Secondary prevention lifestyle interventions initiated within 90 days after TIA or ‘minor’ stroke: a systematic review and meta-analysis of rehabilitation programmes

Abstract

BackgroundStrokes are often preceded by a transient ischaemic attack (TIA) or ‘minor’ stroke. The immediate period after a TIA/minor stroke is a crucial time to initiate secondary prevention. However, the optimal approach to prevention, including non-pharmacological measures, after TIA is not clear.AimTo systematically review evidence about the effectiveness of delivering secondary prevention, with lifestyle interventions, in comprehensive rehabilitation programmes, initiated within 90 days of a TIA/minor stroke. Also, to categorise the specific behaviour change techniques used.Design and settingThe review identified randomised controlled trials by searching the Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Web of Science, EBSCO CINAHL and Ovid PsycINFO.MethodTwo review authors independently screened titles and abstracts for eligibility (programmes initiated within 90 days of event; outcomes reported for TIA/minor stroke) and extracted relevant data from appraised studies; a meta-analysis was used to synthesise the results.ResultsA total of 31 potentially eligible papers were identified and four studies, comprising 774 patients post-TIA or minor stroke, met the inclusion criteria; two had poor methodological quality. Individual studies reported increased aerobic capacity but meta-analysis found no significant change in resting and peak systolic blood pressure, resting heart rate, aerobic capacity, falls, or mortality. The main behaviour change techniques were goal setting and instructions about how to perform given behaviours.ConclusionThere is limited evidence of the effectiveness of early post-TIA rehabilitation programmes with preventive lifestyle interventions. Further robust randomised controlled trials of comprehensive rehabilitation programmes that promote secondary prevention and lifestyle modification immediately after a TIA are needed.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…140 Similar results have been reported in patients recovering from TIA. 141 In ambulatory exercise-based cardiac rehabilitation, a detailed pre-participation screening is important to rule out or treat risk factors for recurrent TIA or stroke. In this regard, patients should undergo clinical evaluation by a healthcare professional with expertise in stroke care to determine risk for recurrent stroke and initiate appropriate investigations and management strategies.…”

A Nomogram to Predict the Probability of Relapse during Hospitalization after Minor Ischemic Stroke in Chinese Patients.

“…Studies have shown that higher levels of total bilirubin are associated with lower risk of asymptomatic cerebral infarction. [24] Tan et al [17]also proved that total bilirubin can be used as an independent risk factor for MIS. Indeed, as nomogram shows, it is reasonable that higher levels of bilirubin can prevent the recurrence of cerebral infarction to some extent.…”

Scalp acupuncture plus low-frequency rTMS promotes repair of brain white matter tracts in hemiplegic patients with stroke: A diffusion tensor imaging study

“…Stable vital signs, clear consciousness; (4). Unilateral upper limb Brunnstrom evaluation: I-IV period; (5) Age from 20 to 80 years old; (6) The course of the diseases from 2 weeks to 6 months. The exclusion criteria for this study included the following: (1) A history of epilepsy; (2) Function failure in important organs such as heart, lung, liver, kidney, etc.…”

“…Motor dysfunction after stroke leads to a heavy financial pressure on the families. Post-stroke hemiplegic rehabilitation includes early rehabilitation treatment [2], routine treatment [3], computer aided rehabilitation training [4], secondary prevention by improving the life style [5], transcranial direct current stimulation [6], scalp acupuncture (SA) [7,8], repetitive transcranial magnetic stimulation (rTMS) [9] and other interventions. When traditional Chi-nese treatment is combined with Western medicine rehabilitation therapy, it is more common that SA [10,11] and rTMS are used in hemiplegia rehabilitation after stroke.…”