Does behaviour modification affect post-stroke risk factor control? Three-year follow-up of a randomized controlled trial

Abstract

Objective: Little is known about the long-term effectiveness after stroke of interventions for behaviour modification and ensuring concordance with therapies. We describe a follow-up study of a previous randomized controlled trial of a brief period of behaviour modification. The aim of this study was to determine outcomes three years after the initial intervention.

Design: Survivors of the original cohort were contacted and asked to attend for follow-up interview, within a geriatric day hospital. This study was carried out in the Geriatric Day Hospital at Stobhill Hospital, Balornock Road, Glasgow.

Interventions: Details of risk factor control, including blood pressure, cholesterol levels and diabetic control, were assessed. Questionnaires used in the initial study were repeated including the Geriatric Depression Scale score, Euroqol Perceived Health Status and Stroke Services Satisfaction Questionnaire.

Main measures: Primary outcome was collective risk factor control. Clinical outcomes including recurrent cerebrovascular events, medication persistence and perceived health status were also recorded.

Results: Mean length of follow-up was 3.6 years (SD 0.43). Of the 205 patients enrolled in the initial study, 102 patients attended for repeat interview

(49 intervention/53 control). There were no significant differences in the percentage of controlled risk factors between groups (intervention 51.7% versus control 55.9%, P = 0.53). Similarities were observed in the number of recurrent clinical events and medication persistence between groups. No overall difference was observed in perceived health status, satisfaction with care or depression scores.

Conclusions: Brief intervention with respect to behaviour modification and risk factor control does not appear to have any long-term benefit. These results must be cautiously interpreted in light of the small study number and further research is required.

Get full access to this article

View all access options for this article.

References

Sudlow CL , Warlow CP Comparable studies of the incidence of stroke and its pathological subtypes: results from an international collaboration. Stroke 1997; 28: 491-99.

Hillen T. , Coshall C. , Tilling K. , Rudd A. , McGovern R. , Wolfe C. Cause of stroke recurrence is multifactorial. Patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke 2003; 34: 1457-63.

Van Wijk I. , Kappelle LJ , Van Gijn J. et al. for the LiLAC study group. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet 2005; 365: 2098-104.

Lenore J. , Babikian V. , Allen N. , Winter M. Risk factor modification in stroke prevention: the experience of a stroke clinic. Stroke A Journal of Cerebral Circulation 1999; 30: 16-20.

Mouradian MS , Majumdar SR , Senthilselvin A. , Khan K. , Shuaib A.

How well are hypertension, hyperlipidaemia, diabetes and smoking managed after stroke or transient ischaemic attack?

Stroke 2002; 33: 1656-59.

Redfern J. , McKevitt C. , Dundas R. , Rudd AG , Wolfe CD Behavioural risk factor prevalence and lifestyle change after stroke: a prospective study. Stroke 2000; 31: 1877-81.

Roter DL , Hall JA , Merisca R. , Nordstrum B. , Cretin D. , Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis . Med Care 1998; 36: 1138-61.

Mullen PD , Mains DA , Velez R. A meta-analysis of controlled trials of cardiac patient education. Patient Educ Counsel 1992; 19: 143-62.

Freidman RH , Kazis LE , Jette A. et al. A telecommunications system for monitoring and counselling patients with hypertension: impact on medication adherence and blood pressure control . Am J Hypertension 1996; 9: 285-92.

10.

Lee JK , Grace KA , Taylor AJ Effect of a pharmacy care program on medication adherence and persistence, blood pressure and low-density-lipoprotein cholesterol. A randomised controlled trial. JAMA 2006; 296: 2563-71.

11.

Ellis G. , Rodger J. , McAlpine C. , Langhorne P. The impact of a stroke nurse specialist input on risk factor modification:a randomised controlled trial. Age Ageing 2005 ; 34: 389-92.

12.

Yesavage JA , Brink TL , Rose TL et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983; 17: 37-49.

13.

Brown LM , Schinka JA Development and initial validation of a 15-item informant version of the Geriatric Depression Scale. Int J Geriatr Psychiatry 2005; 20: 911-8.

14.

The Euroqol Group. Euroqol - a new facility for the measurement of health related quality of life. Health Policy 1990; 16: 199-208.

15.

Pound P. , Gompertz P. , Ebrahim S. Patients satisfaction with stroke services. Clin Rehabil 1994; 8: 7-17.

16.

Straka RJ , Fish JT , Benson SR , Suh JT Patient self reporting of compliance does not correspond with electronic monitoring: An evaluationusing Isosorbide dinitrate as a model drug. Pharmacotherapy 1997; 17: 126-32.

17.

Dunbar-Jacob J. , Burke LE , Rohay JM et al. Comparability of self-report, pill count and electronic monitored adherence data. Control Clin Trials 1996; 12(suppl 2): 80S.

18.

Ovbiagele B. , Saver JL , Fredieu A. et al. In-hospital initiation of secondary stroke prevention therapies yields high rates of adherence at follow-up. Stroke 2004; 35: 2879-83.

19.

Hamann GF , Weimar C. , Glahn J. , Busse O. , Deiner HC German stroke data bank. Adherence to secondary stroke prevention strategies. Cerebrovasc Dis 2003; 15: 282-88.

20.

Sappok T. , Faulstich A. , Stuckert E. , Kruck H. , Marx P. , Koennecke HC Compliance with secondary prevention of ischaemic stroke: a prospective evaluation . Stroke 2001; 32: 1884-89.

21.

Caro JJ , Salas M. , Speckman JL , Raggio G. , Jackson JD Persistence with treatment for hypertension in actual practice. Can Med Assoc J 1999; 160: 31-37.

22.

Morgan SG , Yan L. Persistence with hypertension treatment among community-dwelling BC seniors . Can J Clin Pharmacol 2004; 12: e267-e273.

23.

Hoffman T. , McKenna K. , Worrall L. , Read S. Randomised trial of a computer-generated tailored education package for patients following stroke. Age Ageing 2007; 36: 280-86.