Suzanne Barker-Collo1, Rita Krishnamurthi2, Emma Witt2, Valery Feigin2, Amy Jones2, Kathryn McPherson2, Nicola Starkey2, Varsha Parag2, Yannan Jiang2, P Alan Barber2, Elaine Rush2, Derrick Bennett2, Bruce Aroll2. 1. From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.). s.barker-collo@auckland.ac.nz. 2. From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.).
Abstract
BACKGROUND AND PURPOSE:Stroke recurrence rates are high (20%-25%) and have not declined over past 3 decades. This study tested effectiveness of motivational interviewing (MI) for reducing stroke recurrence, measured by improving adherence to recommended medication and lifestyle changes compared with usual care. METHODS: Single-blind, prospective phase III randomized controlled trial of 386 people with stroke assigned to eitherMI treatment (4 sessions at 28 days, 3, 6, and 9 months post stroke) or usual care; with outcomes assessed at 28 days, 3, 6, 9, and 12 months post stroke. Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months. Secondary outcomes included self-reported adherence, new stroke, or coronary heart disease events (both fatal and nonfatal); quality of life (Short Form-36); and mood (Hospital Anxiety and Depression Scale). RESULTS: MI did not significantly change measures of blood pressure (mean difference in change, -0.2.35 [95% confidence interval, -6.16 to 1.47]) or cholesterol (mean difference in change, -0.0.12 [95% confidence interval, -0.30 to 0.06]). However, it had positive effects on self-reported medication adherence at 6 months (1.979; 95% confidence interval, 0.98-3.98; P=0.0557) and 9 months (4.295; 95% confidence interval, 1.56-11.84; P=0.0049) post stroke. Improvement across other measures was also observed, but the differences between MI and usual care groups were not statistically significant. CONCLUSIONS:MI improved self-reported medication adherence. All other effects were nonsignificant, though in the direction of a treatment effect. Further study is required to determine whether MI leads to improvement in other important areas of functioning (eg, caregiver burden). CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ACTRN-12610000715077.
RCT Entities:
BACKGROUND AND PURPOSE:Stroke recurrence rates are high (20%-25%) and have not declined over past 3 decades. This study tested effectiveness of motivational interviewing (MI) for reducing stroke recurrence, measured by improving adherence to recommended medication and lifestyle changes compared with usual care. METHODS: Single-blind, prospective phase III randomized controlled trial of 386 people with stroke assigned to either MI treatment (4 sessions at 28 days, 3, 6, and 9 months post stroke) or usual care; with outcomes assessed at 28 days, 3, 6, 9, and 12 months post stroke. Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months. Secondary outcomes included self-reported adherence, new stroke, or coronary heart disease events (both fatal and nonfatal); quality of life (Short Form-36); and mood (Hospital Anxiety and Depression Scale). RESULTS: MI did not significantly change measures of blood pressure (mean difference in change, -0.2.35 [95% confidence interval, -6.16 to 1.47]) or cholesterol (mean difference in change, -0.0.12 [95% confidence interval, -0.30 to 0.06]). However, it had positive effects on self-reported medication adherence at 6 months (1.979; 95% confidence interval, 0.98-3.98; P=0.0557) and 9 months (4.295; 95% confidence interval, 1.56-11.84; P=0.0049) post stroke. Improvement across other measures was also observed, but the differences between MI and usual care groups were not statistically significant. CONCLUSIONS: MI improved self-reported medication adherence. All other effects were nonsignificant, though in the direction of a treatment effect. Further study is required to determine whether MI leads to improvement in other important areas of functioning (eg, caregiver burden). CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ACTRN-12610000715077.
Authors: Felizitas A Eichner; Christopher J Schwarzbach; Moritz Keller; Karl Georg Haeusler; Gerhard F Hamann; Dirk Sander; Heinrich J Audebert; Klaus Gröschel; Dieter Geis; Stephan von Bandemer; Viktoria Rücker; Martha Schutzmeier; Peter Ulrich Heuschmann; Armin Grau Journal: Eur Stroke J Date: 2020-03-12
Authors: Niteesh K Choudhry; Thomas Isaac; Julie C Lauffenburger; Chandrasekar Gopalakrishnan; Nazleen F Khan; Marianne Lee; Amy Vachon; Tanya L Iliadis; Whitney Hollands; Scott Doheny; Sandra Elman; Jacqueline M Kraft; Samrah Naseem; Joshua J Gagne; Cynthia A Jackevicius; Michael A Fischer; Daniel H Solomon; Thomas D Sequist Journal: Am Heart J Date: 2016-08-08 Impact factor: 4.749
Authors: Niteesh K Choudhry; Thomas Isaac; Julie C Lauffenburger; Chandrasekar Gopalakrishnan; Marianne Lee; Amy Vachon; Tanya L Iliadis; Whitney Hollands; Sandra Elman; Jacqueline M Kraft; Samrah Naseem; Scott Doheny; Jessica Lee; Julie Barberio; Lajja Patel; Nazleen F Khan; Joshua J Gagne; Cynthia A Jackevicius; Michael A Fischer; Daniel H Solomon; Thomas D Sequist Journal: JAMA Intern Med Date: 2018-09-01 Impact factor: 21.873
Authors: Bernadeta Bridgwood; Kate E Lager; Amit K Mistri; Kamlesh Khunti; Andrew D Wilson; Priya Modi Journal: Cochrane Database Syst Rev Date: 2018-05-07