An integrative literature review to examine the provision of self-management support following transient ischaemic attack.

Abstract

To identify the types of self-management support that have been provided to persons with transient ischaemic attack and the evidence for the effectiveness of these programmes. Self-management is a key element for the effective management of chronic conditions. For persons with transient ischaemic attack, secondary stroke prevention is a recognised standard of care. Best practice guidelines indicate that persons who have experienced transient ischaemic attack should be supported to develop self-management skills. However, it is not clear how best to support the development of these skills. An integrative literature review was conducted. A search was conducted using Medline, Embase, HealthSTAR, CINAHL and PsycINFO. Published quantitative and qualitative studies, abstracts or dissertations describing the provision, experience or outcomes of self-management interventions for people with transient ischaemic attack, and published in English before March 2016, were included. Articles were selected and rated separately by two reviewers. The American Academy for Cerebral Palsy and Developmental Medicine Level of Evidence and Conduct Rating tools were used for rating. Interventions were described and compared, and evidence was presented using the traffic lighting system. Sixteen interventions representing a variety of group- and individual-based interventions were identified. Interventions differed in target population, content, structure, duration and outcomes. Only four interventions were specifically designed for persons with transient ischaemic attack. While evidence to support self-management interventions is promising, there is limited evidence to support any one intervention. However, one good-quality randomised controlled trial supports the provision of a group self-management programme for improving blood pressure control. There are numerous interventions to support self-management by persons with transient ischaemic attack. More research is needed to determine which approaches are most effective. Given the limited evidence to support any one program for persons with TIA, clinicians and programs that provide self-management support should evaluate and monitor outcomes to ensure client needs are being met.