BACKGROUND: A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
OBJECTIVES: The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety.
SEARCH METHODS: We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews.
SELECTION CRITERIA: Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence.
MAIN RESULTS: We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being.
AUTHORS' CONCLUSIONS: Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
BACKGROUND: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Stroke services need to be configured to maximise the adoption of evidence-based strategies for secondary stroke prevention. Smoking-related interventions were examined in a separate review so were not considered in this review. This is an update of our 2014 review.
OBJECTIVES: To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events.
SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (April 2017), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2017), CENTRAL (the Cochrane Library 2017, issue 3), MEDLINE (1950 to April 2017), Embase (1981 to April 2017) and 10 additional databases including clinical trials registers. We located further studies by searching reference lists of articles and contacting authors of included studies.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention.
DATA COLLECTION AND ANALYSIS: Four review authors selected studies for inclusion and independently extracted data. The quality of the evidence as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (GRADEpro GDT).Three review authors assessed the risk of bias for the included studies. We sought missing data from trialists.The results are presented in 'Summary of findings' tables.
MAIN RESULTS: The updated review included 16 new studies involving 25,819 participants, resulting in a total of 42 studies including 33,840 participants. We used the Cochrane risk of bias tool and assessed three studies at high risk of bias; the remainder were considered to have a low risk of bias. We included 26 studies that predominantly evaluated organisational interventions and 16 that evaluated educational and behavioural interventions for participants. We pooled results where appropriate, although some clinical and methodological heterogeneity was present.Educational and behavioural interventions showed no clear differences on any of the review outcomes, which include mean systolic and diastolic blood pressure, mean body mass index, achievement of HbA1c target, lipid profile, mean HbA1c level, medication adherence, or recurrent cardiovascular events. There was moderate-quality evidence that organisational interventions resulted in improved blood pressure control, in particular an improvement in achieving target blood pressure (odds ratio (OR) 1.44, 95% confidence interval (CI) 1.09 to1.90; 13 studies; 23,631 participants). However, there were no significant changes in mean systolic blood pressure (mean difference (MD), -1.58 mmHg 95% CI -4.66 to 1.51; 16 studies; 17,490 participants) and mean diastolic blood pressure (MD -0.91 mmHg 95% CI -2.75 to 0.93; 14 studies; 17,178 participants). There were no significant changes in the remaining review outcomes.
AUTHORS' CONCLUSIONS: We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events.
ANTECEDENTES: El objetivo de este estudio fue determinar si las intervenciones que incluyen componentes para mejorar la adherencia a los medicamentos antihipertensivos en los pacientes después del accidente cerebrovascular / accidente isquémico transitorio (TIA) mejorar el cumplimiento y control de la presión arterial.
MÉTODOS Y RESULTADOS: Se realizaron búsquedas en MEDLINE, EMBASE, CINAHL, BNI, PsycINFO, y la referencia al artículo Listas de octubre de 2012. Los términos de búsqueda incluyeron ictus / AIT, la adhesión / prevención, la hipertensión y el ensayo controlado aleatorio (ECA). Los criterios de inclusión fueron los participantes con accidente cerebrovascular / TIA; intervenciones incluyendo un componente para mejorar la adherencia a los medicamentos antihipertensivos y los resultados; incluyendo la presión arterial, la adherencia antihipertensivo, o ambos. Dos revisores evaluaron de forma independiente los estudios para determinar la elegibilidad, validez y calidad. Siete ECA fueron elegibles (n = 1591). La calidad metodológica varió. Todos los ensayos evaluaron intervenciones multifactoriales. Ninguno dirigido adherencia a la medicación sola. Seis ensayos midieron la presión arterial y la adherencia 3. El metanálisis de 6 ensayos mostró que los programas multifactoriales se asociaron con un mejor control de la presión arterial. La diferencia entre la intervención versus control en la mejoría media en la presión arterial sistólica fue de -5,3 mm Hg (IC 95%, -10,2 a -0,4 mm Hg, P = 0,035; I (2) = 67% [21% a 86%]) y de la presión arterial diastólica fue -2,5 mm Hg (-5,0 a -0,1 mm Hg, P = 0,046; I (2) = 47% [0% a 79%]). No hubo efecto sobre la adherencia a la medicación que se mide.
CONCLUSIONES: Las intervenciones multifactoriales que incluyen un componente para mejorar la adherencia a la medicación pueden disminuir la presión arterial después de un ictus / AIT. Sin embargo, no es posible decir si esto se consigue gracias a una mejor adherencia a la medicación. Se necesitan ensayos de intervenciones bien caracterizados para mejorar la adherencia a la medicación y los resultados clínicos con la medición a lo largo del camino causal hipotético.
OBJETIVO: Evaluar los estudios que examinaron el impacto de la interactiva, la educación virtual (ICBE) programas de educación del paciente.
MÉTODOS: Las bases de datos Medline y CINAHL para identificar los estudios controlados aleatorios que evaluaron el impacto de los programas ICBE.
RESULTADOS: Los 25 estudios que cumplían con los criterios de selección apoyaron en general la capacidad de los programas ICBE para promover los beneficios del conocimiento. Los resultados relacionados con los resultados económicos o clínicos fueron menos consistentes. Variaciones significativas se observaron en los estudios de las características del programa, la implementación y las estrategias de integración, y en los atributos del programa de comparación y de calidad. Es probable que estas diferencias ha contribuido a la disparidad de resultados entre los estudios.
CONCLUSIÓN: A pesar de importantes discrepancias en los resultados se observó, la investigación aportó pruebas colectivas que los programas de ICBE tenía el potencial para agregar gran valor para el proceso de la educación del paciente. Los programas deben ser diseñados y los procesos de implementación y la integración de una planificación eficaz con el fin de lograr resultados positivos consistentes.
IMPLICACIONES PARA LA PRÁCTICA: consideración de las "mejores prácticas" derivadas de la investigación y señaló en este informe ayude a los profesionales de la salud en el diseño, selección y aplicación de programas eficaces ICBE.
OBJETIVO: Evaluar la eficacia de las estrategias de suministro de información para mejorar el resultado para los pacientes con accidente cerebrovascular o sus cuidadores identificados.
FUENTES DE INFORMACIÓN: Se realizaron búsquedas en: Cochrane de Ensayos Stroke Group Register, el Registro Cochrane Central de Ensayos Controlados, bases de datos electrónicas MEDLINE, EMBASE, CINAHL, PsycINFO, Science Citation Index y Social Science Citation Index, Assia, Reino Unido Índice de tesis; Dissertation Abstracts; los ensayos en curso y registros de investigación, bibliografías de los artículos recuperados, artículos relevantes y libros; el Journal of Advanced Nursing. También se contactó con los investigadores para obtener información adicional.
Métodos de revisión: Dos revisores evaluaron de forma independiente la elegibilidad del ensayo, extrajeron los datos y evaluaron la calidad metodológica. Los resultados primarios fueron el conocimiento sobre el accidente cerebrovascular y su impacto en el estado de ánimo. Los meta-análisis se llevaron a cabo para los dominios de conocimiento, el estado de ánimo, la satisfacción y la mortalidad.
RESULTADOS: Diecisiete ensayos fueron identificados y 11 aportaron los datos para los metanálisis. Hubo efectos significativos a favor de la intervención sobre el conocimiento del paciente (diferencia de medias estandarizada (DME) 0,29, 95% intervalo de confianza (IC) 0,12 a 0,46), el conocimiento médico (DME 0,74 IC 95%: 0,06 a 1,43), las puntuaciones de depresión del paciente ( diferencia de medias ponderada (DMP) -0,52, IC del 95% -0,93 a -0,10), y un aspecto de la satisfacción del paciente (odds ratio (OR) 2,07, IC 95%: 1,33 a 3,23). Los análisis post hoc de subgrupos mostró que las estrategias que participan activamente los pacientes y los cuidadores tuvo un efecto significativamente mayor en la ansiedad del paciente (P <0,05) y depresión (p <0,02) que las estrategias pasivas.
CONCLUSIÓN: Hay una cierta evidencia para apoyar la provisión regular de información a los pacientes con ictus y sus familias. Aunque la mejor manera de proporcionar la información todavía no está claro, los resultados de esta revisión indican que las estrategias que involucren activamente a los pacientes y los cuidadores deben ser utilizados en la práctica habitual.
A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
OBJECTIVES:
The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety.
SEARCH METHODS:
We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews.
SELECTION CRITERIA:
Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence.
MAIN RESULTS:
We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being.
AUTHORS' CONCLUSIONS:
Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
