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

Abstract

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.

Analyzing the Effect of Telemedicine on Domains of Quality Through Facilitators and Barriers to Adoption: Systematic Review

“…This theme encompassed anxiety, well-being, stress, loneliness, depression, fear, personal satisfaction, helplessness, rumination, acceptance, suicidal ideation, and resilience. There were 13% (12/92) of instances of improved medical engagement [ 28 , 30 , 32 , 35 , 36 , 40 , 43 , 46 , 48 , 60 ]. This theme included medication compliance, program or treatment adherence, follow-up visits, medical knowledge, and decrease in emergency department visits.…”

“…This theme included medication compliance, program or treatment adherence, follow-up visits, medical knowledge, and decrease in emergency department visits. There were 12% (11/92) of instances of 2 themes: changed behavior, which included sexual behavior, self-care, drinking, smoking, physical activity, weight loss, and salt intake [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ] and increased quality of life (QoL), which included sleep, vitality, interpersonal problems, attitude, or as measured by the EuroQoL visual analog scale [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ]. There were 7% (6/92) of instances of increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ].…”

“…There were 12% (11/92) of instances of 2 themes: changed behavior, which included sexual behavior, self-care, drinking, smoking, physical activity, weight loss, and salt intake [ 29 , 32 , 34 , 50 , 53 , 55 , 56 , 58 - 60 ] and increased quality of life (QoL), which included sleep, vitality, interpersonal problems, attitude, or as measured by the EuroQoL visual analog scale [ 31 , 36 , 37 , 39 - 41 , 45 , 54 , 56 , 57 , 59 , 60 ]. There were 7% (6/92) of instances of increased self-efficacy [ 28 , 35 , 36 , 41 , 47 ]. This theme included an increase in self-care, vaccinations, and preventive measures, such as Papanicolaou smears, colorectal exams, and mammograms.…”

“…A total of 24 studies reported on satisfaction. Of the 33 studies, 22 (67%) reported satisfaction or high satisfaction [ 28 - 36 , 39 , 40 , 42 - 44 , 46 - 48 , 50 , 56 - 59 ], 2 (6%) reported dissatisfaction [ 38 , 45 ], and 9 (27%) did not report satisfaction or dissatisfaction [ 37 , 41 , 49 , 51 - 55 , 60 ].…”

Access to and Use of Internet and Social Media by Low-Morbidity Stroke Survivors Participating in a National Web-Based Secondary Stroke Prevention Trial: Cross-sectional Survey

“…This study is a secondary analysis of cross-sectional data obtained during a national randomized controlled trial— Prevent 2 nd Stroke [ 26 , 27 ]. Details regarding the study design and methods have been published elsewhere [ 26 ].…”