The Effectiveness of Secondary Prevention Lifestyle Interventions Designed to Change Lifestyle Behavior following Stroke: Summary of a Systematic Review

Abstract

Background A feature of stroke is that it recurs (25% within five-years). Risk factors for stroke and recurrent stroke include smoking, alcohol consumption, poor diet, and physical inactivity. Aim To evaluate the effectiveness of secondary prevention lifestyle interventions designed to change lifestyle behavior following stroke. This short paper presents a summary of the systematic review process and findings. Methods Ten major databases were searched using subject headings and key words. Papers were screened using review-specific criteria. Critical appraisal and data extraction were conducted independently by two reviewers. Data were pooled in statistical meta-analysis; where this was not possible findings were presented in narrative form. Results Three studies involving 581 participants were reviewed. Two models of intervention delivery were reported: shared care and nurse-led. Interventions were delivered to groups or in one-to-one consultations. Metaanalyses of the pooled lifestyle data favored the interventions (2 P = 0.02). In terms of physiological outcomes, while overall treatment effect was not significant, pooled results did approach statistical significance (2 P = 0.08), however the test of heterogeneity was significant, suggesting differences in the variables that were pooled. Pooled secondary outcomes, including perceived health status and stroke knowledge, favored the interventions (2 P #< 0.00001), however, the test for heterogeneity was highly significant. Conclusion Stroke secondary prevention lifestyle interventions are effective in terms of effecting positive change in lifestyle behaviors and secondary outcomes, and appear promising in relation to physiological outcomes. There was insufficient evidence to determine the effect of intervention on incidence of stroke recurrence.