Effectiveness of a shared team approach between nurses and doctors for improved risk factor management in survivors of stroke: a cluster randomized controlled 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 Impact of Treadmill Exercise on Efficacy Expectations, Physical Activity, and Stroke Recovery Peer education for secondary stroke prevention in inner-city minorities: design and methods of the prevent recurrence of all inner-city strokes through education randomized controlled trial. An exploratory study of anxiety in carers of stroke survivors. Implementation of a stroke self-management program Secondary prevention and health promotion after stroke: can it be enhanced? Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial A randomized trial testing the superiority of a postdischarge care management model for stroke survivors. Multicenter Randomized Controlled Trial of an Outreach Nursing Support Program for Recently Discharged Stroke Patients A telehealth intervention to promote healthy lifestyles after stroke: The Stroke Coach protocol Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors A randomised controlled comparison of alternative strategies in stroke care. Health-promotion behaviors and psychological distress in cancer survivors. Risk Factor Management in Survivors of Stroke: A Double-Blind, Cluster-Randomized, Controlled Trial Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation Stop Stroke: development of an innovative intervention to improve risk factor management after stroke. Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial Randomized controlled pilot study of a SystemCHANGE™ weight management intervention in stroke survivors: rationale and protocol Improving secondary stroke self-care among underserved ethnic minority individuals: a randomized clinical trial of a pilot intervention Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia Mind-Body Interventions, Psychological Stressors, and Quality of Life in Stroke Survivors: A Systematic Review PINGS (Phone-Based Intervention Under Nurse Guidance After Stroke): Interim Results of a Pilot Randomized Controlled Trial
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 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 ABSTRACT Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity . Self-efficacy for exercise is known to play a role in adoption of exercise behaviors . This study examines self-reported psychological outcomes in a group of 64 stroke survivors r and omized to either a 6-month treadmill training program or a stretching program .  Results indicated that , regardless of group , all study participants experienced increased self-efficacy ( F = 2.95 , p = .09 ) and outcome expectations for exercise ( F = 13.23 , p < 0.001 ) and improvements in activities of daily living as reported on the Stroke Impact Scale ( F = 10.97 , p = .002 ) . No statistically significant between-group differences were noted , possibly because of the fact that specific interventions design ed to enhance efficacy beliefs were not part of the study . Theoretically based interventions should be tested to clarify the role of motivation and potential influence on exercise and physical activity in the stroke survivor population BACKGROUND The highest risk for stroke is among survivors of strokes or transient ischemic attacks ( TIA ) . However , use of proven-effective cardiovascular medications to control stroke risk is suboptimal , particularly among the Black and Latino population s disproportionately impacted by stroke . METHODS A partnership of Harlem and Bronx community representatives , stroke survivors , research ers , clinicians , outreach workers and patient educators used community-based participatory research to conceive and develop the Prevent Recurrence of All Inner-city Strokes through Education ( PRAISE ) trial . Using data from focus groups with stroke survivors , they tailored a peer-led , community-based chronic disease self-management program to address stroke risk factors . PRAISE will test , in a r and omized controlled trial , whether this stroke education intervention improves blood pressure control and a composite outcome of blood pressure control , lipid control , and use of antithrombotic medications . RESULTS Of the 582 survivors of stroke and TIA enrolled thus far , 81 % are Black or Latino and 56 % have an annual income less than $ 15,000 . Many ( 33 % ) do not have blood pressures in the target range , and most ( 66 % ) do not have control of all three major stroke risk factors . CONCLUSIONS Rates of stroke recurrence risk factors remain suboptimal in the high risk , urban , predominantly minority communities studied . With a community-partnered approach , PRAISE has recruited a large number of stroke and TIA survivors to date , and may prove successful in engaging those at highest risk for stroke and reducing disparities in stroke outcomes in inner-city communities AIMS AND OBJECTIVES To investigate anxiety in informal carers of stroke survivors in the first three months after discharge . BACKGROUND Informal carers , also called caregivers , play a vital role in supporting stroke survivors . However , caring for stroke survivors can have adverse consequences amongst carers such as burden , stress and reduced quality of life . Emotional distress is also commonly reported but anxiety has received less attention than depression . DESIGN Prospect i ve , longitudinal , descriptive study . METHOD Forty-five carers completed the  Hospital Anxiety and Depression Scale  on two occasions - within one month and at three months after discharge from stroke and rehabilitation units . RESULTS Carers were more likely to have scores indicating anxiety than depression . In the first month , half the carers ( 51·1 % ) scored in the cut-off for anxiety and a third were in the cut-off for depression ( 31·1 % ) . At three months , the picture was very similar with nearly identical proportions in the anxious and depressed categories ( 48·9 % and 28·9 % , respectively ) . Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores ( p=0·048 ) . Fourteen carers ( 31·1 % ) at one month and eleven ( 24·4 % ) at three months fell into both anxious and depressed categories . CONCLUSIONS Anxiety is a relatively neglected emotional outcome in stroke carers . Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months . Given the significant role carers play in rehabilitation of stroke survivors , greater recognition of their emotional state is required . Further , longitudinal research with larger sample sizes from a range of geographical areas and improved underst and ing of factors associated with anxiety is needed . RELEVANCE TO CLINICAL PRACTICE Nurses working in the community are ideally placed to identify and support carers suffering from anxiety ABSTRACT Secondary stroke prevention is championed as guideline care ; yet there are no systematic programs offered . We developed a stroke self-management program to address this gap and pilot test the program . We conducted a r and omized controlled trial at two Veterans Administration ( VA ) hospital sites where we recruited patients with an acute stroke to receive either the stroke program or an attention-control protocol over a 12-week period following hospital discharge . The stroke program included six sessions that facilitated stroke self management focusing on increasing self-efficacy to recover from stroke and engage in secondary stroke risk factor management . We surveyed outcomes at baseline , 3 and 6 months . We conducted an intention to treat analysis comparing the intervention to the control group on changes of outcomes between baseline and follow-up modeled by a linear model with fixed effects for treatment , visit , and the treatment by visit interaction adjusting for baseline . We recruited 63 participants ( 33 control and 30 intervention ) who were hospitalized with a primary diagnosis of ischemic stroke . We found trends in differences between groups on self-efficacy to communicate with physicians , weekly minutes spent in aerobic exercise , and on dimensions of stroke-specific quality of life . This pilot study demonstrated the feasibility of delivering a  stroke self-management program to recent stroke survivors in a healthcare organization . The program also demonstrated improvements in patient self-efficacy , self-management behaviors , specific dimensions of stroke-specific quality of life compared to a group that received an attention placebo program The aim was to study if health outcome and secondary prevention were satisfactory 1 year after stroke and if nurse-led interventions 3 months after stroke could have impact . Design was a r and omized controlled open trial in a 1-year population . Primary outcome was health status 1 year after stroke . One month after stroke , survivors were r and omized into  intervention group ( IG ) with follow-up by a specialist nurse ( SN ) after 3 months ( n = 232 ) , and control group ( CG ) with st and ard care ( n = 227 ) , all to be followed up 1 year after stroke . At the first follow-up , patients grade d their health , replied to the EuroQol-5 Dimensions ( EQ-5D ) health outcome questions , health problems were assessed , and supportive counseling was provided in the IG . Health problems requiring medical interventions were primarily referred to a general practitioner ( GP ) . One year after stroke , 391 survivors were followed up . Systolic blood pressure ( BP ) had decreased in IG ( n = 194 ) from median 140 to 135 ( P = .05 ) , but about half were above the limit 139 in both groups . A larger proportion ( 22 % ) had systolic BP > 155 in the CG ( n = 197 ) than in the IG ( 14 % ; P = .05 ) . In the IG , 62 % needed referrals compared with the 75 % in the CG ( P = .009 ) . Forty percent in the IG and 52.5 % in the CG ( P = .04 ) reported anxiety/depression . In the IG , 75 % and 67 % in the CG rated their general health as fairly good or very good ( P = .05 ) . Although nurse-led interventions could have some effect , the results were not optimal . A more powerful strategy could be closer collaboration between the SN and a stroke clinician , before referring to primary care Background Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites . This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these population s. Home blood pressure telemonitoring ( HBPTM ) and nurse case management ( NCM ) have proven efficacy in addressing the multilevel barriers to blood pressure ( BP ) control and reducing BP . However , the effectiveness of these interventions has not been evaluated in stroke patients . This study is design ed to evaluate the comparative effectiveness , cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension . Methods / Design A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are r and omly assigned to one of two 12-month interventions : 1 ) HBPTM with wireless feedback to primary care providers or 2 ) HBPTM plus individualized , culturally-tailored , telephone-based NCM .  Patients are recruited from stroke centers and primary care practice s within the Health and Hospital Corporations ( HHC ) Network in New York City . Study visits occur at baseline , 6 , 12 and 24 months . The primary outcomes are within-patient change in systolic BP at 12 months , and the rate of stroke recurrence at 24 months . The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months ; and exploratory outcomes include changes in stroke risk factors , health behaviors and treatment intensification . Recruitment for the stroke telemonitoring hypertension trial is currently ongoing . Discussion The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation . Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension . If effective among Black and Hispanic stroke survivors , these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence . Trial registration Clinical Trials.gov NCT02011685 . Registered 10 December 2013 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 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 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 & NA ; Guided by Orem 's self‐care deficit nursing theory , the purpose of this descriptive comparative study was to examine the emotional support , physical help , and health of caregivers of stroke survivors . Seventy‐three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke . Caregivers were r and omized to an online intervention of support and education ( n = 36 Web users ) or a control group ( n = 37 non‐Web users ) . A secondary analysis of data collected during telephone interviews at baseline , 3 , 6 , and 12 months after stroke was performed . No significant mean differences were found between Web and non‐Web users in the above variables at these points in time . Consequently , the caregivers were merged into one group , and the relationships among the variables at the different points in time were analyzed . Significant , moderately positive relationships were found between emotional support and physical help at baseline , 3 , and 12 months . There were also significant , moderately positive relationships between emotional support and caregiver health at 6 and 12 months . Results highlight the importance of caregivers ( dependent care agents in Orem 's terms ) establishing an adequate self‐care system that provides emotional support and physical help . Findings also denote the need for nurses ( as caring agents ) to assess caregiver health later in the caring process and be aware of its relationship to emotional support OBJECTIVES To compare outcomes between stroke patients managed on the stroke unit , on general wards with stroke team support or at home by specialist domiciliary team and to derive prognostic variables that will identify patients most suitable for management by each strategy . To describe organisational aspects of individual strategies of stroke care and to evaluate cost-effectiveness of each strategy and its acceptability to patients , carers and professionals . DESIGN Prospect i ve single-blind r and omised controlled trial undertaken in patients recruited from a community-based stroke register . SETTING Suburban district in south-east Engl and . PARTICIPANTS Patients with disabling stroke who could be supported at home . INTERVENTIONS The stroke unit gave 24-hour care provided by specialist multidisciplinary team based on clear guidelines for acute care , prevention of complications , rehabilitation and secondary prevention . The stroke team provided management on general wards with specialist team support . The team undertook stroke assessment s and advised ward-based nursing and therapy staff on acute care , secondary prevention and rehabilitation aspects . Domiciliary care involved management at home under the supervision of a GP and stroke specialist with support from specialist team and community services . Support was provided for a maximum of 3 months . MAIN OUTCOME MEASURES The primary measure was death or institutionalisation at 1 year . Secondary measures were dependence , functional abilities , mood , quality of life , re source use , length of hospital stay , and patient , carer and professional satisfaction . RESULTS Of the 457 patients r and omised , 152 patients were allocated to the stroke unit ; 152 patients to stroke team and 153 patients to domiciliary stroke care ( average age 76 years , 48 % women ) . The groups were well matched for baseline characteristics , stroke type and severity , level of impairment and initial disability . Fifty-one ( 34 % ) patients in the domiciliary group were admitted to hospital after r and omisation . Mortality and institutionalisation at 1 year were lower on stroke unit compared with stroke team or domiciliary care . Significantly fewer patients on the stroke unit died compared with those managed by the stroke team . The proportion of patients alive without severe disability at 1 year was also significantly higher on the stroke unit compared with stroke team or domiciliary care . These differences were present at 3 and 6 months after stroke . Stroke survivors managed on the stroke unit showed greater improvement on basic activities of daily living compared with other strategies . Achievement of higher levels of function was not influenced by strategy of care . Quality of life at 3 months was significantly better in stroke unit and domiciliary care patients . There was greater dissatisfaction with care on general wards compared with stroke unit or domiciliary care . Poor outcome with domiciliary care and on general wards was associated with Barthel Index < 5 , incontinence and , on general wards , age over 75 years . The total costs of stroke per patient over the 12-month period were pound 11,450 for stroke unit , pound 9527 for stroke team and pound 6840 for home care . However , the mean costs per day alive for the stroke unit were significantly less than those for the specialist stroke team patients , but no different from domiciliary care patients . Costs for the domiciliary group were significantly less than for those managed by the specialist stroke team on general wards . CONCLUSIONS Stroke units were found to be more effective than a specialist stroke team or specialist domiciliary care in reducing mortality , institutionalisation and dependence after stroke . A role for specialist domiciliary services for acute stroke is not supported by this study . Management of patients with strokes on general medical wards , even with specialist team input , is not supported by this study . The stroke unit intervention was less costly per patient day alive and more effective than the stroke team intervention . The stroke unit was more effective and of equivalent cost when compared to home care . Hence , the stroke unit is a more cost-effective intervention than either stroke team or home care . Further research is needed to underst and processes contributing to the reduction in mortality on stroke units and to determine the generalisability of these results and the factors that will influence the implementation of the findings of this study in clinical practice PURPOSE / OBJECTIVES To determine whether cancer survivors engage in health-promotion behaviors , to evaluate the extent of their experience of psychological distress , and to investigate the relationship between the practice of health-promotion behaviors and psychological distress . DESIGN Cross-sectional secondary data analysis . SETTING A national , face-to-face interview conducted by personnel of the U.S. Census Bureau using a r and om sampling of American adults . SAMPLE 1,784 survey respondents who reported a previous cancer diagnosis . METHODS Data from the 2009 National Health Interview Survey were used to examine the prevalence of smoking , physical inactivity , alcohol use , and reports of psychosocial distress . Interviews pertained to the amount and distribution of illness , its effects in terms of disability and chronic impairments , and the kinds of health services people receive . MAIN RESEARCH VARIABLES Age , current smoking prevalence , alcohol consumption , physical activity , and the experience of feeling hopelessness , sadness , and anxiety . FINDINGS Cancer survivors continue to smoke at a rate similar to the national average . Overall , most respondents reported no symptoms of psychological distress . However , age appears to play a major role , showing significant differences in the prevalence of current smoking , participation in physical activity , alcohol use , and reported level of distress . CONCLUSIONS This study provides estimates of the prevalence of health-promotion behaviors and experience of psychological distress among American cancer survivors . The results reveal opportunities for interventions among cancer survivors . IMPLICATION S FOR NURSING Nurses should be proactive in providing guidance to survivors regarding the adoption of healthy lifestyle behaviors . Those who encounter younger cancer survivors need to be alert to the higher potential for distress in that population , perform appropriate screenings , and be prepared to offer guidance , supportive care , and referrals for psychological care if needed 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 Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities OBJECTIVE Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal . The UK Medical Research Council ( MRC ) have proposed a framework for developing and evaluating complex interventions , such as community management of stroke secondary prevention . The Framework outlines a five-phased approach from theory through to implementation of effective interventions . This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke . METHODS The pre- clinical /theoretical phase entailed review ing the literature and undertaking quantitative and qualitative studies to identify current practice s and barriers to secondary prevention . In Phase I ( modelling ) , findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management . The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners . RESULTS This led to the development of the definitive risk factor management  intervention . This comprises multiple components and involves using an on-going population stroke register to target patients , carers and health care professionals with tailored secondary prevention advice . Clinical , socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients , carers and health care professionals at three time points : within 10 weeks , 3 and 6 months post-stroke . CONCLUSION The intervention is currently being evaluated in a r and omised controlled trial . Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases . PRACTICE IMPLICATION S The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health . Implication s for practice in stroke secondary prevention will emerge when the results of our r and omised controlled trial are published Abstract Purpose : This r and omized trial compared 6- and 12-month outcomes of a home-based psychoeducational program to mailed information provided to 159 survivors of stroke ( SS ) and their spousal caregivers ( CG ) . Methods : SS ( age 50 + ) and CG were recruited as dyads post-discharge from inpatient rehabilitation . All dyads received mailed information for 12 months . Dyads r and omized to the home-based group received an average of 36.7 h of psychoeducation over 6 months . Health status , depression , stress , burden , coping , support , mutuality and function were obtained on all dyads . Repeated measures analysis with linear mixed models was used to compare the groups for change over time in the outcome variables . Results : Both groups demonstrated less depression and stress over time . Compared to the mailed information group , SS in the home-based group demonstrated significantly improved self-reported health and cognitive function ; CG demonstrated significantly improved self-reported health and coping strategies . Mutuality and social support decreased in both groups . Conclusions : The home-based intervention was effective in improving self-reported health , coping skills in CG and cognitive functioning in SS . However , the finding that dyads in both groups demonstrated decreased depression and stress suggests that providing repeated doses of relevant , personalized information by mail may result in positive changes . Implication s for Rehabilitation A stroke affects both the stroke survivor and the spousal caregiver , so nurses and therapists should use multicomponent strategies to provide education , support , counseling and linkages to community re sources to ease the transition from hospital to home . Stroke may have a negative impact on the dyad ’s relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge . Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling , as needed . Establishing an ongoing relationship with stroke survivors and their spouses and providing relevant and engaging information by mail can reduce stress and depression over 12 months post-discharge at a minimal cost . Nurses and therapists should consider home visits post-discharge to reinforce education and skills taught in the hospital , increase self-reported health in stroke survivors and spousal CG , increase coping skills and to link the couple to community re sources Background Over 65 % of stroke survivors are either overweight or obese and have multiple cardiovascular risk factors . However , few studies have examined the effects of comprehensive lifestyle behavior interventions to promote weight loss and control cardiovascular risk factors in stroke survivors . Thus , the purpose of this study is to examine a novel behavior change approach - SystemCHANGE ™ - to promote weight loss and improve health and function in stroke survivors .  SystemCHANGE ™ focuses on re design ing the social environment to achieve a specific goal . Methods We will conduct a r and omized controlled pilot study to examine the efficacy , feasibility , and safety of the SystemCHANGE ™ weight management program in overweight and obese stroke survivors . The central hypothesis of the study is that the SystemCHANGE ™ intervention will help overweight and obese stroke survivors lose 5 % of their body weight , thereby improving health and function . Thirty-five stroke survivors will be r and omized into either the 6-month SystemCHANGE ™ intervention or a contact-control intervention . Outcome measures will be assessed at baseline and again at 3 and 6 months after the interventions . Body composition will be assessed using a Bod Pod . Patient-reported outcomes will be the Stroke Impact Scale and Reintegration to Normal Living Index . Objective outcomes will include the 6-Minute Walking Test and Rivermead Motor Assessment . Discussion This study will be the first r and omized controlled trial to evaluate the efficacy and safety of a weight management intervention in stroke survivors using the SystemCHANGE ™ approach . Furthermore , it will be the first empirically-examined comprehensive lifestyle intervention design ed to target physical activity , nutrition , and sleep to promote weight loss in stroke survivors . Trial registration Clinical Trials.gov Identifier : The overall purpose of this study was to pilot a multibehavioral , brief , stroke self-care treatment adapted for implementation with underserved racial/ethnic minority groups and to test the moderating effects of anxiety and depression on engagement in secondary stroke-prevention behaviors . Fifty-two participants were r and omized to the secondary stroke prevention ( STOP ) ( N = 27 ) or usual care ( N = 25 ) group . The STOP program consisted of 3 culturally tailored information sessions and goal - setting activities that were delivered in person by a research assistant . Participants were assessed at baseline and 4-week follow-up for stroke knowledge , exercise , fruit and vegetable consumption , tobacco and alcohol use , and medication adherence ( primary outcomes ) and anxiety and depression ( moderator variables ) . Between-groups analysis of covariance and logistic multiple regressions revealed significant between-group differences for stroke knowledge , tobacco use and moderating effects between tobacco and anxiety , and improved alcohol use . The STOP program decreased secondary stroke risk factors  among underserved racial/ethnic minorities and should be tested in large-scale trials 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 Background and Purpose — Psychological stressors , including poststroke depression , poststroke anxiety , and posttraumatic stress disorder , are highly prevalent in stroke survivors . These symptoms exact a significant toll on stroke survivors . Clinical and research efforts in stroke recovery focus on motor disability , speech and language deficits , and cognitive dysfunction while largely neglecting psychological stressors . Evidence suggests mind-body interventions in other chronic illness population s decrease symptoms of depression , regulate immune responses , and promote resilience , yet similar studies are lacking in stroke population s. This review aims to synthesize evidence of the effects of mind-body interventions on psychological stressors , quality of life , and biological outcomes for stroke survivors . Methods — A systematic search of PubMed , PsycINFO , and CINAHL was conducted from data base inception to November 2017 . Results — Eight studies were included in the review , with a total of 292 participants .  Mind-body interventions included yoga or tai chi . Of the 5 included r and omized controlled trials , most were pilot or feasibility studies with small sample sizes . Psychological stressors , including poststroke depression and anxiety , along with the quality of life , improved over time , but statistically significant between-group differences were largely absent . The 3 included studies with a qualitative design reported themes reflecting improvement in psychological stressors and quality of life . No included studies reported biological outcomes . Conclusions — Studies of mind-body interventions suggest a possible benefit on psychological stressors and quality of life ; however , rigorously design ed , sufficiently powered r and omized controlled trials with mixed- methods design are warranted to delineate specific treatment effects of these interventions . Studies with both biological and psychological stressors as outcomes would provide evidence about interaction effects of these factors on stroke-survivor responses to mind-body interventions Background and Purpose — Stroke exacts an immense toll in sub-Saharan Africa where there are few re sources , and stroke prevention research is limited . The aim of this study is to test the feasibility and preliminary efficacy of an m-Health technology – enabled , nurse-guided intervention in improving blood pressure ( BP ) control among Ghanaian stroke patients within 1 month of symptom onset . Methods — We conducted a 2-arm cluster pilot r and omized controlled trial involving 60 recent stroke survivors encountered within a single tertiary medical system in Ghana . Subjects in the intervention arm ( n=30 ) received a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting BP measurements and medication intake for 3 months compared with st and ard of care ( n=30 ) . Primary outcome measure was systolic BP < 140 mm Hg at month 3 ; secondary outcomes included medication adherence and autonomous self-regulation . Analysis accounting for clustering was made using generalized linear mixed model by intention to treat . Results — Mean±SD age was 55±13 years , 65 % male . Systolic BP < 140 mm Hg at month 3 was found in 20/30 subjects ( 66.7 % ) in the intervention arm versus 14/30 subjects ( 46.7 % ) in the control arm ( P=0.12 ) . Medication possession ratio scores at month 3 were better in the intervention ( 0.88±0.40 ) versus control ( 0.64±0.45 ) arm ( P=0.03 ) . One subject in control arm died from a recurrent hemorrhagic stroke . Conclusions — It is feasible to conduct an m-Health – based , nurse-guided BP control intervention among recent stroke patients in sub-Saharan Africa . We observed a potential signal of efficacy with the intervention , which will need to be tested in a future large definitive study . Clinical Trial Registration — URL : https://www . clinical trials.gov . Unique identifier : NCT02568137
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 .