title: Secondary prevention and health promotion after stroke: can it be enhanced?
abstract: The aim was to study if health outcome and secondary prevention were satisfactory 1 year after stroke and if nurse-led interventions 3 months after stroke could have impact. Design was a randomized controlled open trial in a 1-year population. Primary outcome was health status 1 year after stroke. One month after stroke, survivors were randomized into intervention group (IG) with follow-up by a specialist nurse (SN) after 3 months (n = 232), and control group (CG) with standard care (n = 227), all to be followed up 1 year after stroke. At the first follow-up, patients graded their health, replied to the EuroQol-5 Dimensions (EQ-5D) health outcome questions, health problems were assessed, and supportive counseling was provided in the IG. Health problems requiring medical interventions were primarily referred to a general practitioner (GP). One year after stroke, 391 survivors were followed up. Systolic blood pressure (BP) had decreased in IG (n = 194) from median 140 to 135 (P = .05), but about half were above the limit 139 in both groups. A larger proportion (22%) had systolic BP >155 in the CG (n = 197) than in the IG (14%; P = .05). In the IG, 62% needed referrals compared with the 75% in the CG (P = .009). Forty percent in the IG and 52.5% in the CG (P = .04) reported anxiety/depression. In the IG, 75% and 67% in the CG rated their general health as fairly good or very good (P = .05). Although nurse-led interventions could have some effect, the results were not optimal. A more powerful strategy could be closer collaboration between the SN and a stroke clinician, before referring to primary care.
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden. Electronic address: Ann-Cathrin.Jonsson@med.lu.se.
authors.forename: Ann-Cathrin
authors.initials: AC
authors.lastname: Jönsson
authors.affiliation: Department of Laboratory Medicine, Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.affiliation: Department of Neurology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: Brizzi
authors.affiliation: Department of Neurology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Hélène
authors.initials: H
authors.lastname: Pessah-Rasmussen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D012017:Referral and Consultation; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D057566:Self Report; D020521:Stroke / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome
keywords: Health promotion; nurse's role; referral and consultation; risk factors; secondary prevention; stroke