School of Public Health, Physiotherapy and Sports Science, Health Science Centre, University College Dublin, Dublin, Ireland.
iPASTAR (Improving Pathways for Acute Stroke and Rehabilitation) Collaborative Doctoral Award, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
PLoS One. 2024 Apr 26;19(4):e0302364. doi: 10.1371/journal.pone.0302364. eCollection 2024.
Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking.
Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes.
From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence).
Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.
除了预防药物外，生活方式的改变也能优化中风二级预防。系统评价的证据支持中风后进行以行为改变为基础的干预措施，以解决与生活方式相关的风险。然而，对于影响中风后行为改变的理论驱动因素知之甚少。
检索了 MEDLINE、Embase、Epistemonikos 和 Cochrane 系统评价数据库，以获取 2023 年 3 月前针对中风后行为改变的系统评价。从确定的系统评价中对初级研究进行了查询，以获取支持基于理论的干预措施的证据。使用理论领域框架（TDF）的行为改变领域和二级预防结果进行了新的荟萃分析来综合数据。
从 71 项 SR 中，筛选出 246 项初级研究。仅确定了 19 项试验（N = 2530 名参与者）采用了基于理论的干预措施，并测量了与行为改变相关的中介因素。确定的中介因素映射到 TDF 的 14 个可能领域中的 5 个。试验随访时间在 1-12 个月之间，没有研究涉及中风复发或心血管死亡率和/或发病率等主要结局。针对 TDF 知识领域中介因素的生活方式干预措施可能会提高药物依从性的可能性（OR 6.08 [2.79, 13.26]，I2 = 0%）、体力活动参与度（OR 2.97 [1.73, 5.12]，I2 = 0%）和中风后戒烟（OR 10.37 [3.22, 33.39]，I2 = 20%），这得到了低确定性证据的支持；针对 TDF 知识和后果信念领域中介因素的生活方式干预措施可能会提高中风后药物依从性（SMD 0.36 [0.07, 0.64]，I2 = 13%，非常低确定性证据）；针对 TDF 信念能力和情绪领域中介因素的生活方式干预措施可能会调节中风后的情绪低落（SMD -0.70 [-1.28, -0.12]，I2 = 81%，低确定性证据）。
中风二级预防试验中基于理论的研究和行为改变中介因素的使用有限。知识、后果信念和情绪是积极影响中风后风险降低行为的领域。行为改变干预措施应包括这些已知有效的基于证据的结构。未来的试验应关注心血管结局并确保足够的随访时间。
