Dorien Brouwer

102 Chapter 2.1 PART 2 showed that extra care of a stroke nurse specialist could be beneficial in terms of the cardiovascular risk profile. [31, 81] These studies showed a positive effect of nurse practitioners who used stages of change or self-management techniques as part of vascular preventive programme. [31, 81] Stroke nurse specialists could combine vascular care coordination with promoting selfmanagement or another cognitive behavioral approaches to induce healthy lifestyle. They could also pay attention to patients’ relatives, who play an important role in inducing and promoting healthy lifestyle behaviors in patients. [81] HE is a time-consuming, but potentially effective way of preventing vascular events after TIA or stroke. The HE should offer more than telling patients general facts on vascular disease. It should not only focus on improving knowledge but also on attitude and risk factor behavior, should take the stage of motivation or willingness to change lifestyle into account and demand active participation of patients. A stroke nurse specialist could play an important role in HE. The experience of cardiologists, who have shown that HE results in a change of lifestyle, is important also for neurologists. Nevertheless, the effect of HE on the incidence of vascular events or on outcome after stroke remains to be demonstrated. Future trials investigating the effect of HE in stroke and TIA patients should be large, have a longer follow-up period, should use an intensive and repetitive manner of HE and involve patients’ relatives to induce and maintain a healthy lifestyle.