Background and AimsDespite considerable evidence that secondary-prevention group interventions can improve mortality, morbidity and reduce further myocardial infarction no such groups have been evaluated for stroke patients. This poster will summarise the findings of a project that evaluated the impact and success of the Living Well After Stroke (LWAS) Group in Wandsworth (South West London). The Group was designed as an innovative approach to stroke specific secondary prevention. Using a self-management approach it aims to improve participantu2019s health, wellbeing and confidence in managing their stroke risk factors.MethodThe Group was evaluated in the following ways:1) Pre and post group outcome data2) Post group patient feedback3) Discovery interviews4) Cost and attendance analysis of the groupResultsPatients reported improvement in all outcomes with the exception of fatigue. Outcomes showing the greatest improvement were patientsu2019 understanding of their responsibility for taking care of their own health and their ability to prevent problems with their own health.Significant improvements were also reported in patientu2019s understanding and confidence in their knowledge of health problems and their causes and the importance of maintaining a healthy lifestyle.ConclusionThis project confirmed that the LWAS Group is comparable to other secondary prevention programmes positively addressing similar issues in terms of outcome and attendance rates and is lower in cost than that of a comparable cardiac rehab programme. The group was well evaluated by patients and the outcome data demonstrated improvements in key areas immediately following the group and an increase in confidence in ability to maintain lifestyle changes beyond the group.

Stroke is the second leading cause of death and a leading cause of disability worldwide. This invaluable reference provides clinicians caring for stroke patients with ready access to the optimal evidence for best practice in stroke prevention, acute stroke treatment, and stroke recovery. Now an edited volume, the editors and authors, many of whom are members of the Cochrane Stroke Review Group, describe all available medical, endovascular, and surgical treatments; the rationale for using them; and the strength of the evidence for their safety and effectiveness. New chapters cover key, rapidly advancing therapeutic topics, including prehospital stroke care and regionalized stroke systems, endovascular reperfusion therapy, and electrical and magnetic brain stimulation to enhance recovery. This is an essential resource for clinicians translating into practice the many dramatic advances that have been made in the treatment and prevention of stroke, and suggesting the most appropriate interventions.

In recent years improvements in stroke care with intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) have led to improved clinical outcome by early opening of the occluded vessel to restore blood flow to the salvageable ischemic brain tissue that is not already infarcted. This has also contributed to a substantial decrease in recurrent stroke and vascular event rates over the past five decades. Despite these strides, secondary prevention remains crucial in reducing modifiable risk factors to prevent recurrent cardiovascular events, given the increased risk following a stroke. Recurrent stroke poses long-term risks of physical disability and dementia. However, even with improved functional independence for stroke patients leaving hospitals, those with transient ischemic attacks (TIAs) or minor strokes often face disabilities like fatigue, cognitive impairment, depression, and anxiety. Moreover, many have low levels of cardiorespiratory fitness and lead sedentary lifestyles, further compromising their quality of life and increasing the risk of recurrent cardiovascular events. This thesis aims to enhance stroke care by investigating the efficacy of lifestyle interventions for secondary prevention of cardiovascular events and exploring the interaction of physical activity and exercise in mitigating post-TIA or minor stroke challenges. Tertiary prevention efforts, which extend beyond secondary prevention to address rehabilitation and improve quality of life, are also examined. A systematic review and meta-analysis in Chapter 2 assess the effectiveness of lifestyle interventions in preventing recurrent cardiovascular events after TIA or stroke. While certain interventions, particularly those focusing on cardiovascular fitness and lasting over four months, show promise in reducing systolic blood pressure, comprehensive criteria for future research are recommended to ensure replicability and comparability. Chapter 3 presents findings from a trial investigating the safety and feasibility of a post-stroke care program with a year-long exercise intervention, demonstrating its potential in optimizing secondary prevention. Chapter 4 outlines the rationale and design of the MoveIT trial, a randomized controlled study assessing the impact of an exercise intervention on preventing cognitive decline after TIA or minor stroke. In Chapter 5, cardiorespiratory fitness in TIA and minor stroke patients is explored, revealing associations with cardiovascular and pulmonary disease and modifiable risk factors but not stroke-related factors. The MoveIT trial's results, discussed in Chapter 6, suggest a modest improvement in executive functioning with exercise intervention but no significant effects on global cognitive functioning or secondary outcomes. Further analysis in Chapter 7 indicates that exercise intervention might improve executive functioning over time, emphasizing its potential benefit in post-stroke cognitive rehabilitation. Chapter 8 delves into the association between post-stroke fatigue and cardiorespiratory fitness, highlighting the confounding role of depression and anxiety. Finally, Chapter 9 discusses the overarching findings, emphasizing the need for comprehensive assessment and intervention strategies targeting post-stroke challenges to enhance secondary and tertiary prevention efforts. Overall, this thesis underscores the importance of lifestyle interventions and exercise in mitigating post-stroke complications, while emphasizing the need for tailored rehabilitation strategies and further research to optimize stroke care.

IntroductionIn this patient-oriented study, we engage with patient partners and relevant stakeholders to understand how Carotid Artery Stenting (CAS) can benefit overall patient health and wellness. CAS is surgery that widens narrowed carotid arteries(stenosis) supplying blood to the brain.MethodsPatient partners will be recruited and fully engaged in study design, improving patient research experience, results interpretation, manuscript preparation and dissemination. Also, patients (n~10) with flow-limiting stenosis scheduled for CAS will be recruited to have 3 MRI scans - 1 before the CAS and 2 follow-up scans after CAS. Each MRI scan will be accompanied by cognitive testing. At each time-point, we will compare changes in patient-prioritized outcome measures including cognition, brain function, cerebral circulation, stroke prevention and risks reduction to improve overall health and wellness of patients. Results/FindingsWe have successfully recruited 2 patient partners with relevant and distinct experiences since early 2019 and have engaged them in the study leading to better quality of research design by incorporating patient perspective. Team members also undertook patient-oriented research trainings that will facilitate the project. We have designed and optimized the study procedures to increase patient understanding and comfort. Preliminary MRI results will be ready by the conference date as participant recruitment has just begun.Discussion/ImplicationsThis study will explore the benefits of CAS for patient wellness. We anticipate that the involvement of patient partners and relevant stakeholders will lead to relevant results that could potentially improve healthcare for patients with stroke risks.Dissemination plan/KT ApproachDissemination efforts will focus on medical practitioners (ward rounds, research week, pamphlets,), patients/public (information pamphlets, patient-driven talks) and academia (journal publications & conferences). Given that CAS is already standard clinical practice, knowledge translation efforts will focus on educating clinicians and patients alike of the advantages of CAS. Each team member will drive dissemination efforts towards their member focus groups.How does this presentation demonstrate and inform patient-oriented research?This project addresses a very patient-relevant research question that has the potential of improving the healthcare of patients with stroke risks (carotid artery stenosis) by preventing stroke occurrence, reducing stroke risk and improving cognitive function and overall patient well-being. During the first team meeting, both of our patient partners had emphasized that the project is relevant to their experience as stroke prevention is always advantageous compared to stroke occurrence, treatment and recovery. Also, our multi-disciplinary research team involves patient partners, clinicians, medical directors, neuroimaging scientists and graduate-level and medical trainees. This will aim to ensure that the research outcomes continuously take patient perspective and concerns into consideration and that the dissemination efforts will involve the focus population that will most greatly benefit from the research results leading to improved healthcare.AcknowledgementThis study is supported by funding from the Royal Columbian Hospital Foundation and the presenter (BC) is supported by a Graduate Student Fellowship in Patient-Oriented Research from the BC SUPPORT Unit, Fraser Center. We also thank the BC Patient Voices Network for help with patient partner recruitment and the BC SUPPORT Unit Fraser Centre for providing graduate patient engagement training.

Background The Toronto Stroke Networks worked closely with stroke survivors and their families to co-design a novel patient and family experience questionnaire (PFEQ) to reflect experience across the stroke system of care. The PFEQ provides a deeper understanding of emotional experiences compared to generic satisfaction surveys. In order to capture overall stroke-specific experiences across the continuum of care, this project aimed to implement and evaluate the administration of the PFEQ in a regional stroke prevention clinic (SPC).MethodImplementation was co-designed with six SPC staff. Feedback loops supported an iterative the process for administering the PFEQ to stroke patient/family members. Using thematic analysis, qualitative themes related to lessons learned and patient experiences will be abstracted from staff interviews and completed questionnaires.ResultsSPC staff co-developed the following principles for implementation: 1) administration of the PFEQ by administrative staff when possible; 2) discussion of the PFEQ with stroke patients/family members during their appointment with the SPC nurse; and 3) ensuring that the administration process is iterative and aligns with SPC processes. Within the first two weeks, 20 PFEQs have been completed with no negative feedback from patients, family members or staff. Results of thematic analysis are pending. Conclusions A collaborative and iterative implementation approach allowed for timely uptake and use of a PFEQ in a regional SPC. Further analyses from interviews will identify additional recommendations to support sustainability and spread of the PFEQ to other stroke clinics. Results from the PFEQ will be used to inform stroke system planning.