# Lifestyle intervention as a secondary stroke prevention in vulnerable patients

> Students’ learning task for BIP week on the topic of prevention.

## Overview
Evidence-Based Physical Therapy (EBP) integrates research evidence, clinical expertise, and user preferences to provide effective care. In week 43 of 2024, a Blended Intensive Program (BIP) was held at Charles University in the Czech Republic, focusing on EBP. The program involved over 43 physiotherapy students and 9 teachers from five universities:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Prague
* Universidad Europea de Madrid, Spain
* CEERRF, France

Students collaborated on themes including sports, prevention, injuries, neurological, respiratory, and cardiovascular diseases, as well as care for children and older adults. This report details the group's work on secondary stroke prevention.

## Background and Objectives
Stroke is a leading cause of death and disability, affecting approximately 1.1 million people in Europe. With a 40% recurrence rate within five years, secondary prevention—including lifestyle changes—is a critical component of the physiotherapist's role.

The aim of this study was to explore evidence regarding secondary stroke prevention in vulnerable patients through lifestyle interventions and to identify the most effective modalities.

## Methodology
The group utilized the PICO system to search PubMed and ScienceDirect. 
* **Population:** Adults after stroke or recent transient ischemic attack (TIA).
* **Intervention:** Educational or support programs (diet, exercise, medication adherence).
* **Exclusion Criteria:** Articles in Czech, Finnish, French, or Spanish; articles published more than 10 years ago.
* **Quality Assessment:** The PEDRO scale was used to assess methodological quality (High: ≥8/10; Low: <8/10).

A total of 64 studies were screened, resulting in 6 integral text assessments. One study was excluded for irrelevance, leaving 5 studies for final analysis.

## Results
* **Towfighi (2020):** A six-week intervention (occupational therapist-led group sessions, self-management tools) showed no significant changes in BMI or quality of life at 6 months.
* **Evans-Hudnall (2014):** A cognitive behavioral therapy program for 57 post-stroke patients showed no statistically significant improvement.
* **Sylaja (2021):** "Education visits" in rural India resulted in significant blood pressure changes, but no changes in blood sugar levels.
* **Wan (2016):** Telephone check-ups showed no difference in healthy lifestyle choices compared to regular treatment.
* **Cheng (2018):** Consultations regarding healthy lifestyles showed no significant difference in blood pressure.

## Conclusion
Due to limitations including a small number of databases, low methodological quality of studies, low frequency of interventions, and inadequate descriptions, the group concluded that the effect of lifestyle intervention in secondary stroke prevention for vulnerable patients remains non-significant based on the reviewed data.

## Authors
* **Zuzana Ficenecová**, physiotherapy student, Charles University, Czech Republic
* **Clara Fernández Riveiro**, physiotherapy student, University of A Coruña, Spain
* **Noa Vázquez Recouso**, physiotherapy student, University of A Coruña, Spain
* **Harold Flores Cordova**, physiotherapy student, Universidad Europea de Madrid, Spain
* **Miia Klemetti**, physiotherapy student, Savonia University of Applied Sciences, Finland
* **Marine Veyrat**, physiotherapy student, CEERRF, France
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic
* **Ivana Vláčilová**, Physiotherapist, PhD., Charles University, Czech Republic
* **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland
* **Veronica Robles García**, PhD. PT. OT. Lecturer, University of A Coruña, Spain
* **Beatriz Martínez Toledo**, PT, University of A Coruña, Spain
* **Montserrat Fernández**, PT, University of A Coruña, Spain
* **Lorena Canosa Carro**, PT, MSc, PhD, Lecturer at Universidad Europea de Madrid, Spain
* **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France

## References
* Flach, C., et al. (2020). Risk and Secondary Prevention of Stroke Recurrence: A Population-Base Cohort Study. *Stroke*, 51(8), 2435–2444.
* Wafa, H. A., et al. (2020). Burden of Stroke in Europe: Thirty-Year Projections of Incidence, Prevalence, Deaths, and Disability-Adjusted Life Years. *Stroke*, 51(8), 2418–2427.
* Wan, L-H., et al. (2016). Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial. *Journal of stroke and cerebrovascular diseases*, 25, 2259–70.
* Cheng, E. M., et al. (2018). Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized Controlled Trial. *Circulation. Cardiovascular quality and outcomes*, 11(1), e003228.
* Evans-Hudnall, G. L., et al. (2014). Improving secondary stroke self-care among underserved ethnic minority individuals: a randomized clinical trial of a pilot intervention. *Journal of behavioral medicine*, 37(2), 196–204.
* Towfighi, A., et al. (2020). Results of a Pilot Trial of a Lifestyle Intervention for Stroke Survivors: Healthy Eating and Lifestyle after Stroke. *Journal of stroke and cerebrovascular diseases*, 29(12), 105323.
* Sylaja, P. N., et al. (2021). Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial. *J Clin Neurosci*, 84, 53–9.
* Deijle, I. A., et al. (2022). Effect of an exercise intervention on global cognition after transient ischemic attack or minor stroke: the MoveIT randomized controlled trial. *BMC neurology*, 22(1), 289.