Development of an online secondary prevention programme for stroke survivors: Prevent 2nd Stroke

Denham, Alexandra M. J.; Guillaumier, Ashleigh; McCrabb, Sam; Turner, Alyna; Baker, Amanda; Spratt, Neil J; Pollack, Michael; Magin, Parker; Oldmeadow, Christopher; Collins, Clare E.; Callister, Robin; Wallis, Mark; Wynne, Olivia; Bonevski, Billie

doi:10.1136/bmjinnov-2017-000257

Cited by 4 publications

(9 citation statements)

References 39 publications

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“…Recent studies suggested that an online secondary stroke prevention program is an effective way to modify behaviors and lifestyles. 50,51 The promotion of such strategies to improve secondary prevention of stroke is urgently needed.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Yang

Ngo

Hay

et al. 2022

Stroke

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BACKGROUND: Data on long-term outcomes following an acute stroke are sparse. We assessed survival, risk of recurrent stroke and loss in life expectancy following an acute stroke using population-wide data from Australia and New Zealand. METHODS: We included all adults with the first stroke hospitalization during 2008 and 2017 at all public and most private hospitals. Patients were followed up to 10 years after the stroke by linkage to each region’s Registry of Deaths and subsequent hospitalizations. Flexible parametric survival modeling was used to estimate all-cause mortality, stroke recurrence, and loss in life expectancy. Competing risk model was used when estimating the risk of stroke recurrence. RESULTS: Three hundred thirteen thousand one hundred sixty-two patients were included (mean age 73.0±14.6 y, 52.0% males) with ischemic stroke (175 547, 56.1%) being the most common, followed by hemorrhagic stroke (77 940, 24.9%) and unspecified stroke (59 675, 19.1%). The overall survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years. Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years. Hemorrhagic stroke was associated with greater mortality (hazard ratio, 2.02 [95% CI, 1.99–2.04]) and recurrent stroke (hazard ratio, 1.63 [95% CI, 1.59–1.67]) compared with ischemic stroke. Female sex (hazard ratio, 1.10 [95% CI, 1.09–1.11]) and increasing age (≥85 years versus 18–54 years: hazard ratio, 7.36 [95% CI, 7.15–7.57]) were also associated with increased mortality. Several risk factors including atherosclerotic coronary and noncoronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke. Compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 32.7% of the predicted life expectancy, and was pronounced in patients with a hemorrhagic stroke (7.4 years and 38.5% of predicted life expectancy lost). CONCLUSIONS: In this population-wide study, death and recurrence of stroke were common after an acute stroke and an acute stroke was associated with considerable loss in life expectancy. Further improvements in treatment and secondary prevention of stroke are needed to reduce these risks.

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Section: Discussionmentioning

confidence: 99%

Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Yang

Ngo

Hay

et al. 2022

Stroke

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“…A generic framework was used in less than half (3/8, 38%) of these studies; Pitt et al [ 42 , 43 ] reported that their intervention had been developed according to a guide for complex intervention development that was not specific to digital health, while Rietdijk et al [ 44 ] referred to a generic framework for feasibility to inform study design. Almost twice as many (5/8, 63%) referred to a framework specific to the development of digital interventions, including web-based education [ 45 ], web-based programs [ 46 ], and user-centered design [ 47 - 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…In each study, the nature of ABI and the psychosocial condition under treatment was almost always (56/60, 93%) complicated because it was “not fully characterized or understood” [ 17 ], yet not quite complex because participants were usually recruited in the chronic stages of injury to control for spontaneous recovery. In the remaining 7% (4/60) of studies, the condition shifted into the “unpredictable or high risk” definition of complex when investigators documented that participants experienced multiple neurological events [ 46 , 62 , 63 ] and responded unexpectedly to intervention during the chronic stage of injury [ 62 , 64 ].…”

Section: Resultsmentioning

confidence: 99%

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

Miao¹,

Rietdijk²,

Brunner³

et al. 2022

J Med Internet Res

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Background More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. Objective This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. Methods From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. Results We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. Conclusions Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387 International Registered Report Identifier (IRRID) RR2-10.1177/20552076211035988

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“…The P2S program was developed using behaviour change theory and co-design principles with stroke survivors, and was pilot tested prior to this trial. The development and testing of the intervention have been described in detail elsewhere [ 24 , 25 ]. Briefly, the P2S program is a modularised, tailored program providing evidence-based techniques and information in 6 core modules: (1) blood pressure, (2) smoking, (3) alcohol consumption, (4) physical activity, (5) nutrition, and (6) feelings and mood, as well as a ‘my progress’ section.…”

Section: Methodsmentioning

confidence: 99%

“…The primary aim was to evaluate the effectiveness of an online health behaviour change intervention—Prevent 2nd Stroke (P2S)—at improving HRQoL amongst stroke survivors at 6 months of follow-up. The development of the P2S program [ 24 ] and acceptability and feasibility piloting [ 25 ] of the program have been reported elsewhere. Secondary aims were to examine the effect of the online P2S program on 4 health behaviours (smoking, alcohol use, fruit and vegetable intake, and moderate physical activity), mental health (depression and anxiety), and self-reported physical functioning and independent living.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an online intervention for improving stroke survivors’ health-related quality of life: A randomised controlled trial

et al. 2022

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Background The aim of this trial was to evaluate the effectiveness of an online health behaviour change intervention—Prevent 2nd Stroke (P2S)—at improving health-related quality of life (HRQoL) amongst stroke survivors at 6 months of follow-up. Methods and findings A prospective, blinded-endpoint randomised controlled trial, with stroke survivors as the unit of randomisation, was conducted between March 2018 and November 2019. Adult stroke survivors between 6 and 36 months post-stroke with capacity to use the intervention (determined by a score of ≥4 on the Modified Rankin Scale) and who had access and willingness to use the internet were recruited via mail-out invitations from 1 national and 1 regional stroke registry. Participants completed baseline (n = 399) and 6-month follow-up (n = 356; 89%) outcome assessments via computer-assisted telephone interviewing (CATI). At baseline the sample had an average age of 66 years (SD 12), and 65% were male. Randomisation occurred at the end of the baseline survey; CATI assessors and independent statisticians were blind to group allocation. The intervention group received remote access for a 12-week period to the online-only P2S program (n = 199; n = 28 lost at follow-up). The control group were emailed and posted a list of internet addresses of generic health websites (n = 200; n = 15 lost at follow-up). The primary outcome was HRQoL as measured by the EuroQol Visual Analogue Scale (EQ-VAS; self-rated global health); the outcome was assessed for differences between treatment groups at follow-up, adjusting for baseline measures. Secondary outcomes were HRQoL as measured by the EQ-5D (descriptive health state), diet quality, physical activity, alcohol consumption, smoking status, mood, physical functioning, and independent living. All outcomes included the variable ‘stroke event (stroke/transient ischaemic attack/other)’ as a covariate, and analysis was intention-to-treat. At 6 months, median EQ-VAS HRQoL score was significantly higher in the intervention group than the control group (85 vs 80, difference 5, 95% CI 0.79–9.21, p = 0.020). The results were robust to the assumption the data were missing at random; however, the results were not robust to the assumption that the difference in HRQoL between those with complete versus missing data was at least 3 points. Significantly higher proportions of people in the intervention group reported no problems with personal care (OR 2.17, 95% CI 1.05–4.48, p = 0.0359) and usual activities (OR 1.66, 95% CI 1.06–2.60, p = 0.0256) than in the control group. There were no significant differences between groups on all other secondary outcomes. The main limitation of the study is that the sample comprises mostly ‘well’ stroke survivors with limited to no disability. Conclusions The P2S online healthy lifestyle program improved stroke survivors’ self-reported global ratings of HRQoL (as measured by EQ-VAS) at 6-month follow-up. Online platforms represent a promising tool to engage and support some stroke survivors. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617001205325.

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Development of an online secondary prevention programme for stroke survivors: Prevent 2nd Stroke

Cited by 4 publications

References 39 publications

Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study

Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

Evaluation of an online intervention for improving stroke survivors’ health-related quality of life: A randomised controlled trial

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