Effect of a nurse-led secondary stroke prevention intervention on medium-term stroke outcome in a teaching hospital in Nigeria: A quasi-experimental study

Abstract

Background: Mortality and morbidity attributable to stroke remain high in developing countries. Secondary prevention of stroke can reduce recurrence using targeted interventions addressing modifiable risk factors. This study assessed the effect of a nurse-led secondary stroke prevention intervention on compliance to lifestyle, diet, clinic and physical therapy attendance, and drug compliance over the medium-term poststroke. Methods: The study utilized a case (interventional group)–control (noninterventional group) quasi-experimental design. Sixty consenting acute stroke patients surviving till discharge were consecutively recruited into the study and conveniently assigned to either group in a 1:1 ratio. Recruitment was conducted over the initial 3 months of the study. The intervention group received standardized intensive in-person counseling for cases and designated caregivers at discharge. This means that, apart from standardized intensive in-person counseling for cases and designated caregivers at discharge. There was additional telephone calls and weekly short messages to the intervention group in-order to reinforce information and communication during follow-up. The nonintervention group received discharge instructions provided by the managing physician only. Outcome assessment was conducted at 9 months post stroke. Results: The study recruited 39 (65%) males and 21 (35%) females. The mean age of participants in intervention group was 55.0 ± 14.5 years, while it was 56.0 ± 11.2 years in the nonintervention group. Other demographic parameters were similar between both the groups. At the end of the follow-up period of 9 months, compliance with lifestyle and diet modification, clinic and physical therapy attendance, and drug compliance was statistically significantly higher in the intervention compared to the nonintervention group (P < 0.05 for all comparisons). Conclusion: This study demonstrates the potential utility of a nurse-led intervention incorporating targeted lifestyle risk modification on compliance to strategies aimed at reducing stroke recurrence. Adoption of this task shifting/sharing strategy is recommended.