Abstract WP405: Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing

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Background: Stroke recurrence rates are relatively high (20-25%), and have not declined significantly over past three decades. This study tested the effectiveness of Motivational Interviewing(MI) for reducing stroke recurrence as measured by improving adherence to evidence-based medication and recommended lifestyle changes compared to usual care (UC).

Hypothesis: That MI will improve medication adherence in stroke patients.

Methods: A single-blind, prospective Phase III randomised controlled trial of 386 people with stroke assigned to receive either MI Treatment (4 sessions at 28-days, 3-, 6-, and 9-months post-stroke) or UC; with outcomes assessed at 28-days, 3-, 6-, 9-, and 12-months post-stroke. Primary outcomes were change in systolic blood pressure (BP) and low-density lipoprotein (LDL) cholesterol levels as indicators of adherence at 12-months. Secondary outcomes included self-reported adherence, new stroke or coronary heart disease events (both fatal and non-fatal); quality of life (Short Form-36), and mood (Hospital Anxiety and Depression Scale, HADS).

Results: Motivational Interviewing did not significantly change measures of blood pressure [mean difference in change -.2.35 (95% CI -6.16, 1.47)] or cholesterol (mean difference in change -.0.12(95% CI -0.30, 0.06). However, MI had positive effects on self-reported medication adherence at 6- (1.979, 95% CI 0.98, 3.98, p=0.0557) and 9-months (4.295, 95% CI 1.56, 11.84, p=0.0049) post-stroke. Improvement across other measures were also observed, but the differences between MI and UC groups was not statistically significant.

Conclusion: Motivational Interviewing improved self-reported medication adherence. All other effects were non-significant, though in the direction of a treatment effect. Further study is required to determine if MI leads to improvement in other important areas of functioning, for example, care giver burden.

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