Preventing Recurrent Stroke for general.pptx

Prevention of recurrent stroke

1. Preventing Recurrent Stroke

2. Introduction Organisation : Community Stroke Team (Hunter New England Health) Role: Provide an occupational therapy program that educates clients on improving lifestyle-related factors in prevention of recurrent stroke Population : Stroke survivors above 65 years of age Issue: Preventing risk of recurrent stroke by targeting lifestyle-related factors

3. World Stroke Organisation “Secondary stroke prevention care ideally involves healthcare providers with expertise in stroke care, and takes place in any setting and for patients with all types of stroke and all stroke severities, including in community settings”. (World Stroke Organisation ., 2016) National Stroke Foundation Policies and Guidelines NSWHealth Refers to the National Stroke Foundation Guidelines “A multifactorial behavioural intervention strategy that targets several risk factors can be effective” “Interventions should be individualised and delivered using behavioural techniques such as educational or motivational counselling”, (National Stroke Foundation., 2010)

4. “Stroke with clinical evidence of sudden onset of new neurological deficit with no apparent cause other than that of vascular origin” NATURE Definition of Recurrent Stroke (Fu et al., 2015)

5. First stroke Around 55,000 Australians have strokes annually Second stroke 43% risk of recurrent stroke within 10 years of first stroke 50% remains with disability 1/7 require institutional care Scale of recurrent stroke ( Hardie et al., 2004)

6. Poorer quality of life due to worsening of neurological function (Wang et al., 2014) Increased mortality ( Khanesvski et al., 2019) 39-53% risk of new disability (Bailey, 2018) Impact of recurrent stroke

7. Health Belief Model Theory Perceived threat Needs Assessment Perceived benefits vs. Perceived Barriers Needs Assessment Self-Efficacy Program goals and objectives Cues to Action Program intervention (e.g. education and apply taught strategies) (Reitz et al., 2010; Scaffa et al., 2010)

8. Preliminary Needs Assessment: Factors Age : 65 and above ( Flach et al., 2020) Sex : All Constitutional Factors: Depression (Yu et al., 2016) Vascular factors ( Leoo et al., 2008) Obesity Diabetes Individual Lifestyle Factors: Factors similar to first stroke ( Gallanagh et al., 2011, Lawrence et al., 2009) Physical inactivity ( Gallanagh et al., 2011) Alcohol and tobacco use (Lawrence et al., 2009) Poor diet (Bailey, 2016) Social and Community Networks: Social Isolation (Aron et al., 2015)

9. Preliminary Needs Assessment: Factors Living and Working Conditions Interrelated with socioeconomic status and culture, race, and ethnicity Low socioeconomic status = relatively poor living and working outcomes Poor working outcomes due to impact of first stroke General Socio-economic, Cultural and Environmental Factors Ethnic minorities (Cruz-Flores et al. 2011; Evans-Hudnall et al., 2014) Poor socioeconomic status (Liu et al., 2011) Poor access to resources Poor risk awareness

10. Preliminary Needs Assessment: Factors Priority Lifestyle-related Factors: Physical activity - 25-30% risk reduction of stroke ( Gallanagh et al., 2011) Alcohol Smoking Existing Assets and Resources Master Stroke SLAM-TIA Stroke Foundation World Stroke Organisation NSW Health

11. Key Stakeholders Clients First stroke survivors, >65, at risk of recurrent stroke Hunter New England Community Stroke Team Multidisciplinary team NSW Health Government funding Data Gathering Methods: Focus Group Post stroke experience Awareness of secondary stroke Data to inform needs of program Questionnaire Demographics/characteristics of the respondents attitude and thoughts on secondary stroke prevention Level of importance of risk factors to address Further Needs Assessment

12. To reduce the risk of recurrent stroke through increasing risk awareness through education and strategies to improve lifestyle-related factors (physical activity, smoking and alcohol) Goal of Program Aim

13. Objectives: By the end of the 8 -week program, participants will be able to: 1. Understand the importance of physical activity and develop an exercise plan with assistance from the multidisciplinary team involving at least 2.5 hours of exercise per week through guided muscle-strengthening activities and education. 2. 3. Understand the impact of smoking in relation to the risk of recurrent stroke and apply taught strategies to reduce smoking through education. Understand and reduce the impact of alcohol in relation to the risk of recurrent stroke through education and application of strategies.

14. Evaluation Canadian Occupational Performance Measure (COPM) Ottawa Charter Action Items: Create Supportive Environment Strengthen Community Action Develop Personal Skills (Law et al, 1991) (WHO, 1986)

15. Outline of Intervention 8 weeks program ( Almhdawi et al., 2016; Wasmuth et al., 2020) Week 1 : Orientation + modified COPM Week 2 - 7 : 1 physical activity session + 1 smoking and alcohol session weekly Week 8 : Final meeting on improvement and achievements + modified COPM evaluation Throughout Program Continuous opportunities to develop social participation skills through group-based activities (Christensen et al., 2019)

16. Physical Activity Intervention Week 1 Education session explaining the benefits of exercise and physical activity Baseline: Fill in questionnaire on frequency of physical activity Week 2 Demonstrate strategies Aerobic exercises Week 3 Demonstrate strategies basic strength and flexibility exercises Week 4 Demonstrate strategies balance and coordination exercises Week 5 Create an exercise plan Joint session with physiotherapist Week 6 Recap on education and strategies from week 1 to 4 Week 7 Review on the exercise plan Week 8 Follow-up comparing the results from baseline to post intervention

17. Smoking and Alcohol Intervention 12-steps intervention (Brown et al., 2002; Stoffel & Moyers, 2004) Week 1 Orientation : icebreaking activities Education session on tobacco and alcohol dependence and related to condition after stroke Week 2 Group discussion and activities share participant’s life and past situations Week 3 Group discussion and activities identify and create new occupations Week 4 Group discussion and activities how new occupations help with dependence Week 5 Group discussion and activities identify personal flaws Week 6 Group discussion and activities identify distractions Week 7 Group discussion and activities acknowledge and develop social skills to reflect and forgive Week 8 Follow-up Review and evaluate information and strategies from previous sessions

18. References A arnio , K., Haapaniemi , E., Melkas , S., Kaste , M., Tatlisumak , T., & Putaala , J. (2014). Long-term mortality after first-ever and recurrent stroke in young adults. Stroke, 45 (9), 2670-2676. https://doi.org/doi:10.1161/STROKEAHA.114.005648 Almhdawi , K. A., Mathiowetz, V. G., White, M., & delMas , R. C. (2016). Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation: Task-oriented Therapy Post-stroke. Occupational Therapy International, 23(4), 444–456. https://doi.org/10.1002/oti.1447 Aron, A. W., Staff, I., Fortunato, G., & McCullough, L. D. (2015). Pre stroke living situation and depression contribute to initial stroke severity and stroke recovery. Journal of Stroke and Cerebrovascular Disease, 24 (2), 492-499. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.024 Bailey, R. R. (2018). Lifestyle modification for secondary stroke prevention. American Journal of Lifestyle Medicine, 12 (2), 140-147. https://doi.org/10.1177/1559827616633683 Balasooriya-Smeekens , C., Bateman, A., Mant , J., & De Simoni, A. (2016). Barriers and facilitators to staying in work after stroke: insight from an online forum. BMJ Open, 6 (4), e009974. https://doi.org/10.1136/bmjopen-2015-009974 Billinger , S. A., Arena, R., Bernhardt, J., Eng , J. J., Franklin, B. A., Johnson, C. M., MacKay-Lyons, M., Macko , R. F., Mead, G. E., Roth, E. J., Shaughnessy, M., & Tang, A. (2014). Physical activity and exercise recommendations for stroke survivors. Stroke, 45 (8), 2532-2553. https://doi.org/doi:10.1161/STR.0000000000000022 Boden- Albala , B., Litwak , E., Elkind, M. S., Rundek , T., & Sacco, R. L. (2005). Social isolation and outcomes post stroke. Neurology, 64 (11), 1888-1892. https://doi.org/10.1212/01.WNL.0000163510.79351.AF Boden- Albala , B., & Quarles, L. W. (2013). Education strategies for stroke prevention. Stroke, 44 (6 Suppl 1), 48-51. https://doi.org/10.1161/STROKEAHA.111.000396 Brown, T., Seraganian , P., Tremblay, J., & Annis , H. (2002). Process and outcome changes with relapse prevention versus 12-Step aftercare programs for substance abusers. Addiction (Abingdon, England), 97, 677–689. https://doi.org/10.1046/j.1360-0443.2002.00101.x Chen, J., Li, S., Zheng, K., Wang, H., Xie , Y., Xu, P., Dai, Z., Gu, M., Xia, Y., Zhao, M., Liu, X., & Xu, G. (2019). Impact of smoking status on stroke recurrence. Journal of American Heart Association, 8 (8), e011696. https://doi.org/10.1161/JAHA.118.011696 Christensen, E. R., Golden, S. L., & Gesell, S. B. (2019). Perceived Benefits of Peer Support Groups for Stroke Survivors and Caregivers in Rural North Carolina. North Carolina Medical Journal, 80(3), 143–148. https://doi.org/10.18043/ncm.80.3.143 Coull , A. J., & Rothwell, P. M. (2004). Underestimation of the early risk of recurrent stroke. Stroke, 35 (8), 1925-1929. https://doi.org/doi:10.1161/01.STR.0000133129.58126.67

19. References Cruz-Flores, S., Rabinstein , A., Biller, J., Elkind, M. S., Griffith, P., Gorelick, P. B., Howard, G., Leira , E. C., Morgenstern, L. B., Ovbiagele , B., Peterson, E., Rosamond, W., Trimble, B., Valderrama, A. L., American Heart Association Stroke, C., Council on Cardiovascular, N., Council on, E., Prevention, Council on Quality of, C., & Outcomes, R. (2011). Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42 (7), 2091-2116. https://doi.org/10.1161/STR.0b013e3182213e24 Edjoc , R. K., Reid, R. D., & Sharma, M. (2012). The effectiveness of smoking cessation interventions in smokers with cerebrovascular disease: a systematic review. BMJ Open, 2(6). https://doi.org/10.1136/bmjopen-2012-002022 E vans-Hudnall, G. L., Stanley, M. A., Clark, A. N., Bush, A. L., Resnicow , K., Liu, Y., Kass , J. S., & Sander, A. M. (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. https://doi.org/10.1007/s10865-012-9469-2 Flach , C., Muruet , W., Wolfe, C. D. A., Bhalla, A., & Douiri , A. (2020). Risk and Secondary Prevention of Stroke Recurrence. Stroke, 51 (8), 2435-2444. https://doi.org/doi:10.1161/STROKEAHA.120.028992 Fu, G.-R., Yuan, W.-Q., Du, W.-L., Yang, Z.-H., Fu, N., Zheng, H.-G., Li, Z.-X., Huang, Y.-M., Zhang, Y.-M., Dai, G.-Z., Wang, H.-B., Li, J.-M., Yi, J.-D., Yang, Q.-B., Tian, H.-J., He, L.-N., Li, G.-Y., Zhang, J.-L., Yang, L.-M., Gao, Y., & Fu, Z.-W. (2015). Risk factors associated with recurrent strokes in young and elderly patients: A hospital-based study. International Journal of Gerontology, 9 (2), 63-66. https://doi.org/https://doi.org/10.1016/j.ijge.2015.02.004 Gallanagh , S., Quinn, T. J., Alexander, J., & Walters, M. R. (2011). Physical activity in the prevention and treatment of stroke. ISRN Neurology, 2011 , 953818. https://doi.org/10.5402/2011/953818 Gordon, N. F., Gulanick, M., Costa, F., Fletcher, G., Franklin, B. A., Roth, E. J., Shephard, T., American Heart Association Council on Clinical Cardiology, S. o. E. C. R., Prevention, the Council on Cardiovascular, N., the Council on Nutrition, P. A., Metabolism, & the Stroke, C. (2004). Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council. Circulation, 109 (16), 2031-2041. https://doi.org/10.1161/01.CIR.0000126280.65777.A4 Hardie, K., Hankey, G. J., Jamrozik , K., Broadhurst, R. J., & Anderson, C. (2004). Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke, 35 (3), 731-735. https://doi.org/10.1161/01.STR.0000116183.50167.D9 Harkness, J. A., Edwards, B., Hansen, S. E., Miller, D. R., & Villar, A. (2010). Designing Questionnaires for Multipopulation Research. In Survey Methods in Multinational, Multiregional, and Multicultural Contexts (pp. 31-57). https://doi.org/https://doi.org/10.1002/9780470609927.ch3 Haslam, C., Holme , A., Haslam, S. A., Iyer , A., Jetten , J., & Williams, W. H. (2008). Maintaining group memberships: social identity continuity predicts well-being after stroke. Neuropsychological Rehabilitation, 18 (5-6), 671-691. https://doi.org/10.1080/09602010701643449

20. References Hillen , T., Coshall , C., Tilling, K., Rudd, A. G., McGovern, R., & Wolfe, C. D. A. (2003). Cause of Stroke Recurrence Is Multifactorial. Stroke, 34 (6), 1457-1463. https://doi.org/doi:10.1161/01.STR.0000072985.24967.7F Hollis, V., Openshaw, S., & Goble, R. (2002). Conducting Focus Groups: Purpose and Practicalities. British Journal of Occupational Therapy, 65 (1), 2-8. https://doi.org/10.1177/030802260206500102 Huang, K., Khan, N., Kwan, A., Fang, J., Yun, L., & Kapral , M. K. (2013). Socioeconomic status and care after stroke: results from the Registry of the Canadian Stroke Network. Stroke, 44 (2), 477-482. https://doi.org/10.1161/STROKEAHA.112.672121 Hunter New England Local Health District. (2020). Community Stroke Team Programs . NSW Health. http://www.hnehealth.nsw.gov.au/Community-stroke-team/Pages/Community-Stroke-Team-Programs.aspx Kapral , M. K., Wang, H., Mamdani, M., & Tu, J. V. (2002). Effect of socioeconomic status on treatment and mortality after stroke. Journal of the American Heart Association, 33 (1), 268-273. https://doi.org/10.1161/hs0102.101169 Khanevski , A. N., Bjerkreim , A. T., Novotny, V., Naess , H., Thomassen , L., Logallo , N., Kvistad , C. E., & group, N.-S. s. (2019). Recurrent ischemic stroke: Incidence, predictors, and impact on mortality. Acta Neurologica Scandinavia, 140 (1), 3-8. https://doi.org/10.1111/ane.13093 Law, M., Baptiste, S., Carswell- Opzoomer , A., McColl, M.A., Polatajko, H., & Pollock, N. (1991). Canadian Occupational Performance Measure. Toronto: CAOT Publications ACE. Lawrence, M., Kerr, S., McVey, C., & Godwin, J. (2012). The effectiveness of secondary prevention lifestyle interventions designed to change lifestyle behavior following stroke: Summary of a systematic review. International Journal of Stroke, 7 (3), 243-247. https://doi.org/10.1111/j.1747-4949.2012.00771.x Lawrence, M., Kerr, S., Watson, H. E., Jackson, J., & Brownlee, M. G. (2009). A summary of the guidance relating to four lifestyle risk factors for recurrent stroke. British Journal of Neuroscience Nursing, 5 (10), 471-476. https://doi.org/10.12968/bjnn.2009.5.10.44671 Lee, A. H., Somerford , P. J., & Yau, K. K. (2004). Risk factors for ischaemic stroke recurrence after hospitalisation . Medical Journal of Australia, 181 (5), 244-246. https://doi.org/10.5694/j.1326-5377.2004.tb06261.x Leoo , T., Lindgren, A., Petersson , J., & von Arbin , M. (2008). Risk factors and treatment at recurrent stroke onset: results from the Recurrent Stroke Quality and Epidemiology (RESQUE) Study. Cerebrovasc Disease, 25 (3), 254-260. https://doi.org/10.1159/000113864 Liu, Q., Wang, M., Guo, J., Li, J., Li, C., & Qian, M. (2011). Effect of socioeconomic status on secondary prevention of stroke. International Journal of Quality Health Care, 23 (4), 405-412. https://doi.org/10.1093/intqhc/mzr021

21. References O.Nyumba , T., Wilson, K., Derrick, C. J., & Mukherjee, N. (2018). The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution, 9 (1), 20-32. https://doi.org/https://doi.org/10.1111/2041-210X.12860 Oza , R., Rundell , K., & Garcellano , M. (2017). Recurrent ischemic stroke: Strategies for prevention. Am Family Physician, 96 (7), 436-440. Papadakis, S., Aitken, D., Gocan , S., Riley, D., Laplante , M. A., Bhatnagar-Bost, A., Cousineau, D., Simpson, D., Edjoc , R., Pipe, A. L., Sharma, M., & Reid, R. D. (2011). A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients. BMJ Open, 1 (2), 366. https://doi.org/10.1136/bmjopen-2011-000366 Ramafikeng , M., Galvaan , R., & Amesun , S. (2019). Tobacco use and concurrent engagement in other risk behaviours : A public health challenge for occupational therapists. South African Journal of Occupational Therapy, 49 , 26-35. https://doi.org/10.17159/2310-3833/2019/vol49n1a5 Reitz, S.M., Scaffa , M.E., Campbell, R.M., & Rhynders , P.A. (2010). Health behaviour frameworks for health promotion practice. In M.E. Scaffa , S.M. Reitz, M.A.Pizzi (Eds.), Occupational Therapy in the Promotion of Health and Wellness . (pp. 173-190). F.A.Davis Co. Reshetnyak , E., Ntamatungiro , M., Pinheiro, L. C., Howard, V. J., Carson, A. P., Martin, K. D., & Safford, M. M. (2020). Impact of Multiple Social Determinants of Health on Incident Stroke. Stroke, 51 (8), 2445-2453. https://doi.org/doi:10.1161/STROKEAHA.120.028530 Ribeiro, J., Mira, E., Lourenço , I., Santos, M., & Braúna , M. (2019). The intervention of Occupational Therapy in drug addiction: a case study in the Comunidade Terapêutica Clínica do Outeiro - Portugal. Intervenção da Terapia Ocupacional na toxicodependência : estudo de caso na Comunidade Terapêutica Clínica do Outeiro – Portugal. Ciencia & saude coletiva , 24 (5), 1585–1596. https://doi-org.ezproxy.newcastle.edu.au/10.1590/1413-81232018245.04452019 Scaffa , M. E., Reitz, S. M., & Pizzi , M. (2010). Evaluation Principles in Health Promotion Practice. In M. E. Scaffa , S. M. Reitz, & M. Pizzi (Eds.), Occupational therapy in the promotion of health and wellness (pp. 566). F.A. Davis Co. Skolarus , L. E., Sharrief , A., Gardener, H., Jenkins, C., & Boden- Albala , B. (2020). Considerations in Addressing Social Determinants of Health to Reduce Racial/Ethnic Disparities in Stroke Outcomes in the United States. Stroke, 51 (11), 3433-3439. https://doi.org/doi:10.1161/STROKEAHA.120.030426 Slark , J., & Sharma, P. (2014). Risk awareness in secondary stroke prevention: a review of the literature. JRSM Cardiovascular Disease, 3 . https://doi.org/10.1177/2048004013514737 Stoffel, V. C., & Moyers, P. A. (2004). An evidence-based and occupational perspective of interventions for persons with substance-use disorders. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 58(5), 570–586. https://doi.org/10.5014/ajot.58.5.570 Stroke Foundation. (2010). Clinical guidelines for stroke rehabilitation [Guidelines]. https://extranet.who.int/ncdccs/Data/AUS_D1_Clinical%20Guidelines%20for%20Stroke%20Management.pdf

22. References X., Wang, C. X., Wang, Y. J., & investigators, C. (2014). Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neuroscience Therapy, 20 (12), 1029-1035. https://doi.org/10.1111/cns.12329 WHO, (n.d.). First International Conference on Health Promotion, Ottawa, 1986 . https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference/actions Wasmuth , S. (2020). Qualitative outcomes of an occupation-based theatre intervention for substance use disorders. Online Journal of Complementary & Alternative Medicine, 4 . https://doi.org/10.33552/OJCAM.2020.04.000599 Wasmuth , S., Pritchard, K., & Kaneshiro, K. (2016). Occupation-based intervention for addictive disorders: A systematic review. Journal of Substance Abuse Treatment, 62 , 1-9. https://doi.org/10.1016/j.jsat.2015.11.011 World Stroke Organisation . (n.d.). Global stroke guidelines and action plan: Roadmap to delivering quality stroke care [Guidelines]. https://www.world-stroke.org/publications-and-resources/resources/roadmap-to-delivering-quality-stroke-care-resource Wu, Q. E., Zhou, A. M., Han, Y. P., Liu, Y. M., Yang, Y., Wang, X. M., & Shi, X. (2019). Poststroke depression and risk of recurrent stroke: A meta-analysis of prospective studies. Medicine (Baltimore), 98 (42), 17235. https://doi.org/10.1097/MD.0000000000017235 Yu, S., Arima, H., Bertmar , C., Hirakawa , Y., Priglinger , M., Evans, K., & Krause, M. (2016). Depression but not anxiety predicts recurrent cerebrovascular events. Acta Neurologica Scandinavica, 134 (1), 29-34. https://doi.org/10.1111/ane.12503