of stroke care Background and Purpose — Many stroke patients and informal carers experience a decreased quality of life after discharge home and are dissatisfied with the care received . We assessed the effectiveness of an outreach nursing care program . Methods — In a multicenter trial , 536 stroke patients were r and omized at discharge to st and ard care ( n=273 ) or st and ard care plus outreach care ( n=263 ) . The outreach care consisted of 3 telephone calls and 1 home visit within 5 months after discharge by 1 of 13 stroke nurses . Patients were masked for the trial objectives . Six months after discharge , they assessed the 2 primary outcomes : quality of life ( Short Form 36 [ SF-36 ] ) and dissatisfaction with care . Secondary measures of outcome were disability , h and icap , depression , anxiety , and use of health care services and secondary prevention drugs . Informal carers assessed strain , and social support . Analysis was by intention to treat . Results — Twelve patients died  before follow-up , 38 declined outcome assessment , and 486 completed the primary outcome assessment s. Outreach care patients had better scores on the SF-36 domain “ Role Emotional ” than controls ( mean difference 7.9 [ 95 % confidence limit , 0.1 to 15.7 ] ) . No statistically significant differences were found on the other primary outcome measures . For secondary outcomes , no statistically significant differences were found , except that intervention patients used fewer rehabilitation services ( relative risk , 0.66 [ 0.44 to 1.00 ] ) and had lower anxiety scores ( median difference 1 [ 0.19 to 2.79 ] ) . Conclusions — This outreach nursing stroke care was not effective in improving quality of life and dissatisfaction with care of recently discharged patients Background Secondary prevention after stroke and transient ischemic attack ( TIA ) is essential in order to reduce morbidity and mortality . Secondary stroke prevention studies have , however , been fairly small , or performed as clinical trials with non-representative patient selection . Long-term follow-up data is also limited . A nurse-led follow-up for risk factor improvement may be effective but the evidence is limited . The aims of this study are to perform an adequately sized , nurse-led , long-term secondary preventive follow-up with a population -based inclusion of stroke and TIA patients . The focus will be on blood pressure and lipid control as well as tobacco use and physical activity . Methods A r and omized , controlled , long-term , population -based trial with two parallel groups . The patients will be included during the initial hospital stay . Important outcome variables are sitting systolic and diastolic blood pressure , LDL cholesterol and total cholesterol . Outcomes will be measured after 12 , 24 and 36 months of follow-up . Trained nurses will manage the intervention group with a focus on reaching set treatment goals as soon as possible . The control group will receive usual care .  At least 200 patients will be included in each group , in order to reliably detect a difference in mean systolic blood pressure of 5 mmHg . This sample size is also adequate for detection of clinical ly meaningful group differences in the other outcomes . Discussion This study will test the hypothesis that a nurse-led , long-term follow-up after stroke with a focus on reaching set treatment goals as soon as possible , is an effective secondary preventive method . If proven effective , this method could be implemented in general practice at a low cost . Trial registration Current Controlled Trials IS RCT SIR— Interventions with an educational or counselling component have been reported to be effective in a variety of patient groups to encourage smoking cessation [ 1 ] , lower blood pressure ( BP ) [ 2 , 3 ] , achieve modest reductions in cholesterol [ 4 ] , and promote weight loss [ 5 ] . Evaluation of the impact of education on physical outcomes is lacking in stroke disease , despite evidence that inadequate provision of information may adversely affect compliance with secondary prevention and psychosocial outcomes [ 6 ] . We describe a single-blind r and omised controlled trial of health education and counselling for patients with stroke or transient ischaemic attack ( TIA ) , and its effects on risk factors , satisfaction , mood and perceived health status This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention  had better stroke knowledge , behaviour and self-efficacy than those who were exposed to traditional education programmes . The intervention group consisted of sixty five stroke patients r and omly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks . The normal care group consisted of sixty two stroke patients r and omly selected from a medical centre who received a general stroke education programme .  The stroke patients in two groups were assessed at baseline , after intervention and at the 6-month follow-up . At the 6-month follow-up , the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group . Three months after education , the intervention group exhibited changes in the knowledge of stroke , social participation and self-efficacy compared with those at baseline . Also , self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up ; self-efficacy was correlated with social participation after the 6-month follow-up . A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors , social participation and self-efficacy Abstract Goal : Evidence -based guidelines exist for the prevention and treatment of patients with cerebral ischemia . Despite these guidelines , there are gaps in clinical practice . Our study aim ed to determine if a physician-directed , nurse-case-management program could reduce individual patient vascular risk factors . Methods : Patients hospitalized with atherosclerotic cerebral ischemia with ≥ 1 major uncontrolled risk factor for stroke ( hypertension , tobacco use , dyslipidemia , diabetes ) were eligible to enroll in our study . Patients were r and omized to management by the nurse-prevention program or usual care .  Patients in the usual-care group received their initial risk-factor assessment and a scheduled follow-up at 1 year . Patients in the usual-care group underwent further follow-up by primary care and /or neurology as recommended during their hospitalization or outpatient visit . Patients assigned to the prevention group received individualized education , motivational interviewing , and were aided in setting up their risk-factor modification goal plan . Additional education was tailored to each patient based on individualized risk factors . Prevention-group patients also underwent consultation with a registered dietitian and an exercise physiologist . The primary endpoint of the study was improvement of ≥ 1 major patient risk factor for occurrence of stroke to goal at 1 year . Results : At 1-year post-hospitalization , patients in the nurse-care-management group were 42 % more likely to have met the primary endpoint ( n = 18 ; 61 % nurse-managed patients ) compared with 33 % ( n = 18 ) of patients undergoing usual care ( P = 0.09 ) . There was no significant reduction in minor risk factors for either patient group . Patients in the prevention group had greater reductions in low-density lipoprotein cholesterol levels ( −38 vs −4 ; P = 0.0083 ) , changes in cardiovascular risk score ( −5.2 vs 1.3 ; P = 0.0033 ) , and had a greater reductions in systolic blood pressure ( −12.2 vs −0.105 ; P = 0.07 ) than their usual-care counterparts ( changes shown respectively ) . Patients in the prevention group were more likely to follow a prescribed diet than those in the usual-care group ( 50 % ) vs 7 % , respectively ; P = 0.0070 ) and maintain an exercise program ( 83 % vs 33 % , respectively ; P = 0.0018 ) . Summary : A physician-directed , nurse case-management system for patients post-hospitalization for cerebral ischemia is feasible and may help improve long-term control of major patient risk factors for stroke . A larger trial is needed to verify trends noted in our study Background Comprehensive community care has the potential to improve risk factor management of patients with stroke or transient ischaemic attack . Aim The primary aim is to determine the effectiveness of an individualized management program on risk factor management for patients discharged from hospital after stroke . Design Multicentre , cluster-r and omized , controlled trial , with clusters by general practice . Participants are r and omized to receive intervention or control after a baseline assessment undertaken after discharge from hospital . The general practice they attend is marked as an intervention or control accordingly . All subsequent participants attending those practice s are automatically assigned as intervention or control . Baseline and all outcome assessment s , including an analysis of risk factors , are undertaken by assessors blinded to patient r and omization . Intervention Details Based on the results of blinded assessment s , the individualized management program group will receive targeted advice on how to manage their risk factors using a st and ardized , evidence -based template to communicate ‘ ideal ’ management with their general practitioner . In addition , patients r and omized to the individualized management program group will receive counselling and education about stroke risk factor management by an intervention study nurse . Individualized management programs will be review ed at three-months , six-months , 12 months , and 18 months after stroke , at which times they will be modified if appropriate . Stroke risk management will be evaluated using changes in the Framingham cardiovascular risk score . Analysis will be on an intention-to-treat basis using analysis of covariance or generalized linear model to adjust for baseline risk score and other relevant confounding factors Abstract Purpose : A Web-based education/support intervention for caregivers of stroke survivors was developed . A prospect i ve , descriptive design was used to identify caregivers ’ reported reasons for stroke survivors ’ health care service use ( i.e. , health care provider and emergency department visits , hospital readmissions ) during the first year after initial treatment . Method : Caregivers were recruited in the Midwest and r and omized into an experimental ( Web users , n = 36 ) or control ( non-Web users , n = 37 ) group .  Telephone interviews were conducted with the caregivers every 2 weeks . Reported reasons were organized by group and time period in which the service occurred ( i.e. , Months 1–6 or 7–12 ; 1-year totals ) . Content analysis and descriptive statistics were used to analyze these data . Results : Two themes emerged : wellness- and problem-oriented reasons for health care service use . Web users reported a large percentage of visits for rehabilitations reasons , which may have subsequently contributed to the musculoskeletal issues of this group . Laboratory work and testing was considered by both groups as a primary reason for provider visits . Non-Web users reported that medication adjustment was a common reason for provider visits . They also had more emergency department visits and hospital admissions for cardiology or pulmonology reasons . Conclusion : This study informs professionals about the care and needs of stroke survivors and provides direction for education and supportive interactions with caregivers and survivors OBJECTIVES to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager  would experience , compared to usual post-hospital care , better health-related quality of life ( HRQL ) , fewer emergency room visits and less non-elective hospitalisations . DESIGN a stratified , balanced , evaluator-blinded , r and omised clinical trial . SETTING five university-affiliated acute-care hospitals in Montreal , Quebec , Canada . PARTICIPANTS persons ( n = 190 ) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function , co-morbidity , or isolation . INTERVENTION for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls design ed to coordinate care with the person 's personal physician and link the stroke survivor into community-based stroke services . MEASUREMENTS the primary outcome was the Physical Component Summary ( PCS ) of the Short-Form (SF)-36 survey . A secondary outcome was utilisation of health services . Also measured was the impact of stroke on functioning . Measurements were made at hospital discharge ( baseline ) , following the 6-week intervention and at 6-months post-stroke . RESULTS the average age of the participants was 70 years .  Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity . There were no differences between groups on the primary outcome measure , health services utilisation , or any of the secondary outcome measures . CONCLUSION for this population , there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact , than usual post-discharge management OBJECTIVE We sought to evaluate whether comprehensive postdischarge care management for stroke survivors is superior to organized acute stroke department care with enhanced discharge planning in improving a profile of health and well-being . METHODS This was a r and omized trial of a comprehensive postdischarge care management intervention for patients with ischemic stroke and National Institutes of Health Stroke Scale scores greater than or equal to 1 discharged from an acute stroke department . An advanced practice nurse performed an in-home assessment for the intervention group from which an interdisciplinary team developed patient-specific care plans . The advanced practice nurse worked with the primary care physician and patient to implement the plan during the next 6 months . The intervention and usual care groups were compared using a global and closed hypothesis testing strategy . Outcomes fell into 5 domains : ( 1 ) neuromotor function , ( 2 ) institution time or death , ( 3 ) quality of life , ( 4 ) management of risk , and ( 5 ) stroke knowledge and lifestyle . RESULTS Treatment effect was near 0 SD for all except the stroke knowledge and lifestyle domain , which showed a significant effect of the intervention ( P = .0003 ) . CONCLUSIONS Postdischarge care management was not more effective than organized stroke department care with enhanced discharge planning in most domains in this population . The intervention did , however , fill a postdischarge knowledge gap Rationale PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack . Within one-year of hospital discharge , up to one-third of patients no longer adhere to secondary prevention behaviors . Adherence rates are lower in minority-underserved groups , contributing to health disparities . In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals . In these groups , low literacy , limited healthcare access , and sparse community re sources may reduce adherence . Lay community health workers ( navigators ) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services . Aims and design PROTECT DC is a Phase II , single-blind , r and omized , controlled trial comparing in-hospital education plus stroke navigators to usual care .  Atherogenic ischemic stroke and transient ischemic attack survivors are recruited from Washington , DC hospitals .  Navigators meet with participants during the index hospitalization , perform home visits , and meet by phone . They focus on stroke education , medication compliance , and overcoming practical barriers to adherence . The interventions are driven by the theories of reasoned action and planned behavior . Study outcomes The primary dependent measure is a summary score of four objective measures of stroke risk factor control : systolic blood pressure , low-density lipoprotein , hemoglobin Hb A1C , and antiplatelet agent pill counts . Secondary outcomes include stroke knowledge , exercise , dietary modification , and smoking cessation . Conclusion PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted
Conclusion : We found that interventions in which nurses had a primary role were effective on improving medical and behavioral risk factors , as well as knowledge of risk factors as part of secondary prevention of stroke
Background and purpose : Among members of the health care team , nurses play a large role in actively engaging stroke survivors in secondary stroke prevention programs .
This systematic review and meta- analysis examines the effectiveness of interventions in which nurses have a primary role on modification of risk factors among stroke survivors .