Interventions for behaviour change and self-management in stroke secondary prevention: protocol for an overview of reviews

Olive Lennon, Catherine Blake, Jo Booth, Alex Pollock, Maggie Lawrence

Research output: Contribution to journalArticle

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Abstract

Background: Stroke secondary prevention guidelines recommend medication prescription and adherence, active
education and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positive
behaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour change
and self-management interventions. A growing number of systematic reviews have addressed complex interventions
in stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makes
the mechanism/s that affect positive change difficult to identify or replicate clinically. Adopting a two-phase approach,
this overview will firstly comprehensively summarise systematic reviews in this area and secondly identify and
synthesise primary studies in these reviews which provide person-centred, theoretically informed interventions for
stroke secondary prevention.
Methods: An overview of reviews will be conducted using a systematic search strategy across the Cochrane
Database of Systematic Reviews, PubMed and Epistomonikas. Inclusion criteria: systematic reviews where the
population comprises individuals post-stroke or TIA and where data relating to person-centred risk reduction
are synthesised for evidence of efficacy when compared to standard care or no intervention. Primary outcomes of interest
include mortality, recurrent stroke and other cardiovascular events. In phase 1, two reviewers will independently (1) assess
the eligibility of identified reviews for inclusion; (2) rate the quality of included reviews using the ROBIS tool; (3) identify
unique primary studies and overlap between reviews; (4) summarise the published evidence supporting person-centred
behavioural change and self-management interventions in stroke secondary prevention and (5) identify evidence gaps in
this field. In phase 2, two independent reviewers will (1) examine person-centred, primary studies in each review using
the Template for Intervention Description and Replication (TIDieR checklist), itemising, where present, theoretical
frameworks underpinning interventions; (2) group studies employing theoretically informed interventions by the
intervention delivered and by the outcomes reported (3) apply GRADE quality of evidence for each intervention
by outcome/s identified from theoretically informed primary studies. Disagreement between reviewers at each
process stage will be discussed and a third reviewer consulted.
Discussion: This overview will comprehensively bring together the best available evidence supporting person-centred,
stroke secondary prevention strategies in an accessible format, identifying current knowledge gaps.
Original languageEnglish
Article number231
JournalSystematic Reviews
Volume7
DOIs
Publication statusPublished - 13 Dec 2018

Keywords

  • overview review
  • meta-review
  • stroke
  • secondary prevention
  • self-management
  • behaviour change

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