Heron Neil, Kee Frank, Cardwell Christopher, Tully Mark A, Donnelly Michael, Cupples Margaret E
Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast; UKCRC Centre of Excellence for Public Health (Northern Ireland), Institute of Clinical Science B, Royal Victoria Hospital, Belfast.
Br J Gen Pract. 2017 Jan;67(654):e57-e66. doi: 10.3399/bjgp16X688369. Epub 2016 Dec 5.
Strokes are often preceded by a transient ischaemic attack (TIA) or 'minor' stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear.
To systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used.
The review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO.
Two review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results.
A total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours.
There is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed.
中风通常 preceded by 短暂性脑缺血发作（TIA）或“轻度”中风。TIA/轻度中风后的即刻时期是启动二级预防的关键时机。然而，TIA 后预防的最佳方法，包括非药物措施，尚不清楚。
系统评价在 TIA/轻度中风后 90 天内启动的综合康复计划中，采用生活方式干预进行二级预防的有效性证据。此外，对所使用的具体行为改变技术进行分类。
通过检索考克兰图书馆、Ovid MEDLINE、Ovid EMBASE、科学网、EBSCO CINAHL 和 Ovid PsycINFO 来确定随机对照试验。
两位综述作者独立筛选标题和摘要以确定 eligibility（事件发生后 90 天内启动的计划；报告的 TIA/轻度中风结果），并从评估的研究中提取相关数据；采用荟萃分析来综合结果。
共识别出 31 篇潜在 eligible 论文，4 项研究（包括 774 例 TIA 或轻度中风后患者）符合纳入标准；两项研究方法学质量较差。个别研究报告有氧运动能力有所提高，但荟萃分析发现静息和收缩压峰值、静息心率、有氧运动能力、跌倒或死亡率无显著变化。主要行为改变技术是目标设定和关于如何执行特定行为的指导。
关于 TIA 后早期康复计划结合预防性生活方式干预有效性的证据有限。需要进一步开展强有力的随机对照试验，以研究 TIA 后立即促进二级预防和生活方式改变的综合康复计划。
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