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Issue Date: July 01, 2015
Published Online: February 09, 2016
Updated: January 01, 2020
Randomized Controlled Trial of the Healthy Eating And Lifestyle After Stroke (HEALS) Intervention
Author Affiliations
  • University of Southern California, Los Angeles
Article Information
Neurologic Conditions / Stroke / Prevention and Intervention
Poster Session   |   July 01, 2015
Randomized Controlled Trial of the Healthy Eating And Lifestyle After Stroke (HEALS) Intervention
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515050. https://doi.org/10.5014/ajot.2015.69S1-PO1057
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911515050. https://doi.org/10.5014/ajot.2015.69S1-PO1057
Abstract

Date Presented 4/16/2015

The purpose of this randomized controlled trial was to test the feasibility of an outpatient poststroke lifestyle intervention in a safety-net health care system to estimate and compare effect sizes for short-term changes in body mass index (BMI), diet, and physical activity.

SIGNIFICANCE: Stroke is the leading cause of disability and is the third leading cause of death in the United States. Individuals often experience a stroke due to risk factors and lifestyle practices. Adherence to healthy lifestyle practices is poor among stroke survivors and among socioeconomically disadvantaged race/ethnic minorities. In this study, we present a healthy lifestyle program tailored to address current health needs, prevent a second stroke, and increase quality of life in a safety-net setting with underrepresented individuals with stroke.
INNOVATION: With the Patient Protection and Affordable Care Act of 2010, occupational therapists (OTs) have expanded their practice into habituation. This program provides a new manualized intervention that can be administered in various primary care/community-based settings. This program can provide an example for OTs to address recovery, health, and prevention for individuals with stroke in varied settings. No other program like this exists for individuals with stroke.
APPROACH: Stroke survivors have high rates of subsequent coronary events, recurrent cerebrovascular events, and mortality. Lifestyle factors reduce the risk of cardiovascular disease and mortality. Healthy lifestyle practices reduce these risks, yet adherence to healthy lifestyle practices is poor among stroke survivors and socioeconomically disadvantaged race/ethnic minorities.
Our objective for this study was to conduct a pilot test of an outpatient poststroke lifestyle intervention in a safety-net health care system to estimate and compare effect sizes for short-term changes in body mass index (BMI), diet, and physical activity. Our hypothesis for this study was that participants inHealthy Eating And Lifestyle After Stroke (HEALS) will have better lifestyle outcomes.
METHOD: We used a randomized controlled trial design for this study. Participants were English- or Spanish-speaking adults (≥40 yr) with ischemic stroke or transient ischemic stroke (TIA) ≥90 days prior to the study; randomization was stratified by language. A rehabilitation hospital outpatient therapy clinic served as the setting. Interventions consisted of weekly 2-hr small group sessions led by an OT for 6 wk focusing on nutrition, physical activity, and self-management. The main outcome measures were BMI, diet, and physical activity. For the analysis, we used t tests, Wilcoxon rank sum tests, chi-square tests, and multiple linear regression models.
RESULTS: The total number of participants enrolled as of June 2014 is 41 (15 English speakers and 26 Spanish speakers). Six group clinics have been completed (three English and three Spanish). Thirty-two participants completed 6-mo follow-up.
CONCLUSION: This study suggests that a 6-wk lifestyle management program led by an OT that consists of a 2-hr small group format and healthy lifestyle content may be feasible for underrepresented individuals with stroke in the safety-net setting.