Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol

Neil Heron, Frank Kee, Michael Donnelly, Margaret E Cupples, Neil Heron, Frank Kee, Michael Donnelly, Margaret E Cupples

Abstract

Introduction: Transient ischaemic attacks (TIAs) and strokes are highly prevalent conditions. Stroke killed 5.7 million people worldwide in 2005 and is estimated to cause 6.5 million deaths globally in 2015. Stroke survivors are often left with considerable disability. Many strokes are preceded by a TIA/'minor' stroke in the previous 90 days and therefore the immediate period after a TIA/minor' stroke is a crucial time to intervene to tackle known vascular risk factors. Although rehabilitation following a TIA/minor stroke is widely recommended, there is a paucity of research that offers an evidence base on which the development or optimisation of interventions can be based, particularly for home-based approaches and non-pharmacological interventions in the acute period following the initial TIA/'minor' stroke. This systematic review will investigate the effect of rehabilitation programmes initiated within 90 days of the diagnosis of a TIA or 'minor' stroke aimed at reducing the subsequent risk of stroke.

Methods/design: This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA) guidance. Randomised and quasi-randomised controlled trials of rehabilitation programmes initiated within 90 days of a TIA or 'minor' stroke will be included. Articles will be identified through a comprehensive search of the following databases, guided by a medical librarian: the Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL and PsycINFO. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data on methodological issues. A narrative synthesis will be completed when there is insufficient data to permit a formal meta-analysis.

Discussion: This review will be of value to clinicians and healthcare professionals working in TIA and stroke services as well as to general practitioners/family physicians who care for these patients in the community and to researchers involved in designing and evaluating rehabilitation interventions.

Trial registration number: CRD42015016450.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

References

    1. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182–7. 10.1016/S1474-4422(07)70031-5
    1. Horgan NF, O'Regan M, Cunningham CJ et al. . Recovery after stroke: a 1-year profile. Disabil Rehabil 2009;31:831–9. 10.1080/09638280802355072
    1. Johnston S, Rothwell P, Nguyen-Huynh M et al. . Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–92. 10.1016/S0140-6736(07)60150-0
    1. Clinical Resource Efficiency Support Team (CREST). Guidelines for Investigation and Management of Transient Ischaemic Attack. CREST guidelines 2006.
    1. Selvarajah JR, Smith CJ, Hulme S et al. . Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study. J Neurol Neurosurg Psychiatry 2008;79:38–43. 10.1136/jnnp.2007.129163
    1. Easton JD, Saver JL, Albers GW et al. . Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009;40:2276–93. 10.1161/STROKEAHA.108.192218
    1. Rothwell PM, Giles MF, Chandratheva A et al. . Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370:1432–42. 10.1016/S0140-6736(07)61448-2
    1. National Institute of Health and Clinical Excellence. Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). NICE, 2008.
    1. Siket MS, Edlow JA. Transient ischemic attack: reviewing the evolution of the definition, diagnosis, risk stratification, and management for the emergency physician. Emerg Med Clin North Am 2012;30:745–70. 10.1016/j.emc.2012.05.001
    1. Epstein S, Palmeri S. Mechanisms contributing to precipitation of unstable angina and acute myocardial infarction: implications regarding therapy. Am J Cardiol 1984;54:1245–52. 10.1016/S0002-9149(84)80074-0
    1. Rothwell P, Coull A, Silver L et al. . Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005;366:1773–83. 10.1016/S0140-6736(05)67702-1
    1. Di Pasquale G, Urbinati S, Perugini E et al. . Interactions between cardiovascular and cerebrovascular disease. Curr Treat Options Neurol 2012;14:557–93. ePub 10.1007/s11940-012-0204-7
    1. Adams RJ, Chimowitz MI, Alpert JS et al. , Stroke Council and the Council on Clinical Cardiology of the American Heart Association, American Stroke Association. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation 2003;108:1278–90. 10.1161/
    1. Touze E, Varenne O, Chatellier G et al. . Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005;36:2748–55. 10.1161/01.STR.0000190118.02275.33
    1. Kate M, Sylaja PN, Chandrasekharan K et al. . Early risk and predictors of cerebrovascular and cardiovascular events in transient ischemic attack and minor ischemic stroke. Neurol India 2012;60:165–7. 10.4103/0028-3886.96393
    1. MacKay-Lyons M, Gubitz G, Giacomantonio N et al. . Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial. BMC Neurol 2010;10:122 10.1186/1471-2377-10-122
    1. Blair SN, Kampert JB, Kohl HW III et al. . Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205–10. 10.1001/jama.1996.03540030039029
    1. Sandvik L, Erikssen J, Thaulow E et al. . Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993;328:533–7. 10.1056/NEJM199302253280803
    1. Ekelund LG, Haskell WL, Johnson JL et al. . Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. N Engl J Med 1988;319:1379–84. 10.1056/NEJM198811243192104
    1. Laukkanen JA, Kurl S, Salonen JT. Cardiorespiratory fitness and physical activity as risk predictors of future atherosclerotic cardiovascular diseases. Curr Atheroscler Rep 2002; 4:468–76. 10.1007/s11883-002-0052-0
    1. Simmons BB, Gadegbeku AB, Cirignano B. Transient ischemic attack: part II. Risk factor modification and treatment. Am Fam Physician 2012;86:527–32.
    1. Masuhr F, Busch M. [Primary and secondary prevention of stroke]. Internist (Berl) 2012;53:1496–504. 10.1007/s00108-012-3160-0
    1. MacKay-Lyons M, Thornton M, Ruggles T et al. . Non-pharmacological interventions for preventing secondary vascular events after stroke or transient ischemic attack. Cochrane Database Syst Rev 2013;3:CD008656 10.1002/14651858.CD008656.pub2
    1. Lager K, Mistri A, Khunti K, et al. . Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 2014;5:CD009103 10.1002/14651858.CD009103.pub2
    1. Coull A, Lovett J, Rothwell P. Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 2004;328:326 10.1136/bmj.37991.635266.44
    1. World Health Organisation (WHO). World report on disability. 2011:96.
    1. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. [updated March 2011] The Cochrane Collaboration, 2011.
    1. Nasser M, van Weel C, van Binsbergen JJ et al. . Generalizability of systematic reviews of the effectiveness of health care interventions to primary health care: concepts, methods and future research. Fam Pract 2012;29(Suppl 1):i94–103. 10.1093/fampra/cmr129

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