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

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.

Citation

Hanley, J., Fairbrother, P., Krishan, A., McCloughan, L., Padfield, P., Paterson, M., …McKinstry, B. (2015). Mixed methods feasibility study for a trial of blood pressure telemonitoring for people who have had stroke/transient ischaemic attack (TIA). Trials, 16(1), 117. https://doi.org/10.1186/s13063-015-0628-y

• 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