A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety.
We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews.
Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment.
Data collection and analysis
Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow‐up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence.
We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke‐survivor and 3134 carer participants. Twenty‐two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self‐reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise.
Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke‐related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) ‐0.73, 95% CI ‐1.10 to ‐0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) ‐0.8, 95% CI ‐1.27 to ‐0.34; 8 studies, 1405 participants; moderate‐certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short‐form (WHOQOL‐BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well‐being.
For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety ‐0.40, 95% CI ‐1.51 to 0.70; 3 studies, 921 participants; MD for depression ‐0.30, 95% CI ‐1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well‐being assessed with Bradley’s well‐being questionnaire (MD ‐0.18, 95% CI ‐1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI ‐7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers’ stroke‐related knowledge, and cases of anxiety and depression.
For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI ‐0.37 to 1.71; MD for depression 0.39, 95% CI ‐0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke‐related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke‐related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke‐survivor or carer positive mental well‐being.
Active information provision may improve stroke‐survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke‐survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow‐up for clarification and reinforcement.
The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses . PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome
See more on using PICO in the Cochrane Handbook.
Plain language summary
Providing information to stroke survivors and their carers
What was the review about?
We reviewed the evidence about the effects of providing information to people after stroke. These were people who have had a stroke or mini‐stroke (transient ischaemic attack (TIA)), or their carers, such as friends and family. We mainly looked at the effect on their knowledge of stroke and stroke care, their mood and their quality of life.
A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and mental problems. It can have a major effect on the person’s life and those around them.
Stroke survivors and their carers often say they have not been given enough facts about stroke. They often do not feel ready for life after leaving hospital. Some people say they were overwhelmed. The information was not explained to them or was given at the wrong time. Information may help people to manage their health better and adjust to life after stroke.
We wanted to know whether it was better or worse to be given extra information. We also wanted to know if the way information was provided matters.
We found 33 studies involving 5255 stroke survivors and 3134 carers. In 11 studies, information was provided passively as a leaflet, DVD, medical history or personalised booklet. In 22 studies, information was provided actively, often combining ways such as talks, demonstrations, meetings and phone calls.
For stroke survivors, providing information actively may improve knowledge of stroke and stroke care. It may slightly reduce anxiety and depression, but this may not be noticeable. It may also improve quality of life. The evidence was less clear for providing information passively. However, it may slightly worsen anxiety and depression. Again, this may not be by a noticeable amount. For carers the evidence is very uncertain or absent.
Confidence in the evidence
We generally had low or very low confidence in the evidence. We were moderately confident that the depressive symptoms of stroke survivors were slightly reduced by active information provision. Our confidence was often limited by the following factors.
• The people in the studies knew if they were giving or receiving more information than usual. This may have affected what they did or how they said they felt.
• Too few people had been studied.
• The results were not precise, so they could show either benefit or harm.
• The results of individual studies did not agree with each other enough.
How up‐to‐date is this review?
We searched for studies in May and June 2019 and searched one source again in September 2020. The studies were published between 1987 and 2019.