Dorien Brouwer

118 Chapter 2.2 PART 2 Results Hundred thirty-six patients were enrolled between January 2014 and February 2016 of whom 68 were assigned to the intervention group. Follow-up was completed in 92 patients (Figure 1). Two patients died, 4 patients had a recurrent severe ischemic stroke, and 21 patients refused follow-up, did not filled in the questionnaire during their appointment or did not respond on telephone calls or appointment invitations. The other 6 patients were excluded because of dementia, discharge to a nursing home or rehabilitation center, or being diagnosed as a stroke mimic. Baseline characteristics were well balanced (Table 1), except for history of TIA which was more common in the patients allocated to motivational interviewing, and smoking that occurred more often in the control group. In the total study population, mean age was 63 years (SD 14), 85 (63%) patients were male and 43 (32%) had a TIA. Patients had a moderately healthy lifestyle; median physical activity time was 71 minutes a day (IQ 26-150), Body Mass Index was 28 kg/m 2 (SD 5.01) and median diet score was 1 (IQR -1-3) at baseline. Sixteen patients (12%) used more alcohol than advised (more than 2 units a day for women and three units a day for men) and 28 patients (21%) were smokers. Twenty-five of 55 patients in the intervention group (45%) and 27 of 61 patients in the control group (44%) had changed their lifestyle at six months. We found no evidence for benefit of motivational interviewing on lifestyle behavior change after six months (Table 2, aOR 0.99; 95% CI 0.-2.26). In the per protocol analysis the effect of motivational interviewing was very much the same (Table 3, aOR 0.97; 95% CI 0.37-2.52 and data in supplemental file). Also there were no positive effects of motivational interviewing on reduction of waist, cholesterol levels and blood pressure (Table 4). Overall self-efficacy and self-efficacy for quitting smoking was improved in the intervention group, but this was not significant (aBeta 0.19; 95% CI – 0.07-0.46). Patients in the intervention group with low baseline self-efficacy scores stopped smoking more often than patients in the control group (Table 5). There were no differences in physical activity and dietary behavior between patients with high or low self-efficacy scores. More patients in the motivational interviewing group (50%) than in the control group (33%) quit smoking (p 0.39) at three months follow-up (data in supplemental file). This trend did not sustain after six months. Table 3: Per protocol analysis for behavior change after six months follow-up Control n (%) Intervention n (%) p aOR Overall behavior change (n=95) 26 (43) 15 (43) 0.96 0.97 (0.37-2.52) Quit smoking (n=24) 4 (22) 2 (33) 0.58 1.70 (0.18-16.30) More physical activity (n=77) 19 (41) 10 (32) 0.41 0.61 (0.22-1.72) Healthy diet (n=78) 6 (13) 4 (13) 0.71 0.72 (0.15-3.43) 1 adjusted for age ,sex, history of TIA, baseline self-efficacy and smoking status at baseline