Stop Stroke: Development of an innovative intervention to improve risk factor management after stroke
Abstract
Objective Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal. The UK Medical Research Council (MRC) have proposed a framework for developing and evaluating complex interventions, such as community management of stroke secondary prevention. The Framework outlines a five-phased approach from theory through to implementation of effective interventions. This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke.Methods The pre-clinical/theoretical phase entailed reviewing the literature and undertaking quantitative and qualitative studies to identify current practices and barriers to secondary prevention. In Phase I (modelling), findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management. The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners.Results This led to the development of the definitive risk factor management intervention. This comprises multiple components and involves using an on-going population stroke register to target patients, carers and health care professionals with tailored secondary prevention advice. Clinical, socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients, carers and health care professionals at three time points: within 10 weeks, 3 and 6 months post-stroke.Conclusion The intervention is currently being evaluated in a randomised controlled trial. Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases.Practice implications The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health. Implications for practice in stroke secondary prevention will emerge when the results of our randomised controlled trial are published.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Fourteen included studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners.
“Fourteen studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners [27, 29–32, 34, 36, 37, 39, 40, 42, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [36]
Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions, stroke, cancer and other chronic illnesses.
“Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions [28, 30, 35, 40, 47], stroke [31, 36, 39], cancer [29, 32, 33, 37, 42] and other chronic illnesses [25, 34, 38].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [36]
Several included studies used mixed methods, combining qualitative strategies to explore stakeholders' perspectives and quantitative analysis to estimate the intervention effect.
“Several studies used mixed methods, combining qualitative strategies to explore stakeholders’ perspectives and quantitative analysis to estimate the intervention effect [24, 27, 28, 33, 35–37, 40, 42].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [36]
A few included studies reported that the optimisation processes allowed the research team to identify the 'best ingredients' out of several candidate components.
“A few studies reported that the optimisation processes allowed the research team to identify the ‘best ingredients’ out of several candidate components [33, 35–37, 42].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [36]
Cites
Interpreting Qualitative Data Methods for Analysing Talk, Text and Interaction
Kleinsasser, R. C., & Silverman, D. J. (1997) · Modern Language Journal · doi:10.2307/329190 · Cited by 6,892 · see citing works
Qualitative methods for health research
Green, J., & Thorogood, N. (2009) · Choice Reviews Online · doi:10.5860/choice.47-0901 · Cited by 4,607 · see citing works
Framework for design and evaluation of complex interventions to improve health
Campbell, M. (2000) · BMJ · doi:10.1136/bmj.321.7262.694 · Cited by 3,474 · see citing works
SMOG Grading - A New Readability Formula.
McLaughlin, G. H. (1969) · The Journal of Reading · Cited by 2,067 · see citing works
Sharing decisions with patients: is the information good enough?
Coulter, A., Entwistle, V. A., & Gilbert, D. (1999) · BMJ · doi:10.1136/bmj.318.7179.318 · Cited by 638 · see citing works
Comparing Stroke Incidence Worldwide: What Makes Studies Comparable?
Sudlow, C. L. M., & Warlow, C. P. (1996) · Stroke · doi:10.1161/01.str.27.3.550 · Cited by 451 · see citing works
Information provision for stroke patients and their caregivers
Förster, A., Brown, L., Smith, J., House, A. O., Knapp, P., Wright, J., & Young, J. B. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001919.pub3 · Cited by 413 · see citing works
Ebrahim, S. B. J., & Smith, G. D. (1997) · BMJ · doi:10.1136/bmj.314.7095.1666 · Cited by 312 · see citing works
Stroke : a practical guide to management
Warlow, C. P., Dennis, M. S., van Gijn, J., Hankey, G. J., & Barnett, H. J. M. (2001) · UWA Profiles and Research Repository (UWA) · Cited by 301 · see citing works
Ethnic differences in incidence of stroke: prospective study with stroke register
Stewart, J. A., Dundas, R., Howard, R., Rudd, A. G., & Wolfe, C. D. A. (1999) · BMJ · doi:10.1136/bmj.318.7189.967 · Cited by 297 · see citing works
Self-citationvan Wijk, I., Kappelle, L. J., van Gijn, J., Koudstaal, P. J., Franke, C. L., Vermeulen, M., Gorter, J. W., & Algra, A. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66734-7 · Cited by 296 · see citing works
Hs, J., Nakayama, H., Reith, J., Raaschou, H. O., & Olsen, T. S. (1997) · Neurology · doi:10.1212/wnl.48.4.891 · Cited by 256 · see citing works
Jolly, K. B., Bradley, F., Sharp, S. J., Smith, H. E., Thompson, S. G., Kinmonth, A. L., & Mant, D. (1999) · BMJ · doi:10.1136/bmj.318.7185.706 · Cited by 235 · see citing works
Cupples, M., & Mcknight, A. (1994) · BMJ · doi:10.1136/bmj.309.6960.993 · Cited by 194 · see citing works
Underestimation of the Early Risk of Recurrent Stroke
Coull, A. J., & Rothwell, P. M. (2004) · Stroke · doi:10.1161/01.str.0000133129.58126.67 · Cited by 185 · see citing works
Feder, G. S., Griffiths, C., Eldridge, S., & Spence, M. (1999) · BMJ · doi:10.1136/bmj.318.7197.1522 · Cited by 177 · see citing works
Secondary prevention clinics for coronary heart disease: randomised trial of effect on health
Campbell, N. C., Thain, J., Deans, H. G., Ritchie, L. D., Rawles, J. M., & Squair, J. (1998) · BMJ · doi:10.1136/bmj.316.7142.1434 · Cited by 169 · see citing works
Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly
Kaplan, R. C., Tirschwell, D., Longstreth, W. T., Manolio, T. A., Heckbert, S. R., Lefkowitz, D. S., El‐Saed, A., & Psaty, B. M. (2005) · Neurology · doi:10.1212/01.wnl.0000176058.09848.bb · Cited by 169 · see citing works
Pill, R. (1998) · Family Practice · doi:10.1093/fampra/15.3.229 · Cited by 140 · cited 2× · see citing works
“approaches have included information or education-based initiatives targeted at patients and/or carers to improve stroke knowledge [22,23]; providing education or training to clinicians to improve communication of secondary prevention advice [16]; and development of new clinical roles such as nurse-coordinators to lia…”
BackgroundResultde Lusignan, S. (2005) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v13i1.580 · Cited by 137 · see citing works
Quality Assurance and Quality Control in Longitudinal Studies
Whitney, C. W., Lind, B. K., & Wahl, P. W. (1998) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a017973 · Cited by 127 · see citing works
Long-term Prognosis After a Minor Stroke
Prencipe, M., Culasso, F., Rasura, M., Anzini, A., Beccia, M., Cao, M., Giubilei, F., & Fieschi, C. (1998) · Stroke · doi:10.1161/01.str.29.1.126 · Cited by 110 · see citing works
Discharge from physiotherapy following stroke:
Wiles, R., Ashburn, A., Payne, S. A., & Murphy, C. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.12.022 · Cited by 102 · see citing works
Development of Complex Interventions in Stroke Care
Redfern, J., McKevitt, C., & Wolfe, C. D. A. (2006) · Stroke · doi:10.1161/01.str.0000237097.00342.a9 · Cited by 100 · see citing works
Self-citationBehavioral Risk Factor Prevalence and Lifestyle Change After Stroke
Redfern, J., McKevitt, C., Dundas, R., Rudd, A. G., & Wolfe, C. D. A. (2000) · Stroke · doi:10.1161/01.str.31.8.1877 · Cited by 92 · see citing works
Self-citationRimmer, J. H., Braunschweig, C. L., Silverman, K., Riley, B., Creviston, T., & Nicola, T. L. (2000) · American Journal of Preventive Medicine · doi:10.1016/s0749-3797(00)00129-x · Cited by 91 · see citing works
Ellis, G., Rodger, J., McAlpine, C. H., & Langhorne, P. (2005) · Age and Ageing · doi:10.1093/ageing/afi075 · Cited by 86 · see citing works
Cessation of Smoking After First-Ever Stroke
Bak, S., Sindrup, S. H., Alslev, T., Kristensen, O., Christensen, K., & Gaist, D. (2002) · Stroke · doi:10.1161/01.str.0000027210.50936.d0 · Cited by 82 · see citing works
Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke
Hillen, T., Dundas, R., Lawrence, E., Stewart, J. A., Rudd, A. G., & Wolfe, C. D. A. (2000) · Stroke · doi:10.1161/01.str.31.2.469 · Cited by 78 · see citing works
Self-citationRudd, A. G. (2004) · Age and Ageing · doi:10.1093/ageing/afh107 · Cited by 71 · see citing works
Self-citationRobinson, L., Francis, J., James, P., Tindle, N., Greenwell, K., & Rodgers, H. (2005) · Clinical Rehabilitation · doi:10.1191/0269215505cr787oa · Cited by 58 · see citing works
A Family Support Organiser for Stroke Patients and Their Carers: A Randomised Controlled Trial
Tilling, K. M., Coshall, C., McKevitt, C., Daneski, K., & Wolfe, C. D. A. (2005) · Cerebrovascular Diseases · doi:10.1159/000086511 · Cited by 47 · see citing works
Self-citationStroke: A Practical Guide to Management
Kirshner, H. S. (2002) · Archives of Neurology · doi:10.1001/archneur.59.3.485-a · Cited by 44 · see citing works
A survey on adherence to secondary ischemic stroke prevention
Wang, Y., Wu, D., Wang, Y., Ma, R., Wang, C., & Zhao, W. (2006) · Neurological Research · doi:10.1179/016164106x91816 · Cited by 44 · see citing works
Csako, G., McGriff, N. J., Rotman-Pikielny, P., Sarlis, N. J., & Pucino, F. (2001) · Annals of Pharmacotherapy · doi:10.1345/aph.1a031 · Cited by 40 · see citing works
Byrne, M., Cupples, M., Smith, S. M., Leathem, C. S., Corrigan, M., Byrne, M. C., & Murphy, A. W. (2006) · PubMed · Cited by 38 · see citing works
National clinical guidelines for stroke. 2nd edition
Bowen, A. (2004) · Research Explorer (The University of Manchester) · Cited by 37 · see citing works
Health care follow-up after stroke: opportunities for secondary prevention
Redfern, J. (2002) · Family Practice · doi:10.1093/fampra/19.4.378 · Cited by 33 · see citing works
Self-citationSecondary prevention after ischemic stroke
Girot, M., Mackowiak‐Cordoliani, M., Deplanque, D., H�non, H., Lucas, C., & Leys, D. (2005) · Journal of Neurology · doi:10.1007/s00415-005-0591-8 · Cited by 30 · see citing works
Risk management after stroke: The limits of a patient-centred approach
Redfern, J., McKevitt, C., & Wolfe, C. D. A. (2006) · Health Risk & Society · doi:10.1080/13698570600677266 · Cited by 27 · see citing works
Self-citationGirot, M., Deplanque, D., Pasquier, F., Dest�e, A., & Leys, D. (2004) · Journal of Neurology · doi:10.1007/s00415-004-0357-8 · Cited by 9 · see citing works
Stroke Services:Policy and practice across Europe
Wolfe, C. D. A., McKevitt, C., & Rudd, A. G. (2002) · Cited by 6 · see citing works
Self-citationStroke services: policy and practice across Europe
van der Veen, W. J., & van der Meer, K. (2003) · International Journal of Integrated Care · doi:10.5334/ijic.72 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 44 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Information provision for stroke patients and their caregivers
Förster, A., Brown, L., Smith, J., House, A. O., Knapp, P., Wright, J., & Young, J. B. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001919.pub3 · Cited by 413 · see citing works
Möhler, R., Köpke, S., & Meyer, G. (2015) · Trials · doi:10.1186/s13063-015-0709-y · Cited by 317 · see citing works
Raine, R., Fitzpatrick, R. M., Barratt, H., Bevan, G., Black, N. A., Boaden, R., Bower, P., Campbell, M., Denis, J., Devers, K. J., et al. (2016) · Health Services and Delivery Research · doi:10.3310/hsdr04160 · Cited by 187 · see citing works
O’Cathain, A., Thomas, K. J., Drabble, S. J., Rudolph, A., Goode, J., & Hewison, J. (2014) · Health Technology Assessment · doi:10.3310/hta18380 · Cited by 159 · see citing works
Interventions for improving modifiable risk factor control in the secondary prevention of stroke
Bridgwood, B. M., Lager, K. E., Mistri, A. K., Khunti, K. K., Wilson, A., & Modi, P. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009103.pub3 · Cited by 153 · see citing works
Developing complex interventions for nursing: a critical review of key guidelines
Corry, M., Clarke, M. J., While, A., & Lalor, J. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12173 · Cited by 109 · see citing works
Information provision for stroke survivors and their carers
Crocker, T. F., Brown, L., Lam, N., Wray, F., Knapp, P., & Forster, A. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001919.pub4 · Cited by 105 · see citing works
Levati, S., Campbell, P., Frost, R., Dougall, N., Wells, M., Donaldson, C., & Hagen, S. (2016) · Pilot and Feasibility Studies · doi:10.1186/s40814-016-0058-y · Cited by 101 · see citing works
Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis
Ellis, G., Mant, J., Langhorne, P., Dennis, M. S., & Winner, S. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005066.pub2 · Cited by 82 · see citing works
Wolfe, C. D. A., Redfern, J., Rudd, A. G., Grieve, A. P., Heuschmann, P. U., & McKevitt, C. (2010) · Stroke · doi:10.1161/strokeaha.110.588046 · Cited by 69 · see citing works
Self-citationInterventions for improving modifiable risk factor control in the secondary prevention of stroke
Lager, K. E., Mistri, A. K., Khunti, K. K., Haunton, V. J., Sett, A. K., & Wilson, A. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009103.pub2 · Cited by 67 · see citing works
Touillet, A., Guesdon, H., Bosser, G., Beis, J.-M., & Paysant, J. (2010) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2010.03.005 · Cited by 56 · see citing works
Blood Pressure 1 Year after Stroke: The Need to Optimize Secondary Prevention
Hornnes, N., Larsen, K. G., & Boysen, G. (2010) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2009.10.002 · Cited by 42 · see citing works
Porat, T., Marshall, I. J., Sadler, E., Vadillo, M. A., McKevitt, C., Wolfe, C. D. A., & Ćurčin, V. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030385 · Cited by 35 · see citing works
Self-citationRisk awareness in secondary stroke prevention: a review of the literature
Slark, J., & Sharma, P. (2013) · JRSM Cardiovascular Disease · doi:10.1177/2048004013514737 · Cited by 30 · see citing works
Möhler, R., Bartoszek, G., & Meyer, G. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-125 · Cited by 21 · see citing works
Patomella, A., Mickols, G., Asaba, E., Nilsson, G. H., Fridén, C., Kottorp, A., Bertilson, B. C., & Tham, K. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0883-6 · Cited by 21 · see citing works
Oikarinen, A., Engblom, J., Kääriäinen, M., & Kyngäs, H. A. (2016) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12369 · Cited by 20 · see citing works
Marshall, I. J., McKevitt, C., Wang, Y., Wafa, H. A., Skolarus, L. E., Bhalla, A., Muruet-Gutierrez, W., Emmett, E. S., Sommerville, P., Birns, J., et al. (2022) · NIHR Open Research · doi:10.3310/nihropenres.13257.1 · Cited by 17 · see citing works
Self-citationDeveloping an intervention for cancer patients prescribed oral chemotherapy: a generic patient diary
Oakley, C. M., Johnson, J., & Ream, E. (2010) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2010.01198.x · Cited by 17 · see citing works
Krishnamurthi, R., Witt, E., Barker-Collo, S. L., McPherson, K. M., Davis-Martin, K., Bennett, D., Rush, E. C., Suh, F. M., Starkey, N. J., Parag, V., et al. (2013) · International Journal of Stroke · doi:10.1111/ijs.12107 · Cited by 16 · see citing works
Dregan, A., van Staa, T. P., McDermott, L. M., McCann, G., Ashworth, M. J., Charlton, J., Wolfe, C. D. A., Rudd, A., Yardley, L., & Gulliford, M. C. (2012) · Trials · doi:10.1186/1745-6215-13-181 · Cited by 14 · see citing works
Self-citationBooth, V., Hood-Moore, V., Hancox, J. E., Logan, P., & Robinson, K. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024185 · Cited by 13 · see citing works
Pallan, M. J. (2011) · University of Birmingham Institutional Research Archive (University of Birmingham) · Cited by 3 · see citing works
Stroke services for risk reduction in the secondary prevention of stroke
Lager, K. E., Wilson, A., Mistri, A. K., & Khunti, K. K. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009103 · Cited by 2 · see citing works
Longer‐Term Support for Survivors of Stroke and Their Carers
Redfern, J., Gordon, C., & Cadilhac, D. A.-M. (2019) · Wiley eBooks · doi:10.1002/9781119581161.ch14 · Cited by 2 · see citing works
Self-citationStroke pathway – Evidence Base Commissioning. An Evidence Review
Marshall, I. J., McKevitt, C., Wang, Y., Wafa, H. A., Skolarus, L. E., Bhalla, A., Muruet-Gutierrez, W., Emmett, E. S., Sommerville, P., Birns, J., et al. (2022) · doi:10.3310/nihropenres.1115195.1 · Cited by 2 · see citing works
Self-citationCosta, A. G. D. S., Oliveira, A. R. D. S., Lopes, M. V. D. O., & de Araújo, T. L. (2014) · DOAJ (DOAJ: Directory of Open Access Journals)
Ahmed, S. (2014) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Rose, J. S., Kyle, J. A., & Skellley, J. W. (2017) · INNOVATIONS in pharmacy · doi:10.24926/iip.v8i4.931
- Authors
- Redfern, J., Rudd, A. D., Wolfe, C. D. A., & McKevitt, C.
- Affiliations
- King's College London (GB)
- Corresponding author
- Redfern, Judith
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2008-08
- Volume
- 72
- Issue
- 2
- Pages
- 201-209
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W2052267636
- Cited by
- 34
- References
- 44
- Citations by year
- 2023: 1 · 2022: 3 · 2021: 1 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 2
- FWCI
- 1.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Open Research (University of Surrey) (submittedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Stroke Association
- Medical Research Council
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- secondary stroke prevention, risk factor control, stroke recurrence, complex intervention development, MRC framework for complex interventions, stroke registry, caregivers, general practitioners, intervention feasibility and acceptability, post-stroke care
- MeSH terms
- Aftercare, Feasibility Studies, United Kingdom, Health Promotion, Humans, Patient Acceptance of Health Care, Patient Education as Topic, Pilot Projects, Primary Health Care, Recurrence, Registries, Research Design, Risk Factors, Time Factors, Program Evaluation, Program Development, Survivors, Total Quality Management, Risk Assessment, Needs Assessment, Stroke, Qualitative Research, Risk Reduction Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
