Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing

Abstract

S trokes recur in ≈25% of patients in the first year, 1-4 with a 5-year cumulative recurrent risk of 30% to 40%. 5 Recurrent stroke leads to greater disability and case fatality. 6,7 The stroke recurrence rate has not changed over the past 20 years. 4 Evidence-based secondary stroke prevention guidelines improve stroke outcomes and reduce costs, 8 but remain underutilized.9,10 Poor preventive care training, 11 discharge planning, 12,13 risk factor management, and communication with stroke patients/family 9 are likely contributors. 11,14Motivational interviewing (MI) aims to improve adherence to medication and lifestyle changes. MI facilitates intrinsic motivation to change behavior 15 and attempts to increase awareness of potential problems, consequences, and risks as a result of a behavior 16 and seeks to help people think differently about their behavior and consider potential gains through change. 17 MI is structured, patient-focused, 18-23 and more costeffective 24 than many other behavior change methods. 25,26 MI was developed for substance abuse management 21,22,27,28 but 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). This trial aimed to determine the effectiveness of MI in improving adherence to medications (particularly blood pressure [BP] and cholesterol lowering medications) in stroke patients enrolled into a larger population-based stroke study. Changes in systolic BP and low-density lipoprotein (LDL) cholesterol levels were assessed as primary outcomes. Other lipid fractions (high-density lipoprotein cholesterol, total cholesterol, triglycerides, and glycohemoglobin), self-reported adherence, occurrence of new stroke/coronary heart disease (fatal/nonfatal), changes in quality of life, and mood were also assessed. Results-MI MethodsThree hundred eighty-six people aged ≥16 years with stroke (excluding subarachnoid hemorrhage) were enrolled. The methodology is described in detail elsewhere, 38 but briefly, potential participants were identified by a hospital-based research assistant through checking hospital databases and attendance at weekly team meetings for relevant wards/units. Eligible candidates were approached in...

What Type of Transitional Care Effectively Reduced Mortality and Improved ADL of Stroke Patients? A Meta-Analysis

“…Three trials investigated the effects of motivational interviewing (MI) on reducing stroke recurrence. The effect was measured by the improvement in adherence to recommended medication, lifestyle changes, or mood, and compared with usual care [17,18,42]. One study tested the effectiveness of a structured training program for caregivers (the London Stroke Carers Training Course, LSCTC), which included an assessment of competencies in knowledge or skills essential for the day-to-day management of disabled survivors of stroke [43].…”

Adaptation or recovery after health shocks? Evidence using subjective and objective health measures

“…Recurrence rates are high after stroke and heart attack (De Lima, Saconato, Atallah, & da Silva, ; Liu & Wang, ). For stroke, for example, recurrence rates were estimated to 20–25% and have not declined over the past decades (Barker‐Collo et al ). Furthermore, recurrence is associated with significantly higher mortality compared with the first event.…”

Development of a tool to support person-centred medicine-focused consultations with stroke survivors

“…Most demonstrated modest short-term impact on adherence and clinical markers but did not address the long-term impact. [53][54][55][56][57] The majority of stroke survivors are discharged from specialist care after a few months and are then cared for by a general practitioner with their medicines supplied by a community pharmacist.…”