Evaluating the efficacy and acceptability of the 'Living Well After Stroke' pilot trial

Background and Aims: Stroke survivors face a heightened risk of recurrent strokes. Prompt lifestyle changes post-initial stroke are crucial for prevention yet support for post-discharge secondary prevention is often lacking. The ‘Living Well After Stroke’ (LWAS) program, informed by the Health Action Process Approach, aimed to enhance the performance of key secondary prevention behaviours (e.g., diet, exercise, medication adherence) and equip stroke survivors with skills for sustained self-managed behavioural change. Methods: This prospective single-arm pilot trial involved 54 Australian adults, 3-months to 5-years post-stroke or TIA, who had not been referred to inpatient rehabilitation. Over 8 weeks, a trained facilitator led five theory-based behaviour change sessions via Zoom. The study measured changes in an initial primary goal behaviour and wellbeing at 2, 4, 8, and 16-week intervals with validated instruments, and an additional goal behaviour defined at week 8, evaluated at the 8 and 16-week points. Acceptability of the program was assessed through a mixed-methods exit survey. Results: Participants showed improvement in their primary goal behaviour and wellbeing from baseline to 4-weeks, sustained at 16-weeks, indicating the intervention's effectiveness. The acquisition of self-management skills was evidenced by enhanced performance in a secondary goal behaviour from week 8 to the follow-up. The program was highly acceptable, with the majority reporting it met their health needs and integrated well into their daily lives. Conclusion: The LWAS program, underpinned by a robust theoretical framework and a novel toolkit of behaviour change strategies, demonstrates significant potential in advancing secondary prevention and reshaping care models for stroke survivors, with high acceptability among participants.