Dorien Brouwer

112 Chapter 2.2 PART 2 commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion. [26] It has been developed by Miller in 1983 to support people with alcohol abuse to stop drinking. [27] Empathy, open questions, reflective listening and emphasis on patients autonomy are the basic communication skills of motivational interviewing. [26] Motivational interviewing has been proven effective in adopting healthy lifestyle behavior for patients with chronic diseases as well as in patients with cardiovascular diseases, [14-17] in particular in supporting weight loss behaviors and reducing alcohol and tobacco intake. [28, 29] These effects occur when conversations were short and repeated [29] and may persist at least one year after counselling. [30] Motivational interviewing to support patients in health-related behavior change after TIA or stroke seems an attractive method as this form of support can be effective in short conversations, can be applied everywhere (including outside the hospital) and can be easily trained. Since follow-up rates are often low and many patients are already bothered by many appointments and obligations (like medication adherence) after their stroke these characteristics are very important. A recent study of 49 stroke patients, studied feasibility of motivational interviewing for low mood and showed that it is possible to train staff to deliver motivational interviewing and motivational interviewing sessions are acceptable for both patients as therapists. [31] The effects of motivational interviewing on health-related behavior change after TIA or ischemic stroke are largely unknown. [32-34] A recent randomized controlled trial in 386 patients with minor stroke found no effect on blood pressure or cholesterol levels, but medication adherence was significantly higher. [35] Two small studies have shown promising effects of motivational interviewing on physical activity, dietary behavior, [36] blood pressure and self-efficacy after stroke [37] (a person’s confidence to carry out behavior necessary to reach a desired goal). [24] However, the intensity of the intervention and duration of the conversations has not been well described. Therefore we aimed to assess whether motivational interviewing is an effective and feasible method to support lifestyle changes after a TIA or ischemic stroke. Methods We conducted a randomized clinical trial with blinded outcome assessment. Patients were recruited in the first week after admission to the stroke unit or TIA outpatient clinic. Participants Patients were eligible for inclusion if they were 18 years or older and had a clinical diagnosis of TIA, including amaurosis fugax, or minor ischemic stroke with a modified Rankin Scale score of 3 or less. [38] Patients were excluded if they were discharged to a nursing home,