title: Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Knowledge of Stroke in Hong Kong Chinese Integrated care improves risk-factor modification after stroke: initial results of the Integrated Care for the Reduction of Secondary Stroke model In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-up Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Daily Functioning and Quality of Life in a Randomized Controlled Trial of Therapeutic Exercise for Subacute Stroke Survivors Outcome criteria in smoking cessation trials: proposal for a common standard. Structured Nursing Intervention Versus Routine Rehabilitation After Stroke A randomized, controlled pilot study of a home-based exercise program for individuals with mild and moderate stroke. Satisfaction with information and advice received by stroke patients Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial. Combining Multiple Approaches for the Secondary Prevention of Vascular Events After Stroke: A Quantitative Modeling Study A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population Knowledge About Risk Factors for Stroke: A Population-Based Survey With 28 090 Participants Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors. A community-based group exercise program for persons with chronic stroke. Does behaviour modification affect post-stroke risk factor control? Three-year follow-up of a randomized controlled trial Implementation, Process, and Preliminary Outcome Evaluation of Two Community Programs for Persons with Stroke and Their Care Partners A preliminary study to examine the effects of aerobic and therapeutic (nonaerobic) exercise on cardiorespiratory fitness and coronary risk reduction in stroke survivors. Time frame and predictors of recovery from disability following recurrent ischemic stroke Therapeutic exercise and depressive symptoms after stroke. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of Health-Related Quality of Life Nursing intervention after carotid endarterectomy: a randomized trial of Co-ordinated Care Post-Discharge (CCPD). Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. The impact of stroke nurse specialist input on risk factor modification: a randomised controlled trial. Stroke: a randomized trial of exercise or relaxation.
abstract: Background and Purpose — Reduction in the risk of stroke and increase in the speed of hospital presentation after the onset of stroke both depend on the level of knowledge of stroke in the general population . The aim of the present study was to assess baseline knowledge regarding stroke risk factors , symptoms , treatment , and information re sources . Methods — A community-based telephone interview survey was conducted in the Newcastle urban area in Australia . A total of 1278 potential participants between the ages of 18 to 80 were selected at r and om from an electronic telephone directory . A trained telephone interviewer conducted a telephone survey using the Computer-Assisted Telephone Interviewing ( CATI ) program . Results — A total of 822 participants completed the telephone interview . Six hundred three participants ( 73.4 % ) correctly identified the brain as the affected organ in stroke . The most common risk factors for stroke identified by respondents were smoking ( identified by 324 [ 39.4 % ] ) and stress ( identified by 277 [ 33.7 % ] ) . The most common warning sign of stroke described by respondents was “ blurred and double vision or loss of vision in an eye , ” listed by 198 ( 24.1 % ) . A total of 626 ( 76.2 % ) respondents correctly listed ≥1 established stroke risk factor , but only 409 ( 49.8 % ) respondents correctly listed ≥1 warning sign . Conclusions — The level of knowledge in the community of established stroke risk factors , warning signs , and treatment as indicated by this survey suggests that a community-based education program to increase public knowledge of stroke may contribute to reducing the risk of stroke and to increasing the speed of hospital presentation after the onset of stroke OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke A r and om telephone survey on knowledge of stroke was conducted in 1,238 Hong Kong Chinese . Most respondents realized that effective treatment was available , that stroke was preventable and that it could be fatal or disabling . Sudden unilateral limb weakness , sudden speech and language disturbances , and sudden vertigo and clumsiness were better recognized than other warning symptoms of stroke . A slightly better recognition of symptoms of stroke was seen in those with a belief of knowing about stroke , providing a correct description of stroke , those with a positive household history of stroke and those with a better knowledge of potential risk factors . Most respondents would choose desirable actions if stroke was suspected in their family members or themselves . Friends and relatives , newspapers and magazines , and mass media provided the major sources of their knowledge Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Background and Purpose — The Stroke PROTECT ( Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment ) program systematic ally implements , at the time of acute transient ischemic attack ( TIA ) or ischemic stroke admission , 8 medication/behavioral secondary prevention measures known to improve outcome in patients with cerebrovascular disease . The objective of this study was to determine if the high utilization rates previously demonstrated at hospital discharge were maintained at 90 days after discharge . Methods — Data were prospect ively collected on consecutively encountered ischemic stroke and TIA patients admitted to a university hospital stroke service beginning September 1 , 2002 .  PROTECT interventions were initiated before hospital discharge in all PROTECT – target ( underlying stroke mechanism large vessel atherosclerosis or small vessel disease ) and PROTECT – ACS ( At-risk for Coronary Sequelae ) patients . Adherence to program goals was assessed 3 months after discharge . Results — During the period from September 2002 to August 2003 , 144 individuals met criteria for PROTECT intervention . Of the 130 patients ( 90 % ) with available day 90 follow-up data , mean age was 72 ( range , 37 to 95 ) , and 63 % were male .  Adherence rates in patients without specific contraindications were 100 % for antithrombotics , 99 % for statins , 92 % for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers , and 80 % for thiazides . Awareness of the importance of calling 911 in response to stroke was 87 % . Adherence to diet and exercise guidelines were 78 % and 70 % , respectively . Of the 24 smokers , tobacco cessation was maintained in 20 ( 83 % ) . Conclusions — High rates of adherence to PROTECT therapies were maintained at 90 days after hospital discharge Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background and Purpose — The ability of therapeutic exercise after stroke to improve daily functioning and quality of life ( QOL ) remains controversial . We examined treatment effects on these outcomes in a r and omized controlled trial ( RCT ) of  exercise  in subacute stroke survivors . Methods — This is a secondary analysis of a single-blind RCT of a 12-week program versus usual care . Baseline , post-treatment and 6-month post-treatment daily functioning and QOL were assessed by Barthel index , Functional Independence Measure , instrumental activities of daily living , Medical Outcomes Study short-form 36-item question naire ( SF-36 ) , and Stroke Impact Scale ( SIS ) . Results — Of 100 r and omized subjects , 93 completed the postintervention assessment , ( mean age 70 ; 54 % male ; 81 % white ; mean Orpington Prognostic Score 3.4 ) , and 80 had 6-month post-treatment assessment . Immediately after intervention , the intervention group improved more than usual care in SF-36 social function ( 14.0 points ; P=0.0051 ) and in SIS ( strength [ 9.2 points ; P=0.0003 ] , emotion [ 5.6 points ; P=0.0240 ] , social participation [ 6.6 points ; P=0.0488 ] , and physical function [ 5.0 points ; P=0.0145 ] ) . Treatment was marginally more effective on Barthel score ( 3.3 points ; P=0.0510 ) , SF-36 ( physical function [ 6.8 points ; P=0.0586 ] , physical role function [ 14.4 points ; P=0.0708 ] ) , and SIS upper extremity function ( 7.2 points ; P=0.0790 ) . Effects were diluted 6 months after treatment ended . Conclusion — This rehabilitation exercise program led to more rapid improvement in aspects of physical , social , and role function than usual care in persons with subacute stroke . Adherence interventions to promote continued exercise after treatment might be needed to continue benefit Smoking  cessation treatment is now integrated into many health-care systems and a major research effort is under way to improve current success rates . Until now results from r and omized clinical trials have been reported in many different ways , leading to problems of interpretation . We propose six st and ard criteria comprising the ' Russell St and ard ' ( RS ) . These criteria are applicable to trials of cessation aids where participants have a defined target quit date and there is face-to-face contact with research ers or clinic staff , as follows . ( 1 ) Follow-up for 6 months ( RS6 ) or 12 months ( RS12 ) from the target quit date or the end of a predefined ' grace period ' ; ( 2 ) self-report of smoking abstinence over the whole follow-up period allowing up to five cigarettes in total ; ( 3 ) biochemical verification of abstinence at least at the 6-month or 12-month follow-up point ; ( 4 ) use of an ' intention-to-treat ' approach in which data from all r and omized smokers are included in the analysis unless they have died or moved to an untraceable address ( participants who are included in the analysis are counted as smokers if their smoking status at the final follow-up can not be determined ) ; ( 5 ) following-up ' protocol violators ' and using their true smoking status in the analysis ; and ( 6 ) collecting follow-up data blind to smokers ' allocation to trial group . We believe that these criteria provide the best compromise between practicability and surrogacy for long-term cessation and will enable meaningful comparison between studies . There may be good reasons why other outcome criteria would also be reported , and studies that involve interventions with special groups or where there is no design ated target quit date or face to face contact would need to adapt these criteria accordingly Nir Z , Zolotogorsky Z , Sugarman H : Structured nursing intervention versus routine rehabilitation after stroke . Am J Phys Med Rehabil 2004;83:522–529 . Objective : The goal of this study was to examine the effect of a structured , comprehensive nursing intervention on the course of rehabilitation over the first 6 mos after a first-ever stroke . Design : Intervention ( experimental ) study . The participants were 155 elderly stroke survivors who were admitted to a geriatric rehabilitation department . Stratified r and om sampling generated intervention and control groups . The intervention was design ed to work together with the routine rehabilitation program and consisted of 12 consecutive weekly meetings . The control group received only the routine rehabilitation program . Study variables were measured at entry to study and after 3- and 6-mo intervals . Results : Although there were no significant differences between the two groups at entry to study , at 3 and 6 mos after stroke , the intervention group showed better scores than the control group in functional status ( FIM ™ instrument ) , depression ( Geriatric Depression Scale ) , self-perceived health , self-esteem , and dietary adherence . Conclusion : The nursing intervention had both short- and long-term effects on functional , psychological , and emotional variables . Serious consideration should be given to implementing comprehensive nursing interventions during rehabilitation tailored to meet the specific needs of stroke survivors and their caregivers BACKGROUND AND PURPOSE Many stroke survivors have minimal to moderate neurological deficits but are physically deconditioned and have a high prevalence of cardiovascular problems ; all of these are potentially modifiable with exercise . The purpose s of this r and omized , controlled pilot study were ( 1 ) to develop a home-based balance , strength , and endurance program ; ( 2 ) to evaluate the ability to recruit and retain stroke subjects ; and ( 3 ) to assess the effects of the interventions used . METHODS Twenty minimally and moderately impaired stroke patients who had completed inpatient rehabilitation and who were 30 to 90 days after stroke onset were r and omized to a  control group or to an experimental group that received a therapist-supervised , 8-week , 3-times-per-week , home-based exercise program . The control group received usual care as prescribed by the patients ' physicians . Baseline and postintervention assessment s included the Fugl-Meyer Motor Assessment , the Barthel Index of Activities of Daily Living ( ADL ) , the Lawton Scale of Instrumental ADL , and the Medical Outcomes Study -36 Health Status Measurement . Functional assessment s of balance and gait included a 10-m walk , 6-Minute Walk , and the Berg Balance Scale . Upper extremity function was evaluated by the Jebsen Test of H and Function . RESULTS Of 22 patients who met study criteria , 20 completed the study and 2 refused to participate . The experimental group tended to improve more than the control group in motor function ( Fugl-Meyer Upper Extremity : mean change in score , 8 . 4 versus 2.2 ; Fugl-Meyer Lower Extremity : 4.7 versus -0.9 ; gait velocity : median change , 0.25 versus .09 m/s ; 6-Minute Walk : 195 versus 114 ft ; Berg Balance Score : 7.8 versus 5 ; and Medical Outcomes Study -36 Health Status Measurement of Physical Function : 15 . 5 versus 9 ) . There were no trends in differences in change scores by the Jebsen Test of H and Function , Barthel Index , and Lawton Instrumental ADL Scale . CONCLUSIONS This study demonstrated that a r and omized , controlled clinical trial of a poststroke exercise program is feasible . Measures of neurological impairments and lower extremity function showed the most benefit . Effects of the intervention on upper extremity dexterity and functional health status were equivocal . The lasting effects of the intervention were not assessed Objective : To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors . Design : An interview question naire survey . Setting : A family health services authority area in northern Engl and . Subjects : Stroke survivors identified by a valid screening question naire from a stratified r and om sample of 2000 subjects aged 45 years and over . Main outcome measure : Proportion of subjects interviewed responding positively to the question ' Do you think you have received enough advice and information on ... ? ' eighteen topics considered relevant to stroke survivors . Results : The screening process identified 116 stroke survivors , of whom 76 agreed to be interviewed . The majority ( > 80 % ) of patients were satisfied with information and advice received on lifestyle and health promotion issues , incontinence and their current treatment . However , satisfaction was poor for the areas of stroke disease in general , its effects , available services , and legal and financial affairs ( range , 28 - 75 % satisfied ) . Conclusion : Deficits in the provision of adequate information and advice to stroke patients on relevant issues have been identified in this study of a representative sample of community-dwelling stroke survivors . These deficits need to be addressed by those providing care for stroke patients in order to improve patient satisfaction OBJECTIVE To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program ( CDSMP ) . METHODS A r and omized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment ( waiting-list controls )  in five urban communities in Shanghai , China . Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately ; those in the control group received the same education and book six months later . FINDINGS In total , 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension , heart disease , chronic lung disease , arthritis , stroke , or diabetes who lived in communities were assigned r and omly to treatment ( n = 526 ) and control ( n = 428 ) groups . Overall , 430 ( 81.7 % ) and 349 ( 81.5 % ) patients in the treatment and control groups completed the six-month study . Patients who received treatment had significant improvements in weekly minutes of aerobic exercise , practice of cognitive symptom management , self-efficacy to manage own symptoms , and self-efficacy to manage own disease in general compared with controls . They also had significant improvements in eight indices of health status and , on average , fewer hospitalizations . CONCLUSION When implemented in Shanghai , the CDSMP was acceptable culturally to Chinese patients . The programme improved participants ' health behaviour , self-efficacy , and health status and reduced the number of hospitalizations six months after the course . The locally based delivery model was integrated into the routine of community government organizations and community health services . Chinese lay leaders taught the CDSMP courses as successfully as professionals Background and Purpose — Numerous effective strategies for the secondary prevention of cardiovascular events in high-risk patients have now been established . We sought to calculate the cumulative benefit of combining multiple strategies for preventing recurrent events in patients with a history of ischemic stroke or transient ischemic attack . Methods — A comprehensive literature search was undertaken to identify meta-analyses of r and omized controlled trials reporting on the efficacy of secondary prevention strategies . The baseline incidence of vascular events was modeled from the Life Long After Cerebral Ischemia study . Strategies were combined on a multiplicative scale and cumulative risk reductions were computed over a 5-year interval . Results — The combination of 5 proven strategies applied to survivors of an initial stroke or transient ischemic attack — dietary modification , exercise , aspirin , a statin , and an antihypertensive agent — could result in a cumulative relative risk reduction of 80 % . Given a 5-year major cardiovascular event rate of 24 % , this translates to a number needed to treat of about 5 . Further gains would result from applying multimodality therapy over longer intervals and enriching the base strategy with dual antiplatelet therapy , high-dose statins , and more intensive blood pressure – lowering . Even more benefit would be present in high-risk subgroups with the addition , where appropriate , of carotid endarterectomy , moderate intensity oral anticoagulants , glycemic control , and smoking cessation . Conclusions — At least four-fifths of recurrent vascular events in patients with cerebrovascular disease might be prevented by application of a comprehensive , multifactorial approach BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research Objective : To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects . Design : Single-blinded r and omized control trial . Setting : Outpatient rehabilitation . Subjects : Forty-eight community-dwelling ischaemic stroke patients ( 38 independently mobile , 9 requiring assistance , 1 non-ambulatory ) were r and omly assigned to intervention or control groups by concealed allocation . Intervention : The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10 . Both groups continued usual care ( excluding aerobic exercise ) ; intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes . Main outcome measures : Cardiac risk score ( CRS ) ; VO2 ( mL O2/kg per minute ) and Borg Rate of Perceived Exertion ( RPE ) assessed during a st and ardized ergometry test ; Hospital Anxiety and Depression Scale ( HADS ) ; Frenchay Activity Index ; Fasting Lipid Profiles and Resting Blood Pressure . Results : Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 ( intervention 10.6 ±1.6 to 12.0 ± 2.2 , control 11.1 ±1.8 to 11.1 ±1.9 t=4.734 , P<0.001 ) and CRS ( intervention 13.4 ±10.1 to 12.4 ±10.5 , control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537 , P<0.05 ) . RPE rating decreased in intervention subjects ( 13.4 ±12.2 to 12.4 ±2.0 ) and increased in controls ( 13.8 ±1.8 to 14.4 ±1.6 ) ; Mann — Whitney U ( U = 173.5 , P<0.05 ) . Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone ( 5.1 ±3.4 to 3.0 ±2.8 ) ( Wilcoxon signed ranks test Z=-3.278 , P<0.001 ) . Conclusion : Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme . The intervention was associated with improvement in self-reported depression Background and Purpose — Increased knowledge of stroke risk factors in the general population may lead to improved prevention of stroke . The objective of the present study was to assess knowledge of stroke risk factors and to determine factors associated with knowledge . Methods — In a population -based survey , we sent a question naire to r and omly selected residents in Berlin who were ≥50 years of age enquiring about knowledge of stroke risk factors .  Knowledge was assessed in an open-ended question . In addition , we enquired about the source of participants ' information . Sociodemographic factors , including age , sex , educational level , and nationality , were also assessed . Results — A total of 28 090 of 75 720 residents ( response rate , 37 % ) responded to the question naire . Of all respondents , 68 % were able to name ≥1 correct stroke risk factor , and 13 % named 4 correct risk factors . The majority of respondents named mass media as source of information ( 82 % ) , followed by family/friends ( 45 % ) and by general physicians ( 20 % ) . In multivariable analysis , increased knowledge of stroke risk factors was significantly associated with younger age , a higher educational level , not living alone , a German nationality , and having received any information about stroke during the last year . However , characteristics of respondents using the respective sources of information varied significantly . Conclusions — Mass media was most frequently named as a source of information about stroke risk factors . Source of information used varied according to population characteristics . Health education programs should take this into account and be adapted accordingly BACKGROUND The study examined the effects of a 12-week health promotion intervention for a predominantly urban African-American population of stroke survivors . DESIGN A pre-test/post-test lag control group design was employed . PARTICIPANTS / SETTING Participants were 35 stroke survivors ( 9 male , 26 female ) recruited from local area hospitals and clinics . MAIN OUTCOME MEASURES Biomedical , fitness , nutritional , and psychosocial measures were employed to assess program outcomes . RESULTS Treatment group made significant gains over lag controls in the following areas : ( 1 ) reduced total cholesterol , ( 2 ) reduced weight , ( 3 ) increased cardiovascular fitness , ( 4 ) increased strength , ( 5 ) increased flexibility , ( 6 ) increased life satisfaction and ability to manage self-care needs , and ( 7 ) decreased social isolation . CONCLUSION A short-term health promotion intervention for predominantly African-American stroke survivors was effective in improving several physiological and psychological health outcomes PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke . METHODS Twenty-five subjects ( mean age 63 yr ) participated in a repeated measures design that evaluated the subjects with two baseline assessment s 1 month apart , one postintervention assessment , and one retention assessment 1 month postintervention . Physical outcome measures assessed were the Berg Balance Test , 12-Minute Walk Test distance , gait speed , and stair climbing speed . Psychosocial measures assessed were the Reintegration to Normal Living Index ( RNL ) and Canadian Occupational Performance Measure ( COPM ) . The 8-wk training consisted of a 60-min , 3 x wk-1 group program that focused on balance , mobility , functional strength , and functional capacity . The program was design ed to be accessible by reducing the need for costly one-on-one supervision , specialized setting s , and expensive equipment . RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention . Subjects with lower function improved the most relative to their initial physical status . Significant effects were found for the COPM , but not the RNL Index ; however , subjects with lower RNL improved the most relative to their initial RNL Score . CONCLUSION A short-term community-based exercise program can improve and retain mobility , functional capacity , and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects . Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke ( e.g. , falls result ing in fractures and cardiac events ) Objective : Little is known about the long-term effectiveness after stroke of interventions for behaviour modification and ensuring concordance with therapies . We describe a follow-up study of a previous r and omized controlled trial of a brief period of behaviour modification . The aim of this study was to determine outcomes three years after the initial intervention . Design : Survivors of the original cohort were contacted and asked to attend for follow-up interview , within a geriatric day hospital . This study was carried out in the Geriatric Day Hospital at Stobhill Hospital , Balornock Road , Glasgow . Interventions : Details of risk factor control , including blood pressure , cholesterol levels and diabetic control , were assessed . Question naires used in the initial study were repeated including the Geriatric Depression Scale score , Euroqol Perceived Health Status and Stroke Services Satisfaction Question naire . Main measures : Primary outcome was collective risk factor control . Clinical outcomes including recurrent cerebrovascular events , medication persistence and perceived health status were also recorded . Results : Mean length of follow-up was 3.6 years ( SD 0.43 ) . Of the 205 patients enrolled in the initial study , 102 patients attended for repeat interview ( 49 intervention/53 control ) . There were no significant differences in the percentage of controlled risk factors between groups ( intervention 51.7 % versus control 55.9 % , P = 0.53 ) . Similarities were observed in the number of recurrent clinical events and medication persistence between groups . No overall difference was observed in perceived health status , satisfaction with care or depression scores . Conclusions : Brief intervention with respect to behaviour modification and risk factor control does not appear to have any long-term benefit . These results must be cautiously interpreted in light of the small study number and further research is required Abstract Purpose : This evaluation compared a new self-management program with l and and water exercise ( Moving On after STroke or MOST ) to a st and ard education program ( Living with Stroke or LWS ) . Participants : Of 30 persons with stroke ( average age 68 and 2 years post stroke ) , 18 selected MOST and 12 chose LWS . Sixteen care partners participated . Method : Assessment s at baseline , program completion , and 3-month follow-up included the Reintegration to Normal Living ( RNL ) Index , Activity-specific Balance Confidence ( ABC ) scale , exercise participation , and goal attainment ( for the MOST group ) . Program delivery costs were calculated and focus groups conducted to examine participant expectations and experiences . Results : Social support was an important benefit of both programs , but only MOST participants improved significantly on the RNL ( p < .05 ) and ABC ( p < .001 ) . Seventy-eight percent of all short-term personal goals in MOST were achieved , and overall goal attainment was above the expected level . At follow-up , a higher percentage of MOST participants were enrolled in exercise programs ( p < .05 ) . Conclusion : Although self-management programs with exercise are more costly to deliver than st and ard educational programs , these preliminary results indicate that such programs may be more effective in helping persons with stroke and care partners deal with the challenges of living with stroke OBJECTIVES To compare the effects of 3 different exercise training regimens on cardiorespiratory fitness and coronary risk factor reduction in subjects with unilateral stroke . DESIGN A cluster assignment by residential location repeated- measures design . SETTING University-based medical center . PARTICIPANTS Fifty-five subjects with unilateral ischemic stroke were assigned to the following groups : intensity ( n=18 ) , duration ( n=19 ) , and therapeutic exercise ( n=18 ) . INTERVENTION A 14-week intervention with subjects r and omized to 1 of 3 interventions : ( 1 ) moderate intensity , shorter duration ( MISD ) exercise ( gradually increasing exercise intensity while keeping exercise duration constant at 30 min ) , ( 2 ) low-intensity , longer duration ( LILD ) exercise ( gradually increasing duration to 60 min while keeping exercise intensity constant ) , or ( 3 ) conventional therapeutic exercise ( TE ) consisting mainly of strength , balance , and range of motion activities . All groups exercised 3 days per week . MAIN OUTCOME MEASURES Peak oxygen consumption ( VO2peak ) , submaximal oxygen consumption ( VO2 ) , lipid panel , and resting blood pressure . RESULTS The MISD group attained more favorable effects on systolic ( P<.04 ) and diastolic blood pressure ( P<.002 ) and total cholesterol ( TC ) ( P<.036 ) compared with LILD and TE groups . Both MISD ( P<.029 ) and LILD ( P<.045 ) showed significant reductions in triglycerides compared with TE ( P<.029 ) . There was no significant change in VO2peak and submaximal VO2 in any of the groups . CONCLUSIONS Overall , both MISD and LILD conditions achieved greater clinical and significant gains in coronary risk reduction compared with TE Objective : To assess the rate , degree , and predictors of recovery from a disabled to nondisabled state in patients disabled after recurrent ischemic stroke . Methods : Patients with ischemic stroke enrolled in the Management of Atherothrombosis with Clopidogrel in High Risk Patients ( MATCH ) Study underwent prospect i ve assessment of their modified Rankin score ( mRS ) at 1 , 3 , 6 , 12 , and 18 months after enrollment and after recurrent stroke . Patients disabled ( defined as mRS ≥ 3 ) after recurrence were analyzed for recovery ( defined as mRS < 3 ) during the 18 months , and predictors of recovery were sought using a Cox proportional-hazard multiple regression analysis . Results : Three hundred forty-five ( 54 % ) of 637 patients were disabled after recurrent ischemic stroke ; 115 ( 33 % ) patients had been disabled and 230 ( 66 % ) nondisabled before stroke recurrence . At recurrence , the degree of disability was moderate ( mRS 3 ) in 135 ( 39 % ) patients , severe ( mRS 4 ) in 139 ( 40 % ) , and very severe ( mRS 5 ) in 71 ( 21 % ) . After 12 months ' median follow-up , 117 ( 34 % , 95 % CI : 29 to 39 % ) had recovered : 68 ( 50 % , 42 to 59 % ) of 135 moderately disabled , 45 ( 32 % , 25 to 41 % ) of 139 severely disabled , and 4 ( 6 % , 2 to 14 % ) of 71 very severely disabled ; 70 ( 20.3 % ) patients died . From recurrence , median time to recovery was 6 months ( mRS 3 ) and 18 months ( mRS 4 ) ; 94 % with very severe disability had not recovered at 18 months . Independent predictors of recovery were moderate disability at recurrence ( mRS 3 ) compared with severe ( mRS 4 : hazard ratio [ HR ] 1.5 ; 95 % CI 1.04 to 2.3 ) or very severe disability ( mRS 5 : HR 7.6 ; 2.7 to 20 ) and a nondisabled vs disabled state before recurrence ( HR 4.0 ; 2.3 to 6.8 ) . Conclusions : The rate of recovery from recurrent ischemic stroke was greatest in the first 6 months ; one-third of patients recovered within 12 months . The significant predictors of recovery were a nondisabled state before recurrence and increasing severity of the recurrent stroke OBJECTIVES To examine the effect of exercise on depressive symptoms and the effect of baseline depressive symptoms on the benefits from exercise in stroke survivors who have completed acute rehabilitation . DESIGN Planned secondary analysis of the data from a 9-month r and omized , controlled trial . SETTING Participant homes . PARTICIPANTS One hundred stroke survivors who had completed acute rehabilitation . INTERVENTION A progressive , structured , 3-month physical exercise program . MEASUREMENTS Demographics , stroke characteristics , impairments , functional limitations , the Geriatric Depression Scale , the Stroke Impact Scale , and the Medical Outcomes Study 36-Item Short Form . RESULTS Baseline rates of depressive symptoms and other stroke sequelae were similar between the two arms . Ninety-three participants were assessed immediately after the intervention ( 3 months after enrollment ) , and 80 were assessed 9 months after enrollment . Six ( 14 % ) of the exercise group and 16 ( 35.6 % ) of the usual-care group had depressive symptoms at 3 months ( P = .03 ) . At 9 months , three ( 7.5 % ) of the exercisers had significant depressive symptoms compared with 10 ( 25 % ) who received usual care ( P = .07 ) . Participants with and without baseline depressive symptoms had equivalent treatment-related gains in impairments and functional limitations , but only participants with depressive symptoms had improved quality of life . CONCLUSION Exercise may help reduce poststroke depressive symptoms . Depressive symptoms do not limit gains in physical function due to exercise . Exercise may contribute to improved quality of life in those with poststroke depressive symptoms This paper describes constructing the Assessment of Quality of Life ( AQoL ) instrument ; design ed to measure health-related quality of life ( HRQoL )  , and to be the descriptive system for a multi-attribute utility instrument . Unlike previous utility instruments ' descriptive systems , the AQoL 's has been developed using state-of-the-art psychometric procedures . The result is a descriptive system which emphasizes five different facets of HRQoL and which can cl aim to have construct validity . Based on the WHO 's definition of health a model of HRQoL was developed . Items were written by focus groups of doctors and the research ers . These were administered to a construction sample , comprising hospital patients , and community members chosen at r and om . Final construction was through an iterative process of factor and reliability analyses . The AQoL measures 5 dimensions : illness , independent living , social relationships , physical senses and psychological wellbeing . Each has three items . Exploratory factor analysis showed the dimensions were orthogonal , and each was unidimensional . Internal consistency was α = 0.81 . Structural equation modeling explored its internal structure ; the comparative fit index was 0.90 . These preliminary results indicate the AQoL has the prerequisite qualities for a psychometric HRQoL instrument for evaluation ; replication with a larger sample is needed to verify these findings . Scaling it for economic evaluation using utilities is being undertaken . Respondents have indicated the AQoL is easy to underst and and is quickly completed . Its initial properties suggest it may be widely applicable AIM This paper reports a study evaluating the short-term impact of nursing-led , co-ordinated care after discharge  following carotid endarterectomy . BACKGROUND Patient education about stroke risk factors , combined systematic ally with carotid endarterectomy , holds unrealized potential to improve patient outcomes . Nurses are well-placed in the healthcare system to co-ordinate this type of education . METHODS A r and omized controlled trial was conducted between October 2001 and October 2002 . Patients having carotid endarterectomy ( n = 133 ) were r and omized to either the intervention ( n = 66 ) or control group ( n = 67 ) . The intervention consisted of telephone liaison with the patient by a Registered Nurse at 2 , 6 and 12 weeks following carotid endarterectomy , combined with education about stroke risk factor management and structured liaison with the patient 's surgeon and referring general practitioner . While patients allocated to the control group did not receive any postoperative telephone contact directly from the Registered Nurse during the study , their general practitioners received structured postoperative liaison . RESULTS The co-ordinated care postdischarge intervention had a statistically significant positive effect on patient knowledge of stroke warning signs ( P = 0.002 ) , patient self-reported changes to improve lifestyle ( P = 0.006 ) and diet modification ( P < 0.001 ) . Statistically significant improvements from baseline to follow-up were detected in both groups for other outcomes . CONCLUSIONS While nursing-led , co-ordinated care after discharge achieves important improvements for short-term outcomes , carotid endarterectomy itself may have been a catalyst for improved patient outcomes . Further research of nursing-led co-ordinated care initiatives for vascular surgery patients is needed Objective : To find out if there were any differences in improvement and maintenance of motor function , activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke . Design : A longitudinal r and omized controlled stratified trial . Setting : Rehabilitation institutions , community , patients ' homes and nursing homes . Subjects : Seventy-five male and female first-time-ever stroke patients : 35 in an intensive exercise group and 40 in a regular exercise group . Intervention : The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke . The regular exercise group patients were followed up according to their subjective needs during the corresponding year . Main outcome measures : Motor Assessment Scale , Barthel Index of Activities of Daily Living , and grip strength . Results : Both groups improved significantly up to six months when function stabilized . The groups did not differ significantly on any test occasions . The difference of improvement from admission to discharge was significant in favour of the intensive exercise group , in the Motor Assessment Scale total score ( intensive exercise group 7.5 ; regular exercise group 1.7 , P = 0.01 ) , and in the Barthel Index of Activities of Daily Living total score ( 17.4 versus 8.9 , P = 0.04 ) . Conclusion : Motor function , activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime . This indicates the importance of motivation for regular exercise in the first year following stroke , achieved by regular check-ups OBJECTIVE To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness SIR— Interventions with an educational or counselling component have been reported to be effective in a variety of patient groups to encourage smoking cessation [ 1 ] , lower blood pressure ( BP ) [ 2 , 3 ] , achieve modest reductions in cholesterol [ 4 ] , and promote weight loss [ 5 ] . Evaluation of the impact of education on physical outcomes is lacking in stroke disease , despite evidence that inadequate provision of information may adversely affect compliance with secondary prevention and psychosocial outcomes [ 6 ] . We describe a single-blind r and omised controlled trial of health education and counselling for patients with stroke or transient ischaemic attack ( TIA ) , and its effects on risk factors , satisfaction , mood and perceived health status OBJECTIVES To determine the feasibility and effect of exercise training after stroke . DESIGN R and omized exploratory trial comparing exercise training ( including progressive endurance and resistance training ) with relaxation ( attention control ) . SETTING Interventions were performed in a rehabilitation hospital . PARTICIPANTS Sixty-six independently ambulatory patients ( mean age 72 , 36 men ) without significant dysphasia , confusion , or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital . INTERVENTION Both interventions were held three times a week for 12 weeks . Up to seven patients attended each session . MEASUREMENTS The Functional Independence Measure ; Nottingham Extended Activities of Daily Living ; Rivermead Mobility Index ; functional reach ; sit-to-st and ; elderly mobility score ; timed up- and -go ; Medical Outcomes Study 36-Item Short Form Question naire , version 2 ( SF-36 ) ; Hospital Anxiety and Depression Score ; aspects of physical fitness ( comfortable walking speed , walking economy , and explosive leg extensor power ) were measured at baseline , immediately after interventions ( 3 months ) , and 7 months after baseline . RESULTS The median number of intervention sessions attended was 36 ( interquartile range ( IQR ) 30.00 - 36.75 ) for exercise and 36 ( IQR 30.50 - 37.00 ) for relaxation .  Adherence to the individual exercises ranged from 94 % to 99 % . At 3 months , role-physical ( an item in SF-36 ) , timed up- and -go , and walking economy were significantly better in the exercise group ( analysis of covariance ) . At 7 months , role-physical was the only significant difference between groups . CONCLUSION Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life
target: Conclusions Stroke secondary prevention lifestyle interventions are effective in terms of affecting positive change in relation to lifestyle behaviours , physiological and secondary outcomes .
  However , there was insufficient evidence to determine the effect of intervention on incidence of stroke recurrence .
background: EXECUTIVE SUMMARY Background Each year , approximately 15 million people worldwide have a stroke ; of these , five million die and another five million are chronically disabled .
  Stroke recurs in approximately 25 % of patients during the first five years post-stroke ; recurrence may result in death , increased disability or institutionalisation .
  Modifiable risk factors for recurrent stroke have been identified , and may be addressed by means of behavioural health promotion interventions .
  Objectives This systematic review sought to establish the effectiveness of secondary prevention behavioural interventions , which address one or more modifiable lifestyle risk factors for recurrent stroke i.e. tobacco use , unhealthy diet , physical inactivity and excessive alcohol consumption .