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Introduction
The value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or ‘minor’ stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease.1 Following a TIA and/or minor stroke, patients are at significant risk of further vascular events, particularly within the acute period.2
Aim
We therefore wanted to develop and test the feasibility of conducting a randomised controlled trial of a novel home-based rehabilitation programme,3 4 The Healthy Brain Rehabilitation Manual, with a pedometer and telephone follow-up from a health professional, for patients with a first TIA or minor stroke of atherosclerotic origin, using the core components of home-based CR.
Methods
The methodology that we used to develop this intervention included two systematic reviews5 6 of the literature, qualitative research and feasibility,3 and pilot studies4 of the intervention, following the Medical Research Council (MRC) guidelines for developing complex health service interventions.
Results
Systematic review 1
We found four studies of secondary prevention lifestyle interventions initiated within 90 days after TIA or minor stroke. Evidence regarding the effectiveness of these interventions was limited. In conclusion, evidence of the effectiveness of early post-TIA secondary prevention lifestyle interventions is limited.
Systematic review 2
Eleven studies of home-based CR were included; 20 different behaviour change techniques (BCTs) were identified.5 The most frequently used BCTs were social support (unspecified, 11 studies) and goal setting (behaviour, 10 studies) .
Introducing "The Healthy Brain Rehabilitation Manual"
Feasibility study
Twenty-eight patients were invited to participate: 15 consented and completed all assessment measures except VO2max testing, which all declined. The 15 patients consisted of 10 men and 5 women, with 9 suffering from a TIA and 6 from a minor stroke. The mean age of the study participants was 69 years. The intervention was welcomed and pedometers were valued highly, particularly for goal setting.
Pilot study
Of all eligible patients (44/125), 35.2% consented to contact from a researcher; 90.9% of these (40/44) participated and 97.5% (39/40) completed the study. At 12 weeks’ review, cardiovascular risk factors in both intervention arms had improved.
Qualitative research
Qualitative data confirmed the feasibility and acceptability of the research methods and intervention.
Discussion
Based on findings from our literature review, the most common BCTs used within the manual revolve around goals, planning and social support. The findings from the feasibility and pilot work regarding recruitment, retention and outcomes will be used to further refine the next stage of the intervention’s development, a randomised controlled trial.
The feasibility3 and pilot studies4 showed that it is possible to conduct a trial to evaluate the effectiveness of a novel home-based CR programme, The Healthy Brain Rehabilitation Manual, implemented within 4 weeks of a first TIA/minor stroke. This intervention has been developed following the MRC guidelines, with clear patient and public involvement, and has demonstrated improvements in cardiovascular risk factors. The next stage in the intervention’s development will be a randomised controlled trial comparing it to ‘usual’ post-TIA/stroke care.
Footnotes
Twitter @neilSportDoc
Contributors All authors have designed, conducted and written up the research study findings.
Funding This study was funded by British Association of Sport and Exercise Medicine (PhD doctoral fellowship support) and the National Institute of Health Research (PhD doctoral fellowship).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.