You would need none of this if you had EXACT STROKE PREVENTION PROTOCOLS. That would include diet. This type of intervention is needed because you blithering idiots haven't created those stroke prevention protocols. Do you not understand?
Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach
Abstract
Background
Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors.
Aims
To examine the efficacy of Stroke Coach on lifestyle behavior and risk factor control among community-living stroke survivors within one-year post stroke.
Methods
Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behavior was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioral and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p < 0.05). All analyses were intention-to-treat.
Results
The mean age of the Stroke Coach (n = 64) and Memory Training (n = 62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = −2.87; 95%CI − 8.03 to 2.29; p = 0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p = 0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = −3.05; 95%CI −5.88 to −0.21; p = 0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention.
Introduction
Stroke has considerable long-term consequences, notably deficits in motor and sensory function, communication, and cognition. These deficits pose serious barriers for stroke survivors to effectively manage their health. Unfortunately, post-discharge care remains underdeveloped for stroke survivors1,2 and stroke survivors are observed to have high rates of secondary cerebrovascular events.3 There is a need for the development and investigation of innovative secondary prevention health services for stroke survivors.
We developed the Stroke Coach, a novel telehealth intervention to promote healthy lifestyle behaviors after stroke.4,5 Stroke Coach was developed using Intervention Mapping as a guiding framework to ensure the intervention was theoretically guided and comprised of evidence-based behavior change techniques.6 Social Cognitive Theory was the underlying premise for behavior change, while Control Theory methods were directed towards sustaining the changes to ensure long-term health benefits. Furthermore, Stroke Coach is based on evidence that improvements to lifestyle can improve cardiometabolic risk,7,8 and that the delivery of health services using technology to stroke survivors is feasible and acceptable.9 Stroke Coach resources and manuals are available at www.neurorehab.ubc.ca.
Aims and hypotheses
We hypothesized that individuals who participate in Stroke Coach would experience greater improvements in lifestyle behavior than individuals in an attention-controlled Memory Training Program. We also examined the effects of Stroke Coach on individual behavioral and cardiometabolic stroke risk factors, quality of life, and health outcomes.
Methods
Study design and participants
In this multi-site, single-blinded (assessors) randomized controlled trial we recruited from acute, rehabilitation, and outpatient stroke units from four regional hospitals in British Columbia, Canada. We used multiple recruitment strategies, including in-person recruitment by clinicians and research coordinators and mailouts. Participants were community-living individuals, ≥50 years of age, within one-year post-stroke, with a modified Rankin Scale (mRS)10 score of 1 to 4, and telephone access. The University of British Columbia Clinical Research Ethics Board approved the study (H13-03353), and all participants provided informed consent. This study’s protocol is reported in detail elsewhere.5 Appendix A documents our reporting of the study according to the consolidated standards of reporting trials (CONSORT) guidelines.11
Baseline evaluation (T1 = 0 months)
Sociodemographic and stroke information were collected using a self-report form.
Primary outcome
Lifestyle behavior was measured using the 52-item Health Promoting Lifestyle Profile II (HPLPII).12 We determined 50 participants per group would have 85% power to detect a group mean difference of 12 points13,14 on the HPLPII (alpha = 0.05). We recruited 126 participants to adjust for a potential 20% dropout.
Secondary outcomes
Health-related quality of life (HRQoL) was measured using the Physical and Mental Component Summaries of the Medical Outcomes Study: Short Form-36.15 Depressive symptoms and cognitive function were assessed using the Center for Epidemiologic Studies Depression Scale16 and Montreal Cognitive Assessment,17 respectively.
Walking physical activity averaged over four days was measured using the StepWatch Activity Monitor.18 Daily grams of fat consumption, medication adherence, and body composition were measured using the Canadian version of the SmartDiet Questionnaire,19 Morisky Medication Adherence Scale,a,20 and body mass index, respectively. Blood pressure measurements21 were taken using a digital blood pressure monitor. Glycated hemoglobin (HbA1c), fasting glucose, high- and low-density lipoprotein, C-reactive protein, and homocysteine were measured using standard outpatient blood laboratory services.
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