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
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
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 .