Brouwer-Goossensen Dorien, Scheele Maaike, van Genugten Lenneke, Lingsma Hester F, Dippel Diederik W J, Koudstaal Peter J, den Hertog Heleen M
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Neurology, Isala Hospital, Zwolle, The Netherlands.
Eur J Cardiovasc Nurs. 2022 Jan 11;21(1):36-45. doi: 10.1093/eurjcn/zvab001.
Modification of health behaviour is an important part of stroke risk management. However, the majority of people with cardiovascular disease fail to sustain lifestyle modification in the long term. We aimed to evaluate the effectiveness of motivational interviewing to encourage lifestyle behaviour changes after transient ischaemic attack (TIA) or minor ischaemic stroke.
We performed a randomized controlled open-label phase II trial with blinded endpoint assessment. The intervention consisted of three 15-minute visits in 3 months by a motivational interviewing trained nurse practitioner. Patients in the control group received standard consultation after 1 and 3 months by a nurse practitioner. Primary outcome was lifestyle behaviour change, defined as smoking cessation and/or increased physical activity (30 min/day) and/or healthy diet improvement (5 points at the Food Frequency Questionnaire) at 6 months. We adjusted for age and sex with multivariable logistic regression. Between January 2014 and February 2016, we included 136 patients (of whom 68 were assigned to the intervention group). Twenty-five of 55 patients in the intervention group (45%) and 27 of 61 patients in the control group (44%) had changed their lifestyle at 6 months. We found no effect of motivational interviewing on lifestyle behaviour change after 6 months (aOR 0.99; 95% confidence interval: 0.44-2.26).
Our results do not support the effectiveness of motivational interviewing in supporting lifestyle behaviour change after TIA or ischaemic stroke. However, the overall lifestyle behaviour change was high and might be explained by the role of specialized nurses in both groups.
改变健康行为是中风风险管理的重要组成部分。然而，大多数心血管疾病患者无法长期维持生活方式的改变。我们旨在评估动机性访谈对短暂性脑缺血发作（TIA）或轻度缺血性中风后鼓励生活方式行为改变的有效性。
我们进行了一项随机对照开放标签的II期试验，并采用盲法终点评估。干预措施包括由一名接受过动机性访谈培训的执业护士在3个月内进行三次每次15分钟的访视。对照组的患者在1个月和3个月后由一名执业护士进行标准咨询。主要结局是生活方式行为改变，定义为在6个月时戒烟和/或增加体力活动（每天30分钟）和/或改善健康饮食（食物频率问卷增加5分）。我们使用多变量逻辑回归对年龄和性别进行了调整。在2014年1月至2016年2月期间，我们纳入了136例患者（其中68例被分配到干预组）。干预组55例患者中有25例（45%），对照组61例患者中有27例（44%）在6个月时改变了生活方式。我们发现6个月后动机性访谈对生活方式行为改变没有影响（调整后比值比0.99；95%置信区间：0.44 - 2.26）。
我们的结果不支持动机性访谈对TIA或缺血性中风后支持生活方式行为改变的有效性。然而总体生活方式行为改变率较高，这可能是由两组中专科护士的作用所解释的。
