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Farooqi HA, Safwan Z, Nabi R. Innovative approaches in stroke care: insights from recent studies on patient delay, telemedicine, artificial intelligence, and machine learning. Neurosurg Rev 2024; 47:392. [PMID: 39088136 DOI: 10.1007/s10143-024-02651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 07/20/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024]
Affiliation(s)
| | | | - Rayyan Nabi
- Islamic International Medical College, Rawalpindi, Pakistan
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Vyas MV, Saposnik G, Yu AYX, Austin PC, Chu A, Alonzo R, Fang J, Lee C, Quraishi F, Marwaha S, Kapral MK. Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada. Neurology 2024; 103:e209536. [PMID: 38861692 DOI: 10.1212/wnl.0000000000209536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. METHODS We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. RESULTS We included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (-4.79%; -7.86 to -1.72) or have visits to a specialist (-1.68%; -3.12 to -0.24). There was minimal variation by region of origin or time since immigration in immigrants. DISCUSSION Compared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors.
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Affiliation(s)
- Manav V Vyas
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Gustavo Saposnik
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Amy Ying Xin Yu
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Peter C Austin
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Anna Chu
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Rea Alonzo
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Jiming Fang
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Charlotte Lee
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Fatima Quraishi
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Seema Marwaha
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
| | - Moira K Kapral
- From the Division of Neurology (M.V.V., G.S., A.Y.X.Y.), Department of Medicine, University of Toronto; St. Michael's Hospital-Unity Health Toronto (M.V.V., G.S., F.Q., S.M.); ICES (M.V.V., G.S., A.Y.X.Y., P.C.A., A.C., R.A., J.F., M.K.K.); Institute of Health Policy, Management and Evaluation (M.V.V., G.S., P.C.A., M.K.K.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Toronto; Daphne Cockwell School of Nursing (C.L.), Toronto Metropolitan University; and Division of General Internal Medicine (M.K.K.), Department of Medicine, University of Toronto, Ontario, Canada
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Liang F, Yang X, Peng W, Zhen S, Cao W, Li Q, Xiao Z, Gong M, Wang Y, Gu D. Applications of digital health approaches for cardiometabolic diseases prevention and management in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100817. [PMID: 38456090 PMCID: PMC10920052 DOI: 10.1016/j.lanwpc.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 03/09/2024]
Abstract
Cardiometabolic diseases (CMDs) are the major types of non-communicable diseases, contributing to huge disease burdens in the Western Pacific region (WPR). The use of digital health (dHealth) technologies, such as wearable gadgets, mobile apps, and artificial intelligence (AI), facilitates interventions for CMDs prevention and treatment. Currently, most studies on dHealth and CMDs in WPR were conducted in a few high- and middle-income countries like Australia, China, Japan, the Republic of Korea, and New Zealand. Evidence indicated that dHealth services promoted early prevention by behavior interventions, and AI-based innovation brought automated diagnosis and clinical decision-support. dHealth brought facilitators for the doctor-patient interplay in the effectiveness, experience, and communication skills during healthcare services, with rapidly development during the pandemic of coronavirus disease 2019. In the future, the improvement of dHealth services in WPR needs to gain more policy support, enhance technology innovation and privacy protection, and perform cost-effectiveness research.
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Affiliation(s)
- Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Xueli Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, 22 Qixiangtai Rd, Tianjin 300070, People's Republic of China
| | - Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, 251 Ningda Road, Xining City 810016, People's Republic of China
- Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, Xining 810008, People's Republic of China
| | - Shihan Zhen
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Wenzhe Cao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Qian Li
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Zhiyi Xiao
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
| | - Mengchun Gong
- Institute of Health Management, Southern Medical University, No. 1023-1063, Shatai South Road, Guangzhou 510515, People's Republic of China
| | - Youfa Wang
- The First Affiliated Hospital of Xi'an Jiaotong University Public Health Institute, Global Health Institute, School of Public Health, International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Dongfeng Gu
- School of Public Health and Emergency Management, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
- School of Medicine, Southern University of Science and Technology, 1088 Xueyuan Avenue, Shenzhen 518055, People's Republic of China
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Deng L, Wu Q, Ding F, Liu Y, Shen J, Lin Y, Shi K, Zeng B, Wu L, Tong H. The effect of telemedicine on secondary prevention of atherosclerotic cardiovascular disease: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:1020744. [PMID: 36440018 PMCID: PMC9683074 DOI: 10.3389/fcvm.2022.1020744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
AimThe purpose of this systematic review was to evaluate the efficiency of telemedicine on the secondary level of prevention of patients with arteriosclerotic cardiovascular disease (ASCVD), provide evidence for the application of telemedicine in secondary prevention and promote the development of telemedicine in secondary prevention.MethodsA computer-based search was conducted in MEDLINE, Embase, Pubmed, EBSCO, CINAHL, the Cochrane Library, and Web of Science. Randomized controlled trials regarding the effect of telemedicine on secondary prevention of ASCVD were included from inception to May, 2022. Meta-analysis was used to compare the results of the included studies by RevMan5.4 software. The Cochrane Collaboration bias risk tool was used to perform risk of bias assessment in this study. Outcomes included risk factors, physical activity and exercise, muscle function, exercise compliance, medication adherence, healthy diet, depression and anxiety, self-efficacy, knowledge score, economy, and safety endpoints. Subgroup analysis was carried out for different main intervention measures included in the literature.ResultsA total of 32 randomized clinical studies (n = 10 997 participants) were included in the meta-analysis. Compared with usual secondary prevention (USP) group, participants in telemedicine of secondary prevention (TOSP) group showed significant improvement in some risk factors including BMI (MD –0.87, p = 0.002), SBP (MD –4.09, p = 0.007) and DBP (MD –2.91, p = 0.0002) when they use the telephone as the intervention. In physical activity and exercise, Patients in TOSP showed an improvement in VO2 Peak (mL⋅kg–1⋅min–1) (OR 1.58, p = 0.02), 6MWT (MD 21.41, p = 0.001), GSLTPA score (MD 2.89, p = 0.005). Effects on medication adherence, exercise compliance, muscle function, healthy diet, economy and self-efficacy were synthesized narratively. Patients in TOSP did not show a reduction in knowledge score, depression, anxiety and safety endpoints.ConclusionThere is a net benefit of secondary prevention supported by telemedicine (especially when using the telephone as an intervention) in patients with ASCVD in the terms of some risk factors, physical activity and exercise. There are still controversies in the improvement of medication adherence, exercise compliance, muscle function, healthy diet, knowledge score, self-efficacy and economy via telemedicine, which is worth exploring. Larger samples size and longer-term follow-ups are needed in future studies.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=330478], identifier [CRD42022330478].
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Schoenfelder J, Zarrin M, Griesbaum R, Berlis A. Stroke care networks and the impact on quality of care. Health Care Manag Sci 2022; 25:24-41. [PMID: 34564805 PMCID: PMC8983551 DOI: 10.1007/s10729-021-09582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
Lack of rapidly available neurological expertise, especially in rural areas, is one of the key obstacles in stroke care. Stroke care networks attempt to address this challenge by connecting hospitals with specialized stroke centers, stroke units, and hospitals of lower levels of care. While the benefits of stroke care networks are well-documented, travel distances are likely to increase when patients are transferred almost exclusively between members of the same network. This is particularly important for patients who require mechanical thrombectomy, an increasingly employed treatment method that requires equipment and expertise available in specialized stroke centers. This study aims to analyze the performance of the current design of stroke care networks in Bavaria, Germany, and to evaluate the improvement potential when the networks are redesigned to minimize travel distances. To this end, we define three fundamental criteria for assessing network design performance: 1) average travel distances, 2) the populace in the catchment area relative to the number of stroke units, and 3) the ratio of stroke units to lower-care hospitals. We generate several alternative stroke network designs using an analytical approach based on mathematical programming and clustering. Finally, we evaluate the performance of the existing networks in Bavaria via simulation. The results show that the current network design could be significantly improved concerning the average travel distances. Moreover, the existing networks are unnecessarily imbalanced when it comes to their number of stroke units per capita and the ratio of stroke units to lower-care hospitals.
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Affiliation(s)
- Jan Schoenfelder
- Department of Health Care Operations/Health Information Management, Faculty of Business and Economics, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany.
| | - Mansour Zarrin
- Department of Health Care Operations/Health Information Management, Faculty of Business and Economics, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany
| | - Remo Griesbaum
- Department of Health Care Operations/Health Information Management, Faculty of Business and Economics, University of Augsburg, Universitätsstraße 16, 86159, Augsburg, Germany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Shah AC, O'Dwyer LC, Badawy SM. Telemedicine in Malignant and Nonmalignant Hematology: Systematic Review of Pediatric and Adult Studies. JMIR Mhealth Uhealth 2021; 9:e29619. [PMID: 34255706 PMCID: PMC8299344 DOI: 10.2196/29619] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/21/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Telemedicine, including video-, web-, and telephone-based interventions, is used in adult and pediatric populations to deliver health care and communicate with patients. In the realm of hematology, telemedicine has recently been used to safely and efficiently monitor treatment side-effects, perform consultations, and broaden the reach of subspecialty care. OBJECTIVE We aimed to synthesize and analyze information regarding the feasibility, acceptability, and potential benefits of telemedicine interventions in malignant and nonmalignant hematology, as well as assess the recognized limitations of these interventions. METHODS Studies were identified through a comprehensive Medical Subject Headings (MeSH) search on the PubMed MEDLINE, Controlled Register of Clinical Trials (Cochrane CENTRAL from Wiley), Embase, and CINAHL (EBSCO) databases on February 7, 2018. A second search, utilizing the same search strategy, was performed on October 1, 2020. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the reporting of included evidence. Included studies were original articles researching the feasibility, acceptability, and clinical outcomes of telemedicine or telehealth interventions in pediatric or adult populations with malignant or nonmalignant hematological conditions. Data items in the extraction form included first author name, publication year, country, malignant or nonmalignant hematological condition or disease focus of the study, participant age, participant age subgroup (pediatric or adult), study design and setting, telemedicine intervention type and description, study purpose, and main study outcomes. RESULTS A total of 32 articles met the preset criteria and were included in this study. Most (25/32) studies were conducted in adults, and the remaining (7/32) were conducted in the pediatric population. Of the 32 studies, 12 studied malignant hematological conditions, 18 studied nonmalignant conditions, and two studied both malignant and nonmalignant conditions. Study types included pilot study (11/32), retrospective study (9/32), randomized controlled trial (6/32), cross-sectional study (2/32), case study (1/32), pre-post study (1/32), noncomparative prospective study (1/32), and prospective cohort study (1/32). The three main types of telemedicine interventions utilized across all studies were video-based (9/32), telephone-based (9/32), and web-based interventions (14/32). Study results showed comparable outcomes between telemedicine and traditional patient encounter groups across both pediatric and adult populations for malignant and nonmalignant hematological conditions. CONCLUSIONS Evidence from this review suggests that telemedicine use in nonmalignant and malignant hematology provides similar or improved health care compared to face-to-face encounters in both pediatric and adult populations. Telemedicine interventions utilized in the included studies were well received in both pediatric and adult settings. However, more research is needed to determine the efficacy of implementing more widespread use of telemedicine for hematological conditions.
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Affiliation(s)
- Aashaka C Shah
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL, United States
| | - Linda C O'Dwyer
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Pediatric Hematology, Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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8
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Sammut M, Fini N, Haracz K, Nilsson M, English C, Janssen H. Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review. Disabil Rehabil 2020; 44:337-352. [PMID: 32478574 DOI: 10.1080/09638288.2020.1768599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: The risk of recurrent stroke following a transient ischaemic attack (TIA) or non-disabling stroke is high. Clinical guidelines recommend this patient population accumulate at least 150 minutes of moderate-to-vigorous physical activity each week to reduce the risk of recurrent stroke. We aimed to identify interventions that increase time adults spend in moderate-to-vigorous physical activity following TIA or non-disabling stroke.Method: We searched thirteen databases for articles of secondary prevention interventions reporting outcomes for duration in moderate-to-vigorous physical activity or exercise capacity.Results: Eight trials were identified (n = 2653). Of these, three (n = 198) reported changes in time spent in moderate-to-vigorous physical activity. Only one trial (n = 70), reported significant change in time spent engaging in moderate-to-vigorous physical activity (between-group difference: 11.7 min/day [95% CI 4.07-19.33]) when comparing participation in a six-month exercise education intervention to usual care. No trial measured moderate-to-vigorous physical activity after intervention end.Conclusion: Despite recommendations to participate in regular physical activity at moderate-to-vigorous intensity for secondary stroke prevention, there is very little evidence for effective interventions for this patient population. There is need for clinically feasible interventions that result in long-term participation in physical activity in line with clinical guidelines. Trial registration: Protocol registration: PROSPERO CRD42018092840Implications for rehabilitationThere is limited evidence of the effectiveness of interventions that aim to increase time spent engaging in moderate-to-vigorous physical activity (MVPA) for people following a TIA or non-disabling stroke.A program comprising aerobic and resistance exercises ≥2 per week, supervised by a health professional (supplemented with a home program) over at least 24 weeks appears to be effective in assisting people adhere to recommended levels of moderate to vigorous physical activity after TIA or non-disabling stroke.Secondary prevention programs which include health professional supervised exercise sessions contribute to better adherence to physical activity guidelines; didactic sessions alone outlining frequency and intensity are unlikely to be sufficient.
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Affiliation(s)
- Maria Sammut
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Natalie Fini
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kirsti Haracz
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,Florey Institute of Neuroscience, University of Melbourne, Melbourne, Australia
| | - Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,Stroke Service, Hunter New England Local Health District, Newcastle, Australia
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9
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Kim DY, Kwon H, Nam KW, Lee Y, Kwon HM, Chung YS. Remote Management of Poststroke Patients With a Smartphone-Based Management System Integrated in Clinical Care: Prospective, Nonrandomized, Interventional Study. J Med Internet Res 2020; 22:e15377. [PMID: 32130140 PMCID: PMC7068458 DOI: 10.2196/15377] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/24/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. Objective We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. Methods With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. Results The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had −13.92 mmHg (P=.001) and −6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9% [SD 37.2%]) than at visit 1-2 (47.8% [SD 38.7%], P<.001). Conclusions Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost.
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Affiliation(s)
- Do Yeon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Medical Corps, Republic of Korea Navy, Jeju Island, Republic of Korea
| | - Hee Kwon
- LifeSemantics, Corp, Seoul, Republic of Korea
| | - Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yongseok Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Seob Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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10
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Huang L, Yan Z, Huang H. The effect of short message service intervention on glycemic control in diabetes: a systematic review and meta-analysis. Postgrad Med 2019; 131:566-571. [PMID: 31524035 DOI: 10.1080/00325481.2019.1668723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Li Huang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhe Yan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Huang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
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11
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Valenzuela Espinoza A, Steurbaut S, Dupont A, Cornu P, van Hooff RJ, Brouns R, Putman K. Health Economic Evaluations of Digital Health Interventions for Secondary Prevention in Stroke Patients: A Systematic Review. Cerebrovasc Dis Extra 2019; 9:1-8. [PMID: 30616238 PMCID: PMC6489060 DOI: 10.1159/000496107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/15/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the first 5 years after their stroke, about a quarter of patients will suffer from a recurrent stroke. Digital health interventions facilitating interactions between a caregiver and a patient from a distance are a promising approach to improve patient adherence to lifestyle changes proposed by secondary prevention guidelines. Many of these interventions are not implemented in daily practice, even though efficacy has been shown. One of the reasons can be the lack of clear economic incentives for implementation. We propose to map all health economic evidence regarding digital health interventions for secondary stroke prevention. SUMMARY We performed a systematic search according to PRISMA-P guidelines and searched on PubMed, Web of Science, Cochrane, and National Institute for Health Research Economic Evaluation Database. Only digital health interventions for secondary prevention in stroke patients were included and all study designs and health economic outcomes were accepted. We combined the terms "Stroke OR Cardiovascular," "Secondary prevention," "Digital health interventions," and "Cost" in one search string using the AND operator. The search performed on April 20, 2017 yielded 163 records of which 26 duplicates were removed. After abstract screening, 20 articles were retained for full-text analysis, of which none reported any health economic evidence that could be included for analysis or discussion. Key Messages: There is a lack of evidence on health economic outcomes on digital health interventions for secondary stroke prevention. Future research in this area should take health economics into consideration when designing a trial and there is a clear need for health economic evidence and models.
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Affiliation(s)
- Alexis Valenzuela Espinoza
- Vrije Universiteit Brussel (VUB), Interuniversity Center for Health Economics Research (I-CHER), Brussels, Belgium,
| | - Stephane Steurbaut
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Alain Dupont
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Pieter Cornu
- Vrije Universiteit Brussel (VUB), Research Group Clinical Pharmacology and Clinical Pharmacy (KFAR), Brussels, Belgium
| | - Robbert-Jan van Hooff
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Brussels, Belgium
- Neurovascular Center, Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Raf Brouns
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Brussels, Belgium
- Department of Neurology, Hospital ZorgSaam, Terneuzen, The Netherlands
| | - Koen Putman
- Vrije Universiteit Brussel (VUB), Interuniversity Center for Health Economics Research (I-CHER), Brussels, Belgium
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12
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Dos Santos ADF, Mata-Machado ATGD, Melo MDCBD, Fonseca Sobrinho D, Araújo LL, Silva ÉA, Lima AMDLDD, Abreu DMXD, Rocha HAD. Implementation of Telehealth Resources in Primary Care in Brazil and Its Association with Quality of Care. Telemed J E Health 2018; 25:996-1004. [PMID: 30592699 DOI: 10.1089/tmj.2018.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Although several reviews on the relation between telemedicine and health care outcomes have pointed out some evidence, they have also underscored the need for further investigation. Introduction: Brazil has a national telehealth program implemented in 2007, involving teleconsulting and distance education actions in primary care. Objective: This study aims to describe the implementation of telehealth in primary care in Brazil and to identify if there is an association between telehealth and quality of care. Methods: A cross-sectional study analyzing data from interviews with 29,778 primary care team professionals in Brazil in 2014, which represents 92.5% of existing health care teams, on aspects of information technology, telehealth, and care was carried out. A multiple binary regression analysis was performed to study the associations between the extent of health care actions and using telehealth. Results: Of the 24,055 primary care units in Brazil where teams worked, only 50.1% (n: 12,055) had internet access, and 32.71% of teams claimed to be involved in telehealth actions in 2014. Between 2012 and 2014 there was an expansion in the use of telehealth resources in all regions of Brazil. The highest magnitude was observed for the association between employment of telehealth and improvement in child care (odds ratio [OR] = 2.09), followed by diabetes mellitus care (OR = 1.91), hypertension (OR = 1.89), and finally, women's health (OR = 1.86).
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Affiliation(s)
| | | | | | | | - Lucas Lobato Araújo
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Érica Araújo Silva
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Hugo André da Rocha
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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13
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Ögren J, Irewall AL, Söderström L, Mooe T. Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial. BMC Neurol 2018; 18:153. [PMID: 30241499 PMCID: PMC6148791 DOI: 10.1186/s12883-018-1158-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Background Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). We investigated whether nurse-led, telephone-based follow-up that included medication titration was more efficient than usual care in improving BP and LDL-C levels 36 months after discharge following stroke or TIA. Methods All patients admitted for stroke or TIA at Östersund hospital that could participate in the telephone-based follow-up were considered eligible. Participants were randomized to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C were measured one month after discharge and yearly thereafter. Intervention group patients who did not meet the target values received additional follow-up, including lifestyle counselling and medication titration, to reach their treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L). The primary outcome was the systolic BP level 36 months after discharge. Results Out of 871 randomized patients, 660 completed the 36-month follow-up. The mean systolic and diastolic BP values in the intervention group were 128.1 mmHg (95% CI 125.8–130.5) and 75.3 mmHg (95% CI 73.8–76.9), respectively. This was 6.1 mmHg (95% CI 3.6–8.6, p < 0.001) and 3.4 mmHg (95% CI 1.8–5.1, p < 0.001) lower than in the control group. The mean LDL-C level was 2.2 mmol/L in the intervention group, which was 0.3 mmol/L (95% CI 0.2–0.5, p < 0.001) lower than in controls. A larger proportion of the intervention group reached the treatment goal for BP (systolic: 79.4% vs. 55.3%, p < 0.001; diastolic: 90.3% vs. 77.9%, p < 0.001) as well as for LDL-C (69.3% vs. 48.9%, p < 0.001). Conclusions Compared with usual care, a nurse-led telephone-based intervention that included medication titration after stroke or TIA improved BP and LDL-C levels and increased the proportion of patients that reached the treatment target 36 months after discharge. Trial registration ISRCTN Registry ISRCTN23868518 (retrospectively registered, June 19, 2012). Electronic supplementary material The online version of this article (10.1186/s12883-018-1158-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joachim Ögren
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden.
| | - Anna-Lotta Irewall
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden
| | - Lars Söderström
- Unit of Research, Development and Education, Östersund, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Umeå University, Östersund, Sweden
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14
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Denham AMJ, Halpin S, Twyman L, Guillaumier A, Bonevski B. Prevent 2 nd Stroke: a pilot study of an online secondary prevention program for stroke survivors. Aust N Z J Public Health 2018; 42:484-490. [PMID: 29888829 DOI: 10.1111/1753-6405.12794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The prevalence of modifiable health risk factors and psychological distress following a stroke is high and markedly increase the chance of a second stroke. This study aimed to examine the usability and acceptability of an online secondary prevention program addressing modifiable psycho-behavioural risk factors for stroke survivors. METHODS A pre-post pilot study was conducted in Australia between 2016 and 2017. Participants were recruited through the Australian Stroke Clinical Registry and completed measures of health-related quality of life, physical activity, smoking status, depression and anxiety, alcohol status, nutrition and internet use. Participants also used an online secondary prevention program (Prevent 2nd Stroke) over a two-week period. At follow-up, acceptability and usability of the program were assessed. RESULTS A total of 18 out of 19 participants reported engaging in multiple health risk behaviours. Participants reported that they were interested in receiving an online program that provided health information (73.7%). Participants indicated Prevent 2nd Stroke was easy to use (63.1%) and that they would recommend the program to other stroke survivors (63.1%). CONCLUSIONS The results indicated that online programs are an acceptable way to address these health outcomes. Implications to public health: Further research is needed to assess the effectiveness of these interventions using powered trials.
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Affiliation(s)
- Alexandra M J Denham
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Sean Halpin
- School of Psychology, University of Newcastle, New South Wales
| | - Laura Twyman
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
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