Interventions for behaviour change and self-management in stroke secondary prevention: protocol for an overview of reviews

Abstract

Background: Stroke secondary prevention guidelines recommend medication prescription and adherence, activeeducation and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positivebehaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour changeand self-management interventions. A growing number of systematic reviews have addressed complex interventionsin stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makesthe mechanism/s that affect positive change difficult to identify or replicate clinically. Adopting a two-phase approach,this overview will firstly comprehensively summarise systematic reviews in this area and secondly identify andsynthesise primary studies in these reviews which provide person-centred, theoretically informed interventions forstroke secondary prevention.Methods: An overview of reviews will be conducted using a systematic search strategy across the CochraneDatabase of Systematic Reviews, PubMed and Epistomonikas. Inclusion criteria: systematic reviews where thepopulation comprises individuals post-stroke or TIA and where data relating to person-centred risk reductionare synthesised for evidence of efficacy when compared to standard care or no intervention. Primary outcomes of interestinclude mortality, recurrent stroke and other cardiovascular events. In phase 1, two reviewers will independently (1) assessthe eligibility of identified reviews for inclusion; (2) rate the quality of included reviews using the ROBIS tool; (3) identifyunique primary studies and overlap between reviews; (4) summarise the published evidence supporting person-centredbehavioural change and self-management interventions in stroke secondary prevention and (5) identify evidence gaps inthis field. In phase 2, two independent reviewers will (1) examine person-centred, primary studies in each review usingthe Template for Intervention Description and Replication (TIDieR checklist), itemising, where present, theoreticalframeworks underpinning interventions; (2) group studies employing theoretically informed interventions by theintervention delivered and by the outcomes reported (3) apply GRADE quality of evidence for each interventionby outcome/s identified from theoretically informed primary studies. Disagreement between reviewers at eachprocess stage will be discussed and a third reviewer consulted.Discussion: This overview will comprehensively bring together the best available evidence supporting person-centred,stroke secondary prevention strategies in an accessible format, identifying current knowledge gaps