Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial

• Published in: Clinical rehabilitation 2010-09, Vol.24 (9), p.822-830
• Main Authors: Gillham, Sarah, Endacott, Ruth
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Alcohol; Anxiety-Depression; Behavioural changes; Clinical trials; Consent; Female; Fruits; Health Behavior; Healthy food; Humans; Intention; Intervention; Ischemia; Ischemic Attack, Transient - rehabilitation; Lifestyles; Male; Middle Aged; Mortality; Outpatient care facilities; Prevention; Risk factors; Risk Reduction Behavior; Secondary prevention; Secondary Prevention - methods; Self report; Single-Blind Method; Stages of change; Stroke; Stroke Rehabilitation; Strokes; Telemedicine; Transient ischemic attack
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/0269215510367970

Objective: To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack, compared with conventional stroke secondary prevention. Design: Single-blind randomized control trial. Setting: Rural district general hospital outpatient clinic. Subjects: Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack. Interventions: The intervention group received ‘enhanced secondary prevention’ (additional advice, motivational interviewing and telephone support) to change health behaviour. Both groups received ‘conventional care’ which included advice given during routine care. Main measures: The primary outcome was ‘readiness to change behaviour’ measured using a validated stroke specific score based on the transtheoretical model. Secondary outcomes were the Hospital Anxiety and Depression Scale, and self-reported alcohol consumption, smoking behaviour, exercise frequency, and fruit and vegetable consumption. Results: Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour. Statistically significant improvements for change in self-reported exercise were demonstrated (P = 0.007); to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group, and in fruit and vegetable consumption (P = 0.033); to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group. No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale. Conclusions: While no difference was demonstrated between the groups for readiness to change behaviour, a clinically significant effect in reported exercise behaviour and diet were demonstrated in the intervention group. This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change, potentially indicating a lack of sensitivity of the scale to detect a change in this patient group.