TEAMS-BP (The Enhancement of Social Networks to Augment Management of Stroke-Blood Pressure)

Brigham and Women's Hospital64 enrolled

Overview

This study aims to compare the efficacy of a social network intervention versus individual hypertension counseling to improve blood pressure control after stroke. The investigators hope to understand whether the involvement of family, friends and other members of individual's social network can help achieve better blood pressure after experiencing a stroke. Participants will be stratified to two groups according to network size (\<5 vs 5 or more) and randomized to receive individual hypertension counseling (control) or the social network intervention. The primary outcome of the study will be the absolute reduction in systolic blood pressure at 3 months follow-up. The secondary outcomes will be attainment of a post-stroke hypertension treatment goal and patient-reported physical function.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Stroke, Acute Ischemic Hypertension

Interventions

Researchers will identify the influential network members based on their network position, driving distance from the patient, speaking frequency, and whether they have high blood pressure. The index patient and social network members will meet with the study nurse on weeks 2, 6, and 12 after initial enrollment. The study nurse will begin the social network counseling session in which she will provide counseling on teamwork and blood pressure control. The teamwork specific topics will include how networks can work together as a team, communication tips for engaging with one another, spreading positive messages, and establishing the roles and responsibilities of each network team member. The blood pressure control specific topics will include the basics of blood pressure, taking and adjusting medications, monitoring blood pressure, reducing salt, and being physically active. Patient and social network members will receive text messages every week in the weeks between sessions.

Individual CounselingOTHER

The index patient will meet individually with the study nurse on weeks 2, 6, and 12 after initial enrollment. The nurse will provide counseling on the basics of blood pressure, taking and adjusting medications, monitoring blood pressure, reducing salt, and being physically active. The patient will receive text messages every week in the weeks between sessions.

Eligibility

Sex: ALLMin age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. First acute ischemic stroke defined clinically with support from imaging if necessary 2. 21 years of age or older 3. Within 14 days after stroke 4. History of hypertension or has been newly prescribed blood pressure medications during index admission Exclusion Criteria: 1. Prior ischemic or hemorrhagic stroke 2. NIHSS \> 21 3. Significant aphasia (Score\>1 on the language section of the NIHSS) 4. Medical conditions for which death is likely within 6 months 5. Does not have capacity to consent for the project or participate in survey interview 6. Diagnosis of dementia 7. Patient has no phone or incapable of using text messages 8. Patient has opted out of participating in research noted within MGB Epic EHR system

Outcomes

Primary Outcomes

Change in Systolic Blood Pressure for Patient-Subjects

Blood pressure was not collected for social network members.

Time frame: baseline and 3 months

Secondary Outcomes

Achievement of Post-stroke Hypertension Treatment Goal for Patient-Subjects

This was evaluated as achieving a blood pressure of \<130/80 mmHg. Blood pressure was not collected for social network members.

Time frame: 3 months

Patient Reported Physical Function for Patient-Subjets

This was evaluated for patient-subjects only (not collected for social network subjects), using the validated Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. For most PROMIS instruments, a score of 50 is the average for the United States general population with a standard deviation of 10 because calibration testing was performed on a large sample of the general population. The T-score is provided with an error term (Standard Error or SE). The Standard Error is a statistical measure of variance and represents the "margin of error" for the T-score. A higher PROMIS T-score represents better physical function. A T-score of 60 indicates one SD better than the average physical function for the United States general population.