title: Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial.
abstract: BACKGROUND
  Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke.
  
  
  OBJECTIVE
  The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke.
  
  
  METHODS
  Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points.
  
  
  RESULTS
  Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood.
  
  
  CONCLUSIONS
  The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant.
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Rita
authors.initials: R
authors.lastname: Krishnamurthi
authors.forename: Emma
authors.initials: E
authors.lastname: Witt
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barker-Collo
authors.forename: Kathryn
authors.initials: K
authors.lastname: McPherson
authors.forename: Kelly
authors.initials: K
authors.lastname: Davis-Martin
authors.forename: Derrick
authors.initials: D
authors.lastname: Bennett
authors.forename: Elaine
authors.initials: E
authors.lastname: Rush
authors.forename: Flora
authors.initials: F
authors.lastname: Suh
authors.forename: Nicola
authors.initials: N
authors.lastname: Starkey
authors.forename: Varsha
authors.initials: V
authors.lastname: Parag
authors.forename: Yogini
authors.initials: Y
authors.lastname: Rathnasabapathy
authors.forename: Amy
authors.initials: A
authors.lastname: Jones
authors.forename: Paul
authors.initials: P
authors.lastname: Brown
authors.forename: Braden
authors.initials: B
authors.lastname: Te Ao
authors.forename: Valery L
authors.initials: VL
authors.lastname: Feigin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D010349:Patient Compliance; D012107:Research Design; D055502:Secondary Prevention; D016037:Single-Blind Method; D020521:Stroke / Q000517:prevention & control*
keywords: adherence; motivational interviewing; recurrent stroke; secondary prevention