Abstract
Although the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context. To pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or 'minor' stroke. Pilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018. Patients within 4 weeks of a first TIA or 'minor' stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants' views were elicited about the study via focus groups. Over a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme 'filled a gap' in current post-TIA management. Findings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or 'minor' stroke.
Highlights
The immediate period after a transient ischaemic attack (TIA) or ‘minor’ stroke is a crucial time to intervene to reduce risk of future cardiovascular events,[1,2] with GPs often managing this secondary prevention
Findings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or ‘minor’ stroke
Organisational interventions in general practice for secondary prevention of cardiovascular disease reduce mortality,[3] and participation in cardiac rehabilitation programmes after acute cardiac events are associated with reduced mortality and morbidity.[4,5]
Summary
The immediate period after a transient ischaemic attack (TIA) or ‘minor’ stroke is a crucial time to intervene to reduce risk of future cardiovascular events,[1,2] with GPs often managing this secondary prevention. Organisational interventions in general practice for secondary prevention of cardiovascular disease reduce mortality,[3] and participation in cardiac rehabilitation programmes after acute cardiac events are associated with reduced mortality and morbidity.[4,5] Home-based cardiac rehabilitation programmes may be as effective as those delivered in hospitals, with better compliance.[4] cardiovascular and cerebrovascular disease share common pathological mechanisms and risk factors, the impact of cardiac rehabilitation and lifestyle interventions after stroke and TIA requires further research.[6,7,8] physical activity, a core element of cardiac rehabilitation, is supported by different behaviour change methods including goal setting, providing feedback, and monitoring, and by using pedometers,[9,10] but there are few studies of pedometer use by patients early after TIA or stroke.[11,12]. The importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context
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