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 accidente cerebrovascular es la tercera causa más común de mortalidad y una de las principales causas de discapacidad física para adultos en Inglaterra. El tratamiento médico es imprescindible para la gestión de los accidentes cerebrovasculares y la reducción del riesgo de accidente cerebrovascular recurrente. El éxito de un tratamiento médico se determina en gran medida por la adherencia. Sin embargo, la investigación ha demostrado que la adherencia a la medicación en los pacientes que han sufrido un derrame cerebral a menudo es subóptima. Intervenciones de autogestión se ha demostrado para mejorar la adherencia en condiciones a largo plazo. El impacto de las intervenciones de autogestión específicamente en la adherencia a la medicación accidente cerebrovascular es desconocido.
OBJETIVO: Revisar sistemáticamente el impacto que las intervenciones de autogestión tienen en la adherencia a la medicación accidente cerebrovascular.
MÉTODO: Las bases de datos en línea que fueron sistemáticamente buscado incluidos PsychINFO, MEDLINE, EMBASE, Scopus, Base de Datos Cochrane de Revisiones Sistemáticas, CINAHL y Web of Science. Las listas de referencias de los estudios recuperados se realizaron búsquedas manuales.
RESULTADOS: Seis estudios cumplieron los criterios de inclusión en la revisión sistemática. Intervenciones de autocuidado para pacientes con accidente cerebrovascular fueron eficaces en la mejora de la adherencia a la medicación accidente cerebrovascular en el corto plazo. Sin embargo, en el largo plazo, no se mantuvieron estos beneficios.
Conclusiones: La aplicación de intervenciones de autocuidado para mejorar la adherencia a la medicación en los pacientes con ictus en todos los entornos clínicos integrados muestra promesa. Sin embargo, se recomienda un mayor desarrollo de este tipo de intervenciones y la investigación, con metodologías más rigurosas y períodos de seguimiento más largos.
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.
ANTECEDENTES: Muchos pacientes experimentan la depresión, aislamiento social y la ansiedad después del accidente cerebrovascular. Estos se asocian con un peor resultado. Mejorar estos problemas pueden mejorar el bienestar del paciente.
OBJETIVOS: Evaluar el impacto de un trabajador de salud o voluntario cuya multidimensionales funciones se han agrupado en "trabajador de enlace accidente cerebrovascular" el título.
ESTRATEGIA DE BÚSQUEDA: Se realizaron búsquedas en el Cochrane Stroke Group Trials Register (búsqueda de febrero de 2009), el Registro Cochrane Central de Ensayos Controlados (CENTRAL) (The Cochrane Library Número 1, 2009), MEDLINE (1966 a 2009), EMBASE (1980 a 2009) y cuatro otras bases de datos. Se realizó una búsqueda de referencias citadas, búsquedas en los resúmenes de conferencias y los registros de ensayos, se verificaron las listas de referencia y contacto con autores e investigadores de los ensayos.
CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorios que investigan el impacto de un trabajador de enlace accidente cerebrovascular en comparación con la atención habitual.
RECOPILACIÓN Y ANÁLISIS DE DATOS: Nos invitó a investigadores a participar en una revisión de datos de pacientes individuales. Los resultados primarios de los pacientes fueron el estado de salud subjetivo y actividades extendidas de la vida diaria. Los resultados primarios para los cuidadores fueron el estado de salud subjetivo, incluidas las medidas de la tensión del cuidador.
RESULTADOS PRINCIPALES: Se incluyeron 16 ensayos con 4759 participantes. El análisis no mostró una diferencia significativa global para el estado de salud subjetivo (diferencia de medias estandarizada (DME) -0,03, IC del 95% intervalo de confianza (IC) del -0,11 a 0,04, P = 0,34) o las actividades extendidas de la vida diaria (DME 0,04, IC del 95% : -0,03 a 0,11, p = 0,22). No hubo un efecto global significativo para el resultado del estado de salud subjetiva cuidador (DME 0,04, IC 95%: -0,05 a 0,14, P = 0,37). Los pacientes con discapacidad leve a moderada (Barthel 15 a 19) tuvieron una reducción significativa de la dependencia (odds ratio (OR) 0,62, IC 95%: 0,44 a 0,87, P = 0,006). Esto equivaldría a menos de 10 pacientes dependientes (IC 95% 17 menos de 4 menos) por cada 100 pacientes atendidos por el trabajador de enlace accidente cerebrovascular. Se observaron resultados similares para el resultado de muerte o dependencia para el subgrupo con Barthel 15 a 19 (OR 0.55, IC 95%: 0,38 a 0,81, P = 0,002). Esta diferencia de riesgo equivale a 11 número de pacientes muertos o dependientes (IC 95% 17 menos de 4 menos) por cada 100 pacientes atendidos por el trabajador de enlace accidente cerebrovascular.
CONCLUSIONES DE LOS REVISORES: No hay evidencia de la efectividad de esta intervención multifacética para mejorar los resultados para todos los grupos de pacientes o cuidadores. Los pacientes con insuficiencia renal leve a moderada prestación de invalidez de una reducción en la muerte y la discapacidad. Los pacientes y cuidadores hacer una mejor satisfacción del informe con algunos aspectos de la prestación de servicios.
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.
