A Scoping Review of Non-Pharmacological, Non-Surgical Secondary Prevention Strategies in Ischaemic Stroke and TIA in National Stroke Guidelines and Clinical Audit Documents

Abstract

The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke secondary prevention recommendations and associated performance indicators. Using a snowballing methodology, 27 guideline documents met the inclusion criteria. Sixteen (59%) detailed, non-pharmacological, non-surgical stroke secondary prevention-addressing known, modifiable population attributable risk factors, of physical inactivity (N = 11), smoking (N = 11), unsafe alcohol consumption (N = 10), diet (N = 8), weight (N = 5), stress (N = 4) and depression (N = 2). Strategies recommended to address these risk factors were: assessment of stroke risk/risk factors (N = 4); provision of advice and information on reducing lifestyle related risk (N = 16); education and counselling for lifestyle behaviour change (N = 8) and onward referral for specialist management of risk (N = 4). Of the nine stroke audits/registries identified, only three (33%) included non-pharmacological, non-surgical quality indicators of documented provision of advice or information on the following: general lifestyle (N = 2); smoking cessation for current smokers (N = 2); reduction in alcohol consumption, where relevant (N = 1), exercise participation (N = 1) and diet (N = 1). Preventive quality indicators addressing the management of weight, stress or depression were absent. This review highlights current gaps in optimal stroke secondary prevention recommendations and their implementation.

Mindfulness and Relaxation Techniques for Stroke Survivors with Aphasia: A Feasibility and Acceptability Study

“…It has also been acknowledged as a risk factor for secondary strokes in a Delphi study conducted by a group of international experts in secondary stroke prevention [ 13 ]. A recent scoping review of the national stroke guidelines of 27 countries concluded that psychosocial stress is poorly addressed as a modifiable population attributable risk factor in secondary stroke prevention [ 14 ]. As noted previously, PWA and, indeed, stroke patients with aphasia report high levels of anxiety and psychosocial stress.…”

“I Assumed It Would Be Somebody Who Had a Stroke That Was Doing This”: Views of Stroke Survivors, Caregivers, and Health Professionals on Tailoring a Relaxation and Mindfulness Intervention

“…For the modified intervention, that will be someone belonging to the stroke community, demonstrating techniques that have been specifically designed for them. This will act as a visual cue that the techniques can be completed by other stroke survivors, demonstrating that the current intervention has been specifically tailored to stroke survivors, which should increase uptake and engagement [31] as well possibly reducing the risk of secondary stroke [9].…”

“…By having an intervention that is specifically tailored to reduce post-stroke stress and anxiety, it is more likely that stroke survivors and caregivers will engage with the materials and achieve the desired frequency of practice, which will lead to enhanced intervention effectiveness. This could also reduce the risk of a secondary stroke [9]. Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.…”

“…Psychosocial stress has been identified as a secondary stroke risk factor [8]. Consulting a stroke-related PPI group to tailor an intervention to reduce stress and anxiety will therefore encourage engagement from the end users and have an enhanced possibility for the intervention to work, thus reducing the risk of secondary strokes [9].…”

Stroke Secondary Prevention: Everyone’s Business

“…Hall et al (2022), in their scoping review of contemporary stroke guideline documents and clinical audits, shine a spotlight on the current lack of clear direction for clinicians in addressing secondary prevention beyond pharmacological or surgical management [ 2 ]. This work highlights the imperative to raise awareness amongst researchers and clinicians of the urgent need for high-quality holistic secondary prevention stroke care initiatives that will help improve outcomes (medical, psychological, social, and societal) for stroke patients and their families.…”