Abstract
BackgroundMost patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up. Nonetheless, these patients have a high prevalence of cognitive impairments and a considerable risk of recurrent stroke. Smoking cessation, physical activity, and adherence to antihypertensive and antithrombotic medication are highly recommended in patients with minor stroke and TIA. Evidence suggests that simple encouragement to change lifestyle is ineffective. Behavioural interventions might therefore be needed to support patients in managing their own health post-discharge.ObjectivesWe aim to test the (1) feasibility of randomisation acceptance and an early initiated, client-centred lifestyle and behavioural intervention in a clinical setting, and (2) potential effect of the intervention on arterial blood pressure in patients with minor stroke or TIA and (3) explore the participants experience of barriers and facilitators for health behaviour after a stroke, including perceived needs and social support.MethodsWe will conduct a randomized controlled pilot trial: Eligible patients with acute minor stroke or TIA (n = 40) will be randomly allocated to either early initiated counselling with four weekly post-discharge follow-up sessions for 12 weeks or usual care. The primary outcome will be program feasibility and to discuss the relevance of arterial blood pressure as primary outcome after 12 weeks intervention. Selected participants will be invited to participate in semi-structured interviews, based on purposeful sampling, to evaluate the intervention and explore their experience of life after a stroke. The interviews will be analysed using a five-step thematic analysis approach.DiscussionThe study will provide evidence of the feasibility and potential effect of early initiated counselling on cardiovascular risk factors in patients with minor stroke and TIA. Qualitative interviews will contribute with a more nuanced understanding of the barriers and facilitators of health enhancing behaviour. Optimizing health behaviour counselling and providing formal support to the patients’ post-discharge may ease the transition and help more patients adhere to lifestyle and medication recommendations.Trial registrationClinicalTrial.gov, NCT03648957
Highlights
Most patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up
More than half of patients admitted with a stroke or transient ischemic attack (TIA) only have mild neurological symptoms and are often discharged after 3-5 days of hospital admission
The overall purpose of our research is to develop effective and clinically feasible interventions to support patients with minor stroke and TIA in engaging in health enhancing behaviour and prevent recurrent strokes
Summary
Most patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up. These patients have a high prevalence of cognitive impairments and a considerable risk of recurrent stroke. There is evidence that the patients after discharge often experience cognitive and communicative impairments such as difficulties with everyday activities, memory, fatigue, reading and participating in conversations [3]. This indicates that patients with recent minor stroke or TIA need more support than previously assumed. Recurrent stroke is an independent risk factor for loss of function, institutionalization and death [5]
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