Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Feb 6, 2025
Date Accepted: May 7, 2025
Effectiveness of a Health Education Program to Reduce Recurrence of Stroke by Controlling Modifiable Risk Factors in a Specialized Hospital in Bangladesh: A Randomized Controlled Trial
ABSTRACT
Background:
Health education could be an effective way to increase knowledge regarding behavioral changes to prevent the recurrence of stroke; however, the evidence is ambiguous. Lack of knowledge and compliance with treatment to control modifiable risk factors and unhealthy lifestyles increases the risk of stroke recurrence.
Objective:
This study aimed to evaluate the effectiveness of a health education program among post-discharge stroke patients and their family caregivers from a tertiary specialized hospital in Bangladesh to reduce stroke recurrence by controlling modifiable risk factors.
Methods:
A parallel (1:1), open-label, prospective randomized controlled trial was conducted in Bangladesh. A total of 432 first-stroke patients were randomly enrolled at the National Institute of Neuroscience & Hospital. Stroke patients with their first attack, age ≥ 18 years, and mRS 0-4 were enrolled. We stratified the patients by their age and type of stroke, and 432 patients were randomly allocated into the intervention group (IG) and the control group (CG). We collected sociodemographic and clinical data by using a structured questionnaire. The intervention group (IG) received (self) management education including monitoring blood pressure, medication, diet, and exercise for 12 months, and the control group (CG) received the usual care. The outcomes were recurrent after 28 days of the stroke and all adverse events related to stroke after 12-month follow-up.
Results:
Out of 432 patients (216 in each group) stroke recurrence was observed 14 (6.5%) in the IG and 8 (3.7%) in the CG and the difference was not significant (p=0.189). Death was lower in the IG [39 (18.1%) vs. 56 (25.9%)] compared to the CG. In Cox-regression analysis, the unadjusted model showed death was significant [Hazard ratio 95% CI: 1.531 (1.017-2.304); p=0.041]; however, the difference was not significant after adjusting modified Rankin Scale at baseline [Hazard ratio 95% CI: 0.818 (0.540-1.238); p=0.341]. Stroke patients' medication adherence was significantly improved at 6-month (p<0.001) and 12-month (p=0.002) after the intervention.
Conclusions:
This study failed to demonstrate the effectiveness of health education in reducing recurrence, death, and stroke-related adverse events. However, health education enhanced the medication adherence. Some causes of death could not be diagnosed due to inadequate healthcare systems. Further research with diagnostic facilities and a long observation period is necessary to explore the underlying cause of recurrence. This study results suggested the importance of structuring the acute care management for stroke patients into the health systems of Bangladesh. Clinical Trial: ClinicalTrials.gov NCT05520034; https://clinicaltrials.gov/ct2/show/NCT05520034
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