title: A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients.
abstract: The aims of this review were to describe the self-management interventions used to improve risk factor control in stroke patients and quantitatively assess their effects on the following: 1) overall risk factor control from lifestyle behaviour (i.e. physical activity, diet and nutrition, stress management, smoking, alcohol, and medication adherence), and medical risk factors (i.e. blood pressure, cholesterol, blood glucose) and (2) individual risk factors.
  
  
  
  We systematically searched the PubMed, PsycINFO, CINAHL and Cochrane Database of Systematic Reviews databases to September 2015 to identify relevant randomized controlled trials investigating self-management to improve stroke risk factors. The self-management interventions were qualitatively described, and the data included in meta-analyses.
  
  
  
  Fourteen studies were included for review. The model estimating an effect averaged across all stroke risk factors was not significant, but became significant when four low-quality studies were removed (SMD = 0.10 [95 % CI = 0.02 to 0.17], I2= 0 %, p = 0.01). Subgroup analyses revealed a significant effect of self-management interventions on lifestyle behaviour risk factors (SMD = 0.15 [95 % CI = 0.04 to 0.25], I2= 0 %, p = 0.007) but not medical risk factors. Medication adherence was the only individual risk factor that self-management interventions significantly improved (SMD = 0.31 [95 % CI = 0.07 to 0.56], I2= 0 %, p = 0.01).
  
  
  
  Self-management interventions appear to be effective at improving overall risk factor control; however, more high-quality research is needed to corroborate this observation. Self-management has a greater effect on lifestyle behaviour risk factors than medical risk factors, with the largest effect at improving medication adherence.
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.|Faculty of Health Sciences, Simon Fraser University, c/o Healthy Heart Program, St. Paul's Hospital 180 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.|Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada.
authors.forename: Brodie M
authors.initials: BM
authors.lastname: Sakakibara
authors.affiliation: Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Kim
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. janice.eng@ubc.ca.|Rehabilitation Research Program, GF Strong Rehabilitation Research Lab, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada. janice.eng@ubc.ca.
authors.forename: Janice J
authors.initials: JJ
authors.lastname: Eng
mesh_terms: D015444:Exercise; D006801:Humans; D008019:Life Style; D055118:Medication Adherence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D020521:Stroke / Q000209:etiology*
keywords: Chronic disease; Meta-analysis; Risk factors; Secondary prevention; Self-management; Stroke