Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Jan;67(654):e57-e66.
doi: 10.3399/bjgp16X688369. Epub 2016 Dec 5.

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes

Neil Heron  1 , Frank Kee  1 , Christopher Cardwell  1 , Mark A Tully  1 , Michael Donnelly  1 , Margaret E Cupples  1
Affiliations
Meta-Analysis

Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes

Neil Heron et al. Br J Gen Pract. 2017 Jan.

Abstract

Background: Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear.

Aim: To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used.

Design and setting: The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO.

Method: Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results.

Results: A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours.

Conclusion: There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed.

Keywords: behaviour change techniques; early rehabilitation; lifestyle interventions; secondary prevention; transient ischaemic attack; ‘minor’ stroke.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram of reviewed and included papers. TIA = transient ischaemic attack.
Figure 2.
Figure 2.
Resting systolic blood pressure (mmHg) in experimental and control groups post-intervention.
Figure 3.
Figure 3.
Six-minute walking test performance (metres walked) in experimental and control groups post-intervention.
Figure 4.
Figure 4.
Exercise testing result in experimental and control groups post-intervention.
See this image and copyright information in PMC

References

    1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182–187. - PubMed
    1. Horgan NF, O’Regan M, Cunningham CJ, Finn AM. Recovery after stroke: a 1-year profile. Disabil Rehabil. 2009;31(10):831–839. - PubMed
    1. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292. - PubMed
    1. Selvarajah JR, Smith CJ, Hulme S, et al. Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study. J Neurol Neurosurg Psychiatry. 2008;79(1):38–43. - PubMed
    1. Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40(6):2276–2293. - PubMed

MeSH terms