Dorien Brouwer

113 Motivational interviewing to support lifestyle behavior change PART 2 were non Dutch-speaking or had severe aphasia. The trial was approved by national and local institutional review boards (trial number 3988107812) and written informed consent was obtained from all patients. Patients were included during admission or visit to the outpatient clinic. Intervention Patients were randomly allocated to motivational interviewing or standard counselling. For this purpose, an independent trial assistant had concealed computer-generated allocation sequences in consecutively numbered, opaque, sealed envelopes. When a patient was included and given a (consecutive) trial number, the corresponding numbered envelope was opened, by which the patient was assigned to intervention or control group. All patients received routine general lifestyle advice during admission or visit to the outpatient clinic including regular physical exercise (more than 30 minutes of moderate or intense activity every day), healthy diet, and advice to stop smoking as part of standard care at baseline by a neurologist. Patients in the intervention group received counselling by an experienced nurse practitioner at approximately four weeks, eight weeks and three months after inclusion. During these sessions of fifteen minutes, lifestyle behavior, motivation and opportunities for change were discussed. Patients were asked what behavior they would change if they changed their lifestyle and how they would approach this change. Previous attempts were discussed in which successes were highlighted. Open questions and complex reflections were used to enlarge ambivalence between intentions and action. When patients were in action phase questions were asked about method and planning of the change and when patients actually changed their behavior maintenance was discussed. Advice was only given with patients consent and emphasis was placed on the positive effects of change without reducing patients autonomy. The nurse practitioner delivering the intervention had completed two days basic and six days expert training in motivational interviewing. During the study the nurse practitioner was coached by a motivational interviewing certified trainer, mean Motivational Treatment Integrity score was 4.6 (out of five, the higher the score, the better the motivational interviewing skills). [39] Patients in the control group received consultation by another experienced, but not motivational interviewing trained nurse practitioner, who was part of the routine care, after approximately four weeks and three months after admission. During these sessions of fifteen minutes, lifestyle behavior and general lifestyle advice were discussed. All consultations were given at the same outpatient clinic, in the same room. Data were collected by a separate investigator in a different room than the consultation room, but the same room for patients in intervention or control group.