title: Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA).
abstract: BACKGROUND
  Good blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemic attack (TIA). Although there is strong evidence that BP telemonitoring helps achieve good control, none of the major trials have considered the effectiveness in stroke/TIA survivors. We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/TIA survivors with uncontrolled BP in primary care.
  
  
  METHODS
  Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BP telemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation and comprised semi-structured interviews with 16 trial participants who received telemonitoring and 3 focus groups with 23 members of stroke support groups and 7 carers.
  
  
  RESULTS
  Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%) patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two participants (95%) attended the 6-month follow-up appointment, but one declined the second daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93% completion rate for ABPM - the proposed primary outcome measure for a full trial. Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38 continued to provide readings throughout the 6 months. There was a mean reduction of 10.1 mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the control group, which suggested the potential for a substantial effect from telemonitoring. Our qualitative analysis found that many stroke patients were concerned about their BP and telemonitoring increased their engagement, was easy, convenient and reassuring.
  
  
  CONCLUSIONS
  A full-scale trial is feasible, likely to recruit well and have good rates of compliance and follow-up.
  
  
  BACKGROUND
  ISRCTN61528726 15/12/2011.
authors: Edinburgh Napier University, Sighthill Campus, Sighthill Court, Edinburgh, EH11 4BN, UK. j.hanley@napier.ac.uk.|Edinburgh Health Services Research Unit/Edinburgh Clinical Trials Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. j.hanley@napier.ac.uk.
authors: Janet
authors: J
authors: Hanley
authors: NHS Lothian, C/O Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Peter.Fairbrother@nhslothian.scot.nhs.uk.
authors: Peter
authors: P
authors: Fairbrother
authors: Edinburgh Health Services Research Unit/Edinburgh Clinical Trials Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. A.Krishan@liverpool.ac.uk.
authors: Ashma
authors: A
authors: Krishan
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Lucy.McCloughan@ed.ac.uk.
authors: Lucy
authors: L
authors: McCloughan
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Paul.Padfield@blueyonder.co.uk.
authors: Paul
authors: P
authors: Padfield
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Mary.Paterson@ed.ac.uk.
authors: Mary
authors: M
authors: Paterson
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Hilary.pinnock@ed.ac.uk.
authors: Hilary
authors: H
authors: Pinnock
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Aziz.sheikh@ed.ac.uk.
authors: Aziz
authors: A
authors: Sheikh
authors: Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Cathie.sudlow@ed.ac.uk.
authors: Cathie
authors: C
authors: Sudlow
authors: NHS Lothian, C/O Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Allison.todd@nhslothian.scot.nhs.uk.
authors: Allison
authors: A
authors: Todd
authors: Edinburgh Health Services Research Unit/Edinburgh Clinical Trials Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. Brian.Mckinstry@ed.ac.uk.|Telescot Programme, Centre for Population Health Sciences, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9DX, UK. Brian.Mckinstry@ed.ac.uk.
authors: Brian
authors: B
authors: McKinstry
mesh_terms: D018660:Blood Pressure Monitoring, Ambulatory; D005240:Feasibility Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000503:physiopathology*; D010865:Pilot Projects; D036301:Qualitative Research; D020521:Stroke / Q000503:physiopathology*; D017216:Telemedicine