Skip to main content

Advertisement

SpringerLink
Log in

Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke

  • Original article
  • Published:
Acta Neurologica Belgica Aims and scope Submit manuscript

Abstract

Despite recent advances in acute stroke care, the risk of recurrent stroke remains high. On behalf of the Belgian Stroke Council (BSC), a nurse-led self-management program was developed, using a personal coach and digital platform with the aim of improving cardiovascular risk factor control in patients after ischemic stroke. The program was implemented in four Belgian hospitals. The stroke coach provided one educational session during hospitalization. After discharge, the patient received tips and tricks concerning a healthy lifestyle through the customized platform. The stroke coach set up video appointments through the platform at regular intervals. Primary endpoint of our study was the change in SCORE (Systematic COronary Risk Evaluation: High and Low cardiovascular Risk Charts) risk at baseline and 6 months compared with a historical control group who received standard care. A total of 147 patients were included for a follow-up period of 6 months. The mean SCORE in the intervention group showed a statistically significant reduction of 3.2 (p < 0.001) at 6 months. However, comparison between control and intervention groups was non-significant (p = 0.55). Secondary endpoints are promising with a medication adherence of 96%. Reported quality of life also improved (p < 0.001). No significant improvement in the modified Rankin scale (mRS) was observed (p = 0.720). Five percent of patients suffered a recurrent stroke. Our project consisting of a coached lifestyle intervention and digital platform shows promise in improving stroke recurrence rates, therapeutic adherence and quality of life in a Belgian healthcare setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wilkins E, Wilson L, Wickramasinghe K, Bhatnagar P, Leal J, Luengo-Fernandez R et al (2017) European cardiovascular disease statistics 2017. European Heart Network, Brussels

    Google Scholar 

  2. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky- Rabas PL, Grieve AP (2011) Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke 42:1489–1494

    Article  Google Scholar 

  3. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S et al (2016) Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 15:913–924

    Article  Google Scholar 

  4. Wissel J, Olver J, Sunnerhagen KS (2013) Navigating the poststroke continuum of care. J Stroke Cerebrovasc Dis 22(1):1–8

    Article  Google Scholar 

  5. Jie Chen J, Mullins CD, Novak P, Thomas SB (2016) Personalized strategies to activate and empower patients in health care and reduce health disparities. Health Educ Behav 43(1):25–34

    Article  Google Scholar 

  6. Mora K, Dorrejo XM, Carreon KM, Butt S (2017) Nurse practitioner-led transitional care interventions: an integrative review. J Am Assoc Nurse Pract 29(12):773–790

    PubMed  Google Scholar 

  7. Arts ML, Kwa VI, Dahmen R (2008) High satisfaction with an individualised stroke care programme after hospitalisation of patients with a TIA or minor stroke: a pilot study. Cerebrovasc Dis 25(6):566–571

    Article  Google Scholar 

  8. Vanacker P, Standaert D, Libbrecht N, Vansteenkiste I, Bernard D, Yperzeele L et al (2017) An individualized coaching program for patients with acute ischemic stroke: feasibility study. Clin Neurol Neurosurg 154:89–93

    Article  CAS  Google Scholar 

  9. Bushnell C, Arnan M, Han S (2014) A new model for secondary prevention of stroke: transition coaching for stroke. Front Neurol 5(219):1–6

    Google Scholar 

  10. Sides EG, Zimmer LO, Wilson L, Pan W, Olson DM, Peterson ED et al (2012) Medication coaching program for patients with minor stroke or TIA: a pilot study. BMC Public Health 12:549

    Article  Google Scholar 

  11. Condon C, Lycan S, Duncan P, Bushnell C (2016) Reducing readmissions after stroke with a structured nurse practitioner/registered nurse transitional stroke program. Stroke 47(6):1599–1604

    Article  Google Scholar 

  12. Hofstad H, Gjelsvik BE, Naess H, Eide GE, Skouen JS (2014) Early supported discharge after stroke in Bergen (ESD Stroke Bergen): three and six months results of a randomised controlled trial comparing two early supported discharge schemes with treatment as usual. BMC Neurol 14:239

    Article  Google Scholar 

  13. Leistner S, Benik S, Laumeier I, Ziegler A, Nieweler G, Nolte CH et al (2012) Secondary prevention after minor stroke and TIA-usual care and development of a support program. PLoS One 7(12):e49985

    Article  CAS  Google Scholar 

  14. Wan LH, Zhang XP, Mo MM, Xiong XN, Ou CL, You LM et al (2016) Effectiveness of goal-setting telephone follow-up on health behaviors of patients with ischemic stroke: a randomized controlled trial. J Stroke Cerebrovasc Dis 25(9):2259–2270

    Article  Google Scholar 

  15. Ögren J, Irewall A, Söderström L, Mooe T (2018) Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial. BMC Neurol 18:153

    Article  Google Scholar 

  16. Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P (2018) Interventions for improving modifiable risk factor control in the secondary prevention of stroke. Cochrane Database Syst Rev 5:CD009103. https://doi.org/10.1002/14651858.CD009103.pub3

    Article  PubMed  Google Scholar 

  17. Vanacker P, Couvreur T, Vanhooren G (2011) Can we improve cerebrovascular risk reduction in real-life? A single centre’s experience. Cerebrovasc Dis 31(suppl 2):289

    Google Scholar 

  18. Philp I, Brainin M, Walker MF et al (2013) Development of a poststroke checklist to standardize follow-up care for stroke survivors. J Stroke Cerebrovasc Dis 22:173–180

    Article  Google Scholar 

  19. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M et al (2012) European guidelines on CVD prevention in clinical practice. Eur Heart J 33:1635–1701

    Article  CAS  Google Scholar 

  20. Banks JL, Marotta CA (2007) Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials. A literature review and synthesis. Stroke 38:1091–1096

    Article  Google Scholar 

  21. Brooks R, Rabin R, de Charro F (eds) (2003) The measurement and valuation of health status using EQ-5D: a European perspective. Kluwer Academic Publishers, Dordrecht

    Google Scholar 

  22. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial: TOAST: Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41

    Article  Google Scholar 

  23. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  Google Scholar 

  24. Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C et al (2013) Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 34(38):2940–2948

    Article  CAS  Google Scholar 

  25. Bushnell CD, Olson DM, Zhao X, Pan W, Zimmer LO, Goldstein LB et al (2011) Secondary preventive medication persistence and adherence 1 year after stroke. Neurology 77(12):1182–1190

    Article  CAS  Google Scholar 

  26. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S et al (2018) Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation 137:e67–e492

    Article  Google Scholar 

Download references

Acknowledgements

We thank the stroke coaches, Delphine Mahieu, Delphine Standaert, Julie Derous and Anja Lorrez for their hard work and dedication to the project. We thank Trendhuis and Zebra Academy for the help and technical support with the platform and VOKA, Wit-Gele Kruis West-Vlaanderen, Lokaal Multidisciplinair Netwerk Brugge-Houtland-Oostende and Bluehealth Innovation Center (MIC) for their input and financial aid. This project was supported by a project funding (mHealth) of the Belgian National Institute for Health and Disability Insurance and the Belgian Stroke Council.

Author information

Authors and Affiliations

  1. Department of Neurology, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Olivia Kamoen, L. Yperzeele, P. Cras & P. Vanacker

  2. Department of Neurology, Sint-Lucas Hospital, Brugge, Belgium

    V. Maqueda

  3. Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Antwerp, Belgium

    L. Yperzeele, P. Cras & P. Vanacker

  4. Born Bunge Institute, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    L. Yperzeele & P. Cras

  5. Public Health and Primary Care, KU Leuven Kulak, Kortrijk, Belgium

    H. Pottel

  6. Department of Neurology, Sint-Jan Hospital, Brugge, Belgium

    G. Vanhooren

  7. Department of Neurology, Groeninge Hospital, Kortrijk, Belgium

    P. Vanacker

Authors
  1. Olivia Kamoen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Maqueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Yperzeele
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Pottel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Cras
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Vanhooren
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Vanacker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olivia Kamoen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamoen, O., Maqueda, V., Yperzeele, L. et al. Stroke coach: a pilot study of a personal digital coaching program for patients after ischemic stroke. Acta Neurol Belg 120, 91–97 (2020). https://doi.org/10.1007/s13760-019-01218-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13760-019-01218-z

Keywords

Search

Navigation