New Delhi: mobile health intervention can lead to better lifestyle behaviors that can prevent secondary strokeaccording to a study conducted in India whose findings were published in the journal Lancet Global Health.
Mobile health (mHealth) refers to the use of mobile and wireless devices to improve health and deliver care. The study was conducted at 31 stroke centers in India and the trial intervention was a package consisting of SMS text messages, education for health videos and stroke prevention Notebooks for patients.
The trial was conducted by SPRINT-India (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package) under ICMR Indian Stroke Clinical Trials Network (INSTRuCT) of Stroke Ready Centers in India, one of its kind in developing countries and the fourth government-supported network worldwide.
Dr. Meenakshi Sharma Scientist-G, Non-communicable diseases Division, ICMR stated that the SPRINT study is the first trial in India (and perhaps globally) to attempt to assess the role of an mHealth intervention in the secondary prevention of stroke on such a large scale.
It was a multicenter, randomized, controlled trial of a semi-interactive mHealth intervention among stroke patients, the ICMR said in a statement.
The messages given on mobile phones focused on controlling blood sugar, blood pressure and cholesterol, improving physical activity, eating a healthy diet and not stopping taking medication to prevent stroke.
The awareness material was produced systematically in 12 different regional languages.
Patients in the control group received standard care, while those in the intervention group received awareness materials at weekly intervals to promote healthy living and medication adherence, according to the statement.
A total of 4,298 patients were randomly assigned to the intervention arm (2,148) and the control arm (2,150). In addition, 1,502 patients in the intervention arm and 1,536 patients in the control arm completed a one-year follow-up. The trial used complex behavioral interventions to reduce stroke recurrence, the statement said.
The trial results revealed that a structured, semi-interactive stroke prevention package improved behavioral factors of lifestyle and medication adherence, which could have long-term benefits.
The trial went a step further than contemporary trials by evaluating the effect on endpoints such as recurrence of cardiovascular events and deaths.
However, the follow-up period was short to show differences between control and intervention groups. The results of the trial were published in the Lancet Global Health on February 14, 2023.
Dr. Jeyaraj D Pandian, professor of neurology and director of Christian Medical College, Ludhiana, who is the principal investigator of the trial’s clinical coordinating center, said the proportion of patients who quit smoking (83) and drinking alcohol (85 pcs.) improved in the intervention group compared to the control group (78 pc and 75 pc respectively).
Medication adherence was also better in the intervention arm (94 units) compared to the control arm (89 units). Events such as stroke, myocardial infarction, and death did not differ between the two groups (5.5% vs. 4.9%) at one year of follow-up.
This may be because the follow-up period was too short, or because the study centers were stroke-ready centers, already providing good quality care for stroke patients.
Findings from the SPRINT India trial have long-term benefit for stroke patients through mobile health interventions.
Dr. Meenakshi Sharma said the trial offers hope for improving lifestyle and medical complications by leveraging technology in a resource-constrained setting.
In phase 2, which started in September 2022, the ICMR has started four more trials on stroke, which are highly relevant to the country. We would get answers to important treatments for stroke in the years to come.
Stroke (brain attack) is one of the leading causes of death and disability in India. There are two types of stroke; ischemic when there is a blockage in one of the cerebral arteries and cerebral hemorrhage when there is a rupture and leak of one of the arteries that supply blood to the brain, according to the statement.
High blood pressure is the number one cause of ischemic and hemorrhagic strokes. High blood sugar, high cholesterol, smoking, obesity, alcohol consumption, lack of exercise, and an unhealthy diet are other reasons why a stroke occurs.
Also, after a stroke, about 15 to 20 percent of patients in India develop another stroke (recurrence).
The main reasons for recurrence are the suspension of medications, lack of control of BP, glycemia, continuing to smoke, alcohol intake, following unhealthy eating habits, etc.
