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Tytuł:
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Results of a Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Healthy Eating and Lifestyle after Stroke.
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Autorzy:
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Towfighi A; Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States; Los Angeles County Department of Health Services, Los Angeles, CA, United States. Electronic address: .
Cheng EM; University of California, Los Angeles, Los Angeles, CA, United States.
Hill VA; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States; University of Cincinnati, Cincinnati, OH, United States.
Barry F; University of California, Los Angeles, Los Angeles, CA, United States.
Lee M; University of California, Los Angeles, Los Angeles, CA, United States.
Valle NP; St Jude Medical Center, Fullerton, CA, United States. Electronic address: .
Mittman B; Kaiser Permanente, Los Angeles, CA, United States.
Ayala-Rivera M; Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States.
Moreno L; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Espinosa A; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Dombish H; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Wang D; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Ochoa D; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Chu A; Los Angeles County + University of Southern California Medical Center, 1100 N State St, A4E, Los Angeles, CA 90033, United States. Electronic address: .
Atkins M; Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States.
Vickrey BG; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Źródło:
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Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Dec; Vol. 29 (12), pp. 105323. Date of Electronic Publication: 2020 Sep 28.
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Typ publikacji:
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Journal Article; Randomized Controlled Trial
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Język:
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English
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Imprint Name(s):
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Publication: Philadelphia, PA : Saunders
Original Publication: New York, NY : Demos Publications, [1991-
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MeSH Terms:
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Diet, Healthy*
Exercise Therapy*
Risk Reduction Behavior*
Stroke Rehabilitation*
Ischemic Attack, Transient/*rehabilitation
Stroke/*therapy
Aged ; Feeding Behavior ; Female ; Health Knowledge, Attitudes, Practice ; Health Status ; Humans ; Ischemic Attack, Transient/diagnosis ; Ischemic Attack, Transient/physiopathology ; Ischemic Attack, Transient/psychology ; Los Angeles ; Male ; Middle Aged ; Patient Education as Topic ; Pilot Projects ; Safety-net Providers ; Self Care ; Stroke/diagnosis ; Stroke/physiopathology ; Time Factors ; Treatment Outcome
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Contributed Indexing:
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Keywords: Diet; Exercise; Lifestyle; Physical activity; Prevention; Stroke
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Molecular Sequence:
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ClinicalTrials.gov NCT01550822
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Entry Date(s):
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Date Created: 20201001 Date Completed: 20201207 Latest Revision: 20201214
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Update Code:
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20240105
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DOI:
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10.1016/j.jstrokecerebrovasdis.2020.105323
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PMID:
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33002791
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Objectives: Although healthy lifestyle practices mitigate recurrent stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a occupational therapy-based lifestyle management intervention, Healthy Eating And Lifestyle after Stroke (HEALS), to improve stroke survivors' self-management skills relating to diet and physical activity and evaluated it in a diverse safety-net population.
Materials and Methods: One hundred English- or Spanish-speaking participants with stroke or transient ischemic attack were randomized to a 6-week occupational therapist-led group lifestyle intervention vs. usual care. Each of the six 2-h group sessions included didactic presentations on diet and physical activity, peer exchange, personal exploration with goal setting, and direct experience through participation in a relevant activity. Primary outcomes at 6 months were change in body mass index, fruit/vegetable intake, and physical activity. Secondary outcomes included change in waist circumference, smoking, blood pressure, high-density lipoprotein, low-density lipoprotein, triglyceride, total cholesterol, glycosylated hemoglobin levels, quality of care, and perceptions of care. Effect sizes were determined in preparation for a larger randomized controlled trial powered to detect a difference in primary outcomes. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and intervention adherence.
Results: There were no significant changes in primary or secondary outcomes at 6 months. Effect sizes for all outcomes were small (< 0.2). Focus group participants recommended extending the intervention program duration with more sessions, additional information on stroke and vascular risk factors, an interdisciplinary approach, additional family involvement, and incentives. Providers recommended longer program duration, more training, fidelity checks to ensure standardized program delivery, and additional incentives for participants.
Conclusions: The HEALS intervention was feasible in a safety-net setting, but effect sizes were small. A longer-duration intervention, with intervener fidelity checks may be warranted.
Trial Registration: NCT01550822.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
