Non-pharmacological interventions for preventing secondary vascular events after stroke or transient attack

Stroke is the second leading cause of adult death worldwide. There is increasing evidence that individuals who have suffered a stroke can significantly benefit from organized stroke care during their period of recovery. Non-pharmacological interventions (treatments that do not involve drugs) may play a role in preventing a secondary vascular event and reducing vascular risk factors. Only one randomized controlled trial was identified, involving 48 participants. Considering the small sample size and methodological limitation, no implications on the effectiveness of non-pharmacological interventions post-stroke can be drawn. Several ongoing trials will, in time, contribute to the current body of evidence. However, more research is needed.

Authors' conclusions: 

There is limited applicable evidence. Therefore, no implications for practice can be drawn. Further research is required and several trials are underway, the findings of which are anticipated to contribute to the body of evidence.

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Background: 

Stroke is the second leading cause of death among adults worldwide. Individuals who have suffered a stroke are at high risk of having another stroke likely leading to greater disability and institutionalization. Non-pharmacological interventions may have a role to play in averting a second stroke.

Objectives: 

To determine the effectiveness of multi-modal programs of non-pharmacological interventions compared with usual care in preventing secondary vascular events and reducing vascular risk factors after stroke or transient ischemic attack (TIA).

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (September 2012); The Cochrane Library databases CENTRAL, CDSR, DARE, HTA and NHS EED (2012 Issue 2); MEDLINE (1950 to February 2012); EMBASE (1974 to February 2012); CINAHL (1982 to February 2012); SPORTDiscus (1800 to February 2012); PsycINFO (1887 to February 2012) and Web of Science (1900 to February 2012). We also searched PEDro, OT Seeker, OpenSIGLE, REHABDATA and Dissertation Abstracts (February 2012). In an effort to identify further published, unpublished and ongoing trials we searched trials registers, scanned reference lists, and contacted authors and researchers.

Selection criteria: 

We included randomized controlled trials evaluating the use of non-pharmacological interventions that included components traditionally used in cardiac rehabilitation (CR) programs in adults with stroke or TIA. Primary outcomes were a cluster of second stroke or myocardial infarction or vascular death. Secondary outcomes were (1) secondary vascular events: second stroke, myocardial infarction, and vascular death, as well as (2) vascular risk factors: blood pressure, body weight, lipid profile, insulin resistance and tobacco use. We also recorded adverse events such as exercise-related musculoskeletal injuries or cardiovascular events.

Data collection and analysis: 

Two review authors independently scanned titles and abstracts and independently screened full reports of studies that were potentially relevant. At each stage, we compared results. The two review authors resolved disagreements through discussion or by involving a third review author.

Main results: 

We identified one study, involving 48 participants, of a 10-week CR program for patients post-stroke that met the inclusion criteria. The results of this completed pilot trial show that patients post-stroke had significantly greater improvement in cardiac risk score in the CR group (13.4 ± 10.1 to 12.4 ± 10.5, P value < 0.05) when compared with usual care (9.4 ± 6.7 to 15.0 ± 6.1, P value < 0.05). In addition, five trials, which are ongoing, will likely meet the inclusion criteria for this review once completed.

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