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Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA)

Hanley, Janet; Fairbrother, Peter; Krishan, Ashma; McCloughan, Lucy; Padfield, Paul; Paterson, Mary; Pinnock, Hilary; Sheikh, Aziz; Sudlow, Cathie; Todd, Allison; McKinstry, Brian

Authors

Peter Fairbrother

Ashma Krishan

Lucy McCloughan

Paul Padfield

Hilary Pinnock

Aziz Sheikh

Cathie Sudlow

Allison Todd

Brian McKinstry



Abstract

Background
Good blood pressure (BP) control reduces the risk of recurrence of stroke/transient ischaemic
attack (TIA). Although there is strong evidence that BP telemonitoring helps achieve good
control, none of the major trials have considered the effectiveness in stroke/TIA survivors.
We therefore conducted a feasibility study for a trial of BP telemonitoring for stroke/ TIA
survivors with uncontrolled BP in primary care.
Method
Phase 1 was a pilot trial involving 55 patients stratified by stroke/TIA randomised 3:1 to BP
telemonitoring for 6 months or usual care. Phase 2 was a qualitative evaluation and
comprised semi-structured interviews with 16 trial participants who received telemonitoring
and 3 focus groups with 23 members of stroke support groups and 7 carers.
Results
Overall, 125 patients (60 stroke patients, 65 TIA patients) were approached and 55 (44%)
patients were randomised including 27 stroke patients and 28 TIA patients. Fifty-two
participants (95%) attended the 6-month follow-up appointment, but one declined the second
daytime ambulatory blood pressure monitoring (ABPM) measurement resulting in a 93%
completion rate for ABPM − the proposed primary outcome measure for a full trial.
Adherence to telemonitoring was good; of the 40 participants who were telemonitoring, 38
continued to provide readings throughout the 6 months. There was a mean reduction of 10.1
mmHg in systolic ABPM in the telemonitoring group compared with 3.8 mmHg in the
control group, which suggested the potential for a substantial effect from telemonitoring. Our
qualitative analysis found that many stroke patients were concerned about their BP and
telemonitoring increased their engagement, was easy, convenient and reassuring
Conclusions
A full-scale trial is feasible, likely to recruit well and have good rates of compliance and
follow-up.

Journal Article Type Article
Acceptance Date Mar 3, 2015
Online Publication Date Mar 25, 2015
Publication Date 2015-12
Deposit Date Mar 31, 2015
Publicly Available Date Mar 31, 2015
Journal Trials
Print ISSN 1745-6215
Electronic ISSN 1745-6215
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 16
Issue 1
Pages 117
DOI https://doi.org/10.1186/s13063-015-0628-y
Keywords Hypertension; Stroke; Transient Ischaemic Attack; General Practice; Home monitoring; Telemonitoring; Pilot Randomised Controlled Trial; Qualitative Research;
Public URL http://researchrepository.napier.ac.uk/id/eprint/7717
Publisher URL http://dx.doi.org/10.1186/s13063-015-0628-y
Contract Date Mar 31, 2015

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