Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke)

Abstract

Background Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330

mHealth Intervention Applications for Adults Living With the Effects of Stroke: A Scoping Review

“…A definitive trial will determine whether such technology could facilitate greater exercise participation after stroke. Kamal et al 48 N=155 ∗ Randomized controlled, outcome assessor-blinded, parallel group single-center superiority trial Pakistan Movies4Stroke Medical management/secondary prevention To evaluate the effectiveness and safety of locally designed 5-min movies. The Movies4Stroke trial failed to achieve its primary specified outcome.…”

“…The 49 articles described 38 apps with content that varied in focus. The apps focused on upper extremity function (n=12; 31.5%) 9 , 12 , 17 , 18 , 23 , 24 , 27 , 28 , 29 , 36 , 43 , 44 , 49 , 50 , 51 , 55 ; lower extremity function (n=2; 5.3%) 12 , 51 ; general exercise, physical activity, and/or functional mobility (n=9; 23.7%) 12 , 31 , 37 , 39 , 41 , 42 , 46 , 47 , 51 , 54 ; trunk control (n=2; 5.3%) 51 , 53 ; medical management and secondary prevention (n=10; 26.3%) 13 , 14 , 15 , 16 , 33 , 39 , 40 , 43 , 44 , 48 , 51 , 52 , 54 , 56 ; language and speech skills (n=8; 20.5%) 19 , 20 , 21 , 22 , 23 , 24 , 25 , 34 , 35 , 38 , 45 ; cognitive skills (n=3; 7.9%) 23 , 24 , 26 ; gene...…”

“…The earliest study included in this review was from 2014. 22 This number has grown substantially, with 15 of the included studies 14 , 15 , 20 , 23 , 24 , 25 , 26 , 27 , 37 , 38 , 39 , 40 , 42 , 43 , 45 being published in 2019 and 14 studies 28 , 41 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 between January and September of 2020. Refer to fig 4 for a visual depiction of articles included by year.…”

The Connotation of Variances in the Risk Predictors, Medications, Homocysteine, and Homocysteine Pathway Gene Polymorphisms with CVA/Stroke

“…5 In Pakistan, there are four million stroke cases, with the rate of CVA/stroke being five to 10 times higher as compared with United Kingdom or United States. 6,7 The number of stroke afflicted persons, in Pakistan, was around 80 of every 0.1 million individuals in year 2010, and number will greatly increase in the coming years. 4,5 The risk factors associated with stroke/CVA include conventionally assigned ones such as old age, male sex, hypercholesterolemia, hypertension, smoking, cardiovascular diseases, coagulopathies, as well as advanced "newly recognized" ones such as genetic polymorphisms, mRNA variants, elevated homocysteine, fibrinogen levels, and CRP among others.…”

“… 5 In Pakistan, there are four million stroke cases, with the rate of CVA/stroke being five to 10 times higher as compared with United Kingdom or United States. 6 7 The number of stroke afflicted persons, in Pakistan, was around 80 of every 0.1 million individuals in year 2010, and number will greatly increase in the coming years. 4 5 …”