Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE)
NCT ID: NCT02712385
Last Updated: 2023-04-04
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
40 participants
INTERVENTIONAL
2016-03-01
2018-03-01
Brief Summary
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AIMS - to determine if a novel rehabilitation programme, 'The Healthy Brain Rehabilitation Manual', for TIA/minor stroke patients can be developed, using MRC guidelines for developing complex health service interventions, from an approved home-based cardiac rehabilitation programme (the 'Heart Manual') and to undertake feasibility and pilot studies of the novel programme.
METHODS-All patients attending a TIA clinic in Belfast within 4 weeks of their first TIA/mild stroke will be invited to participate. The novel home-based programme manual will be developed following systematic reviews of the literature and qualitative exploration with the target population, using focus groups. A feasibility study will initially be undertaken lasting 6 weeks and then developed into a pilot trial of 12 weeks duration. The feasibility will recruit to 3 different treatments: (1) standard care; (2) standard care plus the manual; (3) standard care, manual plus a pedometer. Whilst for the pilot study there will also be 3 arms but this will include: 1) control group; 2) manual and pedometer supported by telephone follow-up with a GP; 3) manual and pedometer supported by telephone follow-up with a stroke nurse. Interviews and focus groups will be employed to assess the interventions' acceptability. The intervention, 'The Healthy Brain Rehabilitation Manual' will be refined and modified at all stages of the research.
CONCLUSIONS - The findings will inform the development of a novel secondary prevention programme, 'The Healthy Brain Rehabilitation Manual', for TIA/minor stroke patients and of a trial to test its effectiveness and longer-term potential to improve outcomes for TIA/stroke patients.
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Detailed Description
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Exploration of relevant theory - Initially, literature relating to cardiac rehabilitation and secondary prevention of TIAs and minor stroke will be reviewed following searches in appropriate databases with input from a medical librarian. The research team (including the applicant, supervisors, collaborators and steering group) will discuss key findings and identify those deemed appropriate to the study setting, with identification of appropriate behaviour change theory using behaviour change taxonomy.
Recruitment: Participants will be recruited from one TIA/ 'minor' stroke assessment unit, based in the Ulster Hospital for the feasibility study and from 4 sites for the pilot study (Royal Victoria Hospital, Ulster Hospital, Antrim and Craigavon Area Hospitals). Patients are typically seen within one week of suffering neurological symptoms suggestive of TIA. After confirmation of diagnosis and initial management on the day of presentation, the attending physician will offer patients a study information sheet and an invitation to participate. If the patient agrees to being contacted, the researcher will telephone twenty-four hours later to invite them to attend the Clinical Research Facility, QUB to participate in the study and written, informed consent will be obtained. The numbers of those who decline to participate in the study will be recorded to provide information about recruitment rates.
Developing the intervention: From those who agree to participate, an initial purposeful sample of patients will be invited to focus groups. Participants will be given the manual approximately a week before the focus group and asked to read it before attending the focus group. The topic guide for focus groups will be based on findings from the literature review and will include the formatting and lay-out of the manual, manual content and potential improvements to the manual. Health and social care staff involved in the clinical care of TIA and stroke patients, members of voluntary organisations, relatives and carers will also be invited to participate in a focus group: initial plans are that a sample of these individuals would be invited to a single group. Participants' and professionals' experiences of and attitudes towards key interventions identified from the literature will also be used in modelling the pilot intervention. With each participant's consent, interviews and focus groups will be audio-recorded and transcribed. Two researchers will then analyse the transcripts independently by: familiarisation; identifying a thematic framework; indexing; charting; and, mapping and interpretation.
Feasibility and then pilot study of the intervention - Baseline assessment: Following analysis of the findings of the literature review and qualitative data, the home-based vascular rehabilitation manual will be developed, adapting the "Heart Manual" (now referred to as 'The Healthy Brain Rehabilitation Manual') accordingly. We plan to conduct both a feasibility and pilot studies of our intervention. As described above, prospective trial participants will be invited to attend the Clinical Research Facility within 4 weeks of their initial TIA/'minor' stroke event, for initial assessment, at which their written consent to participate will be sought. Baseline assessments (taking approximately 60 minutes) will be completed prior to randomisation to ensure allocation concealment. All patients will initially undertake a sub maximal exercise test under the supervision of a trained physician. For the pilot study, all will be given, with appropriate instructions, an accelerometer to wear for one week to provide a blinded baseline physical activity assessment and these will be returned to the applicant after one week.
Randomisation: Block randomisation will be used and patients will be stratified, based on age, sex and diagnosis (TIA/'minor' stroke). Study group allocation will be revealed to participants only at the end of the baseline assessment and following completion of all initial measurements (except accelerometry).
Interventions: The feasibility will recruit to 3 different treatments: (1) standard care; (2) standard care plus the manual; (3) standard care, manual plus a pedometer. Whilst for the pilot study there will also be 3 arms but this will include: 1) control group; 2) manual and pedometer supported by telephone follow-up with a GP; 3) manual and pedometer supported by telephone follow-up with a stroke nurse. The control group (Group 1) will follow standard care guidelines as per treatment protocols and provided by their healthcare professionals at the hospital clinic. 'The Healthy Brain Rehabilitation Manual' programme will be explained to the appropriate participants by the applicant at the end of the baseline assessment. The use of the pedometer, an approach to its use in goal setting and an accompanying diary will also be explained to the relevant participants at that time.
'The Healthy Brain Rehabilitation Manual' will address each of the modifiable vascular risk factors, managing one risk factor each week, whilst encouraging the patient to slowly increase their activity over the (proposed) six week programme in the setting of their home and addressing the issues of anxiety and depression following the diagnosis of TIA or 'minor' stroke. The manual therefore involves education and motivation of the patient to address these risk factors. The facilitator (the applicant (a General Practitioner) and/or a stroke nurse) will also help them identify local support resources, for example smoking cessation services, through telephone contact. 'The Healthy Brain Rehabilitation Manual' will utilise the behaviour change techniques of goal setting, barrier identification, setting graded tasks, self monitoring, feedback, relapse prevention and stress management. Self-set pedometer targets will emerge during discussion with the facilitator who will use simple motivational interviewing techniques and advise keeping a daily step-count diary. Telephone follow-up review, with the applicant, will take place at one and four weeks as per usual "Heart Manual" care for the feasibility study as well as at eight weeks for the pilot study, unless the findings of initial qualitative work would suggest that an alternative design of a follow-up plan would be appropriate. These reviews will include advice regarding addressing the modifiable vascular risk factors and, if appropriate, issues with the home-based vascular rehabilitation programme ('The Healthy Brain Manual') and pedometer targets.
Review assessment: All participants will have a 6 week (feasibility study) and a 3 month (pilot study) follow-up review appointment. This review should take approximately sixty minutes to complete. For the pilot study, all participants will be asked to wear an accelerometer again, for one week, to provide a post-intervention physical activity assessment and to return this to the researcher following this period.
End-of study qualitative assessment: At the end of the pilot study, all participants will be asked about their perceptions of the relevance, acceptability and value of the intervention, using different qualitative techniques, including questionnaires, focus groups and/or semi structured interviews.
The manual will be developed at all stages of the research process as per the MRC guidelines.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
SINGLE
Study Groups
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Control - usual care
Usual post-TIA/minor stroke care as per current healthcare system protocol will be given to patients in control group and details will be recorded.
No interventions assigned to this group
Manual
Receiving usual post-TIA/minor stroke care plus 'The Healthy Brain Rehabilitation Manual'.
'The Healthy Brain Rehabilitation Manual'
The Healthy Brain Rehabilitation Manual is a home-based rehabilitation manual developed for the post-TIA and minor stroke population caused by ischaemic events. The manual addresses all the secondary prevention factors required post-ischaemic TIA/minor stroke, e.g. smoking cessation, physical activity promotion.
Usual care
Usual care provided by healthcare system for patients who suffer a TIA or minor stroke will be recorded and form 'active comparator' control.
Manual + pedometer, 1
Receiving usual post-TIA/minor stroke care plus 'The Healthy Brain Rehabilitation Manual' and a pedometer with telephone follow-up from a General Practitioner.
'The Healthy Brain Rehabilitation Manual'
The Healthy Brain Rehabilitation Manual is a home-based rehabilitation manual developed for the post-TIA and minor stroke population caused by ischaemic events. The manual addresses all the secondary prevention factors required post-ischaemic TIA/minor stroke, e.g. smoking cessation, physical activity promotion.
Pedometer
Pedometer used to measure step counts as an objective measurement of level of physical activity.
Usual care
Usual care provided by healthcare system for patients who suffer a TIA or minor stroke will be recorded and form 'active comparator' control.
Telephone follow-up
Telephone follow-up by either a General Practitioner (GP) or Stroke nurse.
Manual + pedometer, 2
Receiving usual post-TIA/minor stroke care plus 'The Healthy Brain Rehabilitation Manual' and a pedometer with telephone follow-up from a Stroke nurse.
'The Healthy Brain Rehabilitation Manual'
The Healthy Brain Rehabilitation Manual is a home-based rehabilitation manual developed for the post-TIA and minor stroke population caused by ischaemic events. The manual addresses all the secondary prevention factors required post-ischaemic TIA/minor stroke, e.g. smoking cessation, physical activity promotion.
Pedometer
Pedometer used to measure step counts as an objective measurement of level of physical activity.
Usual care
Usual care provided by healthcare system for patients who suffer a TIA or minor stroke will be recorded and form 'active comparator' control.
Telephone follow-up
Telephone follow-up by either a General Practitioner (GP) or Stroke nurse.
Interventions
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'The Healthy Brain Rehabilitation Manual'
The Healthy Brain Rehabilitation Manual is a home-based rehabilitation manual developed for the post-TIA and minor stroke population caused by ischaemic events. The manual addresses all the secondary prevention factors required post-ischaemic TIA/minor stroke, e.g. smoking cessation, physical activity promotion.
Pedometer
Pedometer used to measure step counts as an objective measurement of level of physical activity.
Usual care
Usual care provided by healthcare system for patients who suffer a TIA or minor stroke will be recorded and form 'active comparator' control.
Telephone follow-up
Telephone follow-up by either a General Practitioner (GP) or Stroke nurse.
Eligibility Criteria
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Inclusion Criteria
* male or female
* attendee at a participating TIA clinic within 4 weeks of a first suspected TIA
* diagnosed with a TIA or 'minor' stroke, due to atherosclerosis or small vessel occlusion (diagnosis based on the TOAST classification system (69)(70), following neurological examination and neuroimaging (32)).
Exclusion Criteria
* inability to give informed consent
* presenting after 4 weeks of their first suspected TIA and/or 'minor' stroke
* contra-indication for exercise training, based on guidelines of the American College of Sports Medicine(72)
18 Years
ALL
No
Sponsors
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National Institute for Health Research, United Kingdom
OTHER_GOV
Queen's University, Belfast
OTHER
Responsible Party
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Prof Frank Kee
Professor of Public Health
Principal Investigators
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Frank Kee, MRCGP, MD
Role: PRINCIPAL_INVESTIGATOR
Queen's University, Belfast
Locations
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Ulster Hospital
Belfast, Antrim, United Kingdom
Royal Group of Hospitals
Belfast, Antrim, United Kingdom
Craigavon Area Hospital
Craigavon, Armagh, United Kingdom
Antrim Area
Antrim, , United Kingdom
Countries
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References
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Heron N, Kee F, Donnelly M, Tully MA, Cupples ME. Systematic review of the use of behaviour change techniques (BCTs) in home-based cardiac rehabilitation programmes for patients with cardiovascular disease--protocol. Syst Rev. 2015 Nov 17;4:164. doi: 10.1186/s13643-015-0149-5.
Heron N, Kee F, Donnelly M, Cupples ME. Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol. BMJ Open. 2015 Jun 18;5(6):e007849. doi: 10.1136/bmjopen-2015-007849.
Heron N, Kee F, Cardwell C, Tully MA, Donnelly M, Cupples ME. Secondary prevention lifestyle interventions initiated within 90 days after TIA or 'minor' stroke: a systematic review and meta-analysis of rehabilitation programmes. Br J Gen Pract. 2017 Jan;67(654):e57-e66. doi: 10.3399/bjgp16X688369. Epub 2016 Dec 5.
Cupples M, Heron N. What to do after cardiac rehabilitation programs: the role of the general practitioner in cardiovascular prevention. Monaldi Arch Chest Dis. 2016 Oct 14;86(1-2):755. doi: 10.4081/monaldi.2016.755.
Heron N, Kee F, Donnelly M, Cardwell C, Tully MA, Cupples ME. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review. Br J Gen Pract. 2016 Oct;66(651):e747-57. doi: 10.3399/bjgp16X686617. Epub 2016 Aug 1.
Heron N, Kee F, Mant J, Reilly PM, Cupples M, Tully M, Donnelly M. Stroke Prevention Rehabilitation Intervention Trial of Exercise (SPRITE) - a randomised feasibility study. BMC Cardiovasc Disord. 2017 Dec 12;17(1):290. doi: 10.1186/s12872-017-0717-9.
Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev. 2021 Nov 23;11(11):CD001919. doi: 10.1002/14651858.CD001919.pub4.
Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev. 2021 Jun 29;6(6):CD012996. doi: 10.1002/14651858.CD012996.pub2.
Heron N. Optimising secondary prevention in the acute period following a TIA of ischaemic origin. BMJ Open Sport Exerc Med. 2017 Jan 6;2(1):e000161. doi: 10.1136/bmjsem-2016-000161. eCollection 2016.
Provided Documents
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Document Type: Statistical Analysis Plan
Other Identifiers
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CDV/5053/14
Identifier Type: -
Identifier Source: org_study_id
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