Reducing Recurrent Stroke: Methodology of the Motivational Interviewing in Stroke (MIST) Randomized Clinical Trial Baseline feature of a randomized trial assessing the effects of disease management programs for the prevention of recurrent ischemic stroke. Increased risk of stroke among men with erectile dysfunction: a nationwide population-based study. 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 Risk Factors of Stroke Incidence and Mortality: A 12‐Year Follow‐up of the Oslo Study Preventive effects of multiple domain interventions on lifestyle and risk factor changes in stroke survivors: Evidence from a two-year randomized trial Stroke incidence and risk factors for stroke in Copenhagen, Denmark. 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 [A prospective study of stroke recurrence and the risk factors]. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register Utility of electronic patient records in primary care for stroke secondary prevention trials A telehealth intervention to promote healthy lifestyles after stroke: The Stroke Coach protocol Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled trial Intensified secondary prevention intending a reduction of recurrent events in TIA and minor stroke patients (INSPiRE-TMS): a protocol for a randomised controlled trial A Long-Term Follow-Up Programme for Maintenance of Motor Function after Stroke: Protocol of the life after Stroke—The LAST Study Risk Factor Management in Survivors of Stroke: A Double-Blind, Cluster-Randomized, Controlled Trial
Rationale Recurrent stroke is prevalent in both developed and developing countries , contributing significantly to disability and death . Recurrent stroke rates can be reduced by adequate risk factor management . However , adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor , leading to a large number of preventable recurrent strokes . Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke . Aims and /or hypothesis The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke . Design Recruitment of 430 first-ever stroke participants will occur in the Auckl and and Waikato regions . R and omization will be to intervention or usual care groups . Participants r and omized to intervention will receive four motivational interviews and five follow-up assessment s over 12 months . Nonintervention participants will be assessed at the same time points . Study outcomes Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke . Secondary outcomes include self-reported adherence and barriers to prescribed medications , new cardiovascular events ( including stroke ) , changes in quality of life , and mood . Discussion The results of the motivational interviewing in stroke trial will add to our underst and ing of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant BACKGROUND Comprehensive and long-term patient education programs design ed to improve self-management can help patients better manage their medical condition . Using disease management programs ( DMPs ) that were created for each of the risk factor according to clinical practice guidelines , we evaluate their influence on the prevention of stroke recurrence . METHODS This is a r and omized study conducted with ischemic stroke patients within 1 year from their onset . Subjects in the intervention group received a 6-month DMPs that included self-management education provided by a nurse along with support in collaboration with the primary care physician . Those in the usual care group received ordinary outpatient care . The primary end point is a difference of the Framingham risk score-general cardiovascular disease 10-year risk [ corrected ] . Patients were enrolled for 2 years with plans for a 2-year follow-up after the 6-month education period ( total of 30 months ) . RESULTS A total of 321 eligible subjects ( average age , 67.3 years ; females , 96 [ 29.9 % ] ) , including 21 subjects ( 6.5 % ) with transient ischemic attack , were enrolled in this study . Regarding risk factors for stroke , 260 subjects ( 81.0 % ) had hypertension , 249 subjects ( 77.6 % ) had dyslipidemia , 102 subjects ( 31.8 % ) had diabetes mellitus , 47 subjects ( 14.6 % ) had atrial fibrillation , and 98 subjects ( 30.5 % ) had chronic kidney disease .  There were no significant differences between the 2 groups with respect to subject characteristics . CONCLUSIONS This article describes the rationale , design , and baseline features of a r and omized controlled trial that aim ed to assess the effects of DMPs for the secondary prevention of stroke . Subject follow-up is in progress and will end in 2015 INTRODUCTION Previous cross-sectional studies have suggested that erectile dysfunction ( ED ) represents an independent risk factor for future cardiovascular events . However , very few studies have attempted to examine the association between ED and subsequent stroke . AIM The aim of this study is to estimate the risk of stroke during a 5-year follow-up period after the first ambulatory care visit for the treatment of ED using nationwide , population -based data and a retrospective case-control cohort design in Taiwan . METHODS This study used data source d from the " Longitudinal Health Insurance Data base . " The study cohort comprised 1,501 patients who received a principal diagnosis of ED between 1997 and 2001 and 7,505 r and omly selected subjects as the comparison cohort . Each patient ( N = 9,006 ) was then individually tracked for 5 years from their index ambulatory care visit to identify those who had diagnosed episodes of stroke . MAIN OUTCOME MEASURE Stratified Cox proportional hazard regressions were performed as a means of comparing the 5-year stroke-free survival rate for the two cohorts . RESULTS Of the sample d patients , 918 ( 10.2 % ) developed stroke within the 5-year follow-up period , that is , 188 individuals ( 12.5 % of the patients with ED ) from the study cohort and 730 individuals ( 9.7 % of patients in the comparison cohort ) from the comparison cohort . The log-rank test indicated that patients with ED had significantly lower 5-year stroke-free survival rates than those in the comparison cohort ( P < 0.001 ) . After adjusting for the patient 's monthly income , geographical location , hypertension , diabetes , coronary heart disease , peripheral vascular disease , atrial fibrillation , and hyperlipidemia , patients with ED were more likely to have a stroke during the 5-year follow-up period than patients in the comparison cohort ( hazard ratio = 1.29 , 95 % confidence interval = 1.08 - 1.54 , P < 0.01 ) . CONCLUSIONS These results suggest that ED is a surrogate marker for future stroke in men 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 Background and Purpose The objective of this study was to determine the risk factors of stroke incidence and mortality . Methods Our data are based on a prospect i ve cohort study of men aged 40 to 49 years after 12 years of follow-up . Results In age-adjusted Cox proportional-hazards regression analysis of 14 403 healthy men , diastolic blood pressure was a stronger predictor for stroke incidence and mortality than systolic blood pressure . Smoking was a stronger predictor of mortality than of incidence . However , there was no dose-response relation among smokers by increased cigarette consumption . Total serum cholesterol was a significant ( P < .05 ) risk factor for stroke mortality and of borderline significance ( P=.08 ) for stroke incidence . Increased physical activity  at leisure was associated with reduced stroke incidence but not mortality . The myocardial infa rct ion risk score comprising systolic blood pressure , total serum cholesterol , and daily cigarette smoking was a strong predictor of mortality and incidence . Body mass index , triglycerides , blood glucose , and physical activity at work were not found to be risk factors for stroke . Conclusions Reduction of blood pressure , cessation of smoking , lowered cholesterol  , and increased physical activity at leisure  are individual measures to reduce the risk of stroke Background and aim Behavioral and lifestyle interventions in stroke patients need to be intense enough to result in sustainable treatment differences among groups of a r and omized trial . Therefore , we report the effects of multidomain interventions on lifestyle and laboratory parameters after 12 and 24 months from a trial that examined whether intensive risk factor management can prevent cognitive decline in ischemic stroke patients . Methods This prospect i ve r and omized , open-label , blinded endpoint trial recruited patients within three months after acute stroke in five Austrian neurological clinics during June 2010 and November 2012 . One hundred and one patients were r and omized into multidomain intervention and 101 into st and ard care . Lifestyle interventions were individualized to match predefined targets of regular physical activity , healthy diet , and adequate physiological risk factor control . Results A total of 167 participants ( 80 intervention , 87 control ) completed the 12-month visit and 155 ( 76 intervention , 79 control ) the 24-month visit . During the first 12 months , adherence to healthy lifestyle and adequately controlled physiological parameters ( measured by summary scores ) improved significantly in the intervention group compared to controls ( p < 0.01 ) . The consumption of reduced-fat milk ( p = 0.031 ) , reduced-fat spreads ( p = 0.007 ) , and fish ( p = 0.021 ) increased in the intervention group from baseline to 12 months but not in controls . After 24 months , the group difference was significant for the lifestyle summary score but no longer for the combined laboratory lifestyle score . Conclusions These results demonstrate that intensified individualized multidomain lifestyle interventions in stroke patients are effective in promoting healthy lifestyle in stroke care Stroke incidence in Copenhagen , Denmark was recorded in a r and om population sample of 19,327 persons invited for two health examinations with 5 years ' interval from 1976 to 1983 . Stroke incidence increased exponentially with age . After adjustment to the age and sex distribution of the Danish population in 1980 , the estimated incidence of first stroke was 1.41/1000 women and 2.48/1000 men ; the total incidence was 1.94/1000 population . Risk factor analysis was based on the initial examination of 13,088 persons greater than 35 years old without previous stroke who responded to the first invitation , in whom 295 first strokes were subsequently observed . We used the regression model of Cox . However , our use of this model differs from the somewhat automatic procedures normally used to develop prognostic models . Evaluation of the causative effect of a particular risk factor requires that the direction of mutual influences between the factor in question and other risk factors is established/postulated . Among the 16 potential risk factors for stroke we examined , significant effects were found for age , sex , household income , smoking habits , systolic blood pressure , diabetes , plasma cholesterol concentration , ischemic heart disease , and atrial fibrillation . No significant effect could be demonstrated for a positive family history of stroke , years of school education , marital status , alcohol consumption , daily use of tranquilizers , body mass index , or postmenopausal hormone treatment 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 OBJECTIVE To evaluate prognosis of stroke and identify the risk factors for stroke recurrence . METHODS Based on the West China Hospital stroke register data base , we conducted a prospect i ve follow-up study of stroke patients to record the potential risk factors of stroke recurrence and investigate stroke recurrence at 1 year . Analysis of the risk factors was performed using a logistic regression model . RESULTS A total of 1913 stroke consecutive patients admitted to our department were prospect ively registered . Of these patients , 599 ( 31.3 % ) were identified to have intracerebral hemorrhage ( ICH ) , and 1314 ( 68.7 % ) had ischemic stroke . The total recurrence rate at 1 year was 11.2 % , and was 10.5 % in ischemic patients and 12.7 % in ICH patients . Multivariate analysis adjusted for age and gender identified atrial fibrillation , hypertension , hyperlipemia , family history of stroke , and smoking as the risk factors of stroke recurrence at 1 year . CONCLUSION The 1 year recurrent rate is about 11 % , and monitoring the factors of atrial fibrillation , hyperlipemia , hypertension , and smoking may help reduce the recurrence of stroke Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background and Purpose — This article examines stroke recurrence and whether the subtype of the initial stroke influences the risk and subtypes of further strokes . The proportion of recurrences attributable to conventional risk factors is quantified . Methods — From January 1995 to August 2000 , all first-in-a-lifetime strokes ( n=1626 ) were identified and prospect ively followed up in a defined multiethnic inner city population of 234 533 . Twelve overlapping referral sources and face-to-face follow-up at 3 months and 1 and 3 years were used to attain complete registration of stroke recurrence . Index and recurrent stroke were classified according to the Oxford Community Stroke Project classification . Results — In 2744 person-years of follow-up , 153 recurrences were observed . At 5 years , the cumulative risk of first stroke recurrence was 16.6 % ( 95 % CI , 13.5 to 20.4 ) , and the combined risk of death or stroke recurrence was 65.3 % ( 95 % CI , 61.9 to 68.6 ) . Ethnicity and subtype of index stroke were not associated with stroke recurrence . A change in subtype between index and recurrent stroke occurred in 45.5 % ( 95 % CI , 35.8 to 55.2 ) of cases and was most frequent among index lacunar strokes and primary intracerebral hemorrhages . In multivariable analyses , diabetes mellitus and atrial fibrillation were associated with both stroke recurrence and recurrence-free survival . In the stroke population , 9.1 % ( 95 % CI , −2.0 to 20.2 ) of recurrences were attributable to diabetes and 4.9 % ( 95 % CI , −7.3 to 17.2 ) to atrial fibrillation during the first year after the index stroke . Conclusions — The cause of stroke recurrence is multifactorial , and the subtypes of index and recurrent strokes are often not identical . Most recurrences remain unexplained by conventional risk factors Background This study aim ed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records ( EPRs ) as potential outcome measures . The study also evaluated achievement of recommended st and ards of care ; variation between family practice s ; and changes in risk factor values from before to after stroke . Methods Data from the UK General Practice Research Data base ( GPRD ) were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practice s. For each subject , the EPR was evaluated for the 12 months before and after stroke . Measures relevant to stroke secondary prevention were analysed including blood pressure ( BP ) , cholesterol , smoking , alcohol use , body mass index ( BMI ) , atrial fibrillation , utilisation of antihypertensive , antiplatelet and cholesterol lowering drugs . Intraclass correlation coefficients ( ICC ) were estimated by family practice . R and om effects models were fitted to evaluate changes in risk factor values over time . Results In the 12 months following stroke , BP was recorded for 90 % , cholesterol for 70 % and body mass index ( BMI ) for 47 % . ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol . For subjects with records available both before and after stroke , the mean reductions from before to after stroke were : mean systolic BP , 6.02 mm Hg ; diastolic BP , 2.78 mm Hg ; total cholesterol , 0.60 mmol/l ; BMI , 0.34 Kg/m2 . There was an absolute reduction in smokers of 5 % and heavy drinkers of 4 % . The proportion of stroke patients within the recommended guidelines varied from less than a third ( 29 % ) for systolic BP , just over half for BMI ( 54 % ) , and over 90 % ( 92 % ) on alcohol consumption . Conclusions Electronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention . Stroke prevention interventions in primary care remain suboptimal but important reductions in vascular risk factor values were observed following stroke . Better recording of lifestyle factors in the GPRD has the potential to exp and the scope of the GPRD for health care research and practice Rationale Recurrent stroke is prevalent and associated with high mortality rates , disability , and social and economic costs . Adequate management of risk factors may reduce recurrent stroke ; however , many stroke survivors have poor control of risk factors . We have developed a theoretically sound and evidence -based lifestyle modification program called the Stroke Coach , a telephone-based self-management program to improve control of risk factors . Hypothesis Individuals who participate in Stroke Coach will achieve more lifestyle improvements than individuals in an attention controlled Memory Training Program . Design In this single blind r and omized controlled trial , 126 community-living stroke survivors will be r and omized to Stroke Coach or the attention control group . Participants r and omized to the six-month Stroke Coach will receive seven telephone lifestyle coaching sessions , self-management education and practice , and a self-monitoring kit , comprised of a health report card , with blood pressure and activity monitors . Study Outcomes The primary outcome will be measured using the Health Promoting Lifestyle Profile II . Secondary outcomes include behavioral and physiological risk factors , quality of life , cognitive status , health and social service use . Measurements will be taken at baseline , immediately after the intervention and six-month post-intervention . Summary The results of this trial will add to our underst and ing of the use of self-management to improve control of risk factors , and may facilitate the development of a larger trial evaluating the effect of Stroke Coach on endpoints such as recurrent stroke or cardiac events as the primary outcome 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 Patients with recent stroke or TIA are at high risk for new vascular events . Several evidence based strategies in secondary prevention of stroke are available but frequently underused . Support programs with multifactorial risk factor modifications after stroke or TIA have not been investigated in large-scale prospect i ve controlled trials so far . INSPiRE-TMS is a prospect i ve , multi-center , r and omized open intervention trial for intensified secondary prevention after minor stroke and TIA . Methods / design Patients with acute TIA or minor stroke admitted to the participating stroke centers are screened and recruited during in-hospital stay . Patients are r and omised in a 1:1 ratio to intervention ( support program ) and control ( usual care ) arms . Inclusion of 2.082 patients is planned . The support program includes cardiovascular risk factor measurement and feedback , monitoring of medication adherence , coaching in lifestyle modifications , and active involvement of relatives . St and ardized motivational interviewing is used to assess and enhance patients ’ motivation . Primary objective is a reduction of new major vascular events defined as nonfatal stroke and myocardial infa rct ion or vascular death . Recruitment time is planned for 3.5 years , follow up time is at least 2 years for every patient result ing in a total study time of 5 years ( first patient in to last patient out ) . Discussion Given the high risk for vascular re-events in acute stroke and the available effective strategies in secondary prevention , the INSPIRE-TMS support program has the potential to lead to a relevant reduction of recurrent events and a prolongation of the event-free survival time . The trial will provide the basis for the decision whether an intensified secondary prevention program after stroke should be implemented into regular care . A cost-effectiveness evaluation will be performed . Trial registration clinical trials.gov : Background . There are no evidence -based strategies that have been shown to be superior in maintaining motor function for months to years after the stroke . The LAST study therefore intends to assess the effect of a long-term follow-up program for stroke patients compared to st and ard care on function , disability and health . Design . This is a prospect i ve , multi-site r and omised controlled trial , with blinded assessment 18 months after inclusion . A total of 390 patients will be recruited and r and omised to a control group , receiving usual care , or to an intervention group 10 to 16 weeks after onset of stroke . Patients will be stratified according to stroke severity , age above 80 , and recruitment site . The intervention group will receive monthly coaching on physical activity by a physiotherapist for 18 consecutive months after inclusion . Outcomes . The primary outcome is motor function ( Motor Assessment Scale ) 18 months after inclusion . Secondary outcomes are : dependency , balance , endurance , health-related quality of life , fatigue , anxiety and depression , cognitive function , burden on caregivers , and health costs . Adverse events and compliance to the intervention will be registered consecutively during follow-up 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
Conclusion Stroke secondary prevention lifestyle interventions are effective in terms of effecting positive change in lifestyle behaviors and secondary outcomes , and appear promising in relation to physiological outcomes .
There was insufficient evidence to determine the effect of intervention on incidence of stroke recurrence
Background A feature of stroke is that it recurs ( 25 % within five-years ) .
Risk factors for stroke and recurrent stroke include smoking , alcohol consumption , poor diet , and physical inactivity .
Aim To evaluate the effectiveness of secondary prevention lifestyle interventions design ed to change lifestyle behavior following stroke .
This short paper presents a summary of the systematic review process and findings .