INTRODUCTION Optimised secondary prevention strategies that include lifestyle change are recommended after stroke. Whilst multiple systematic reviews address behaviour-change interventions, intervention definitions and associated outcomes differ between reviews. This overview of reviews addresses the pressing need to synthesise high-level evidence for lifestyle-based, behavioural and/or self-management interventions to reduce risk in stroke secondary prevention in a structured, consistent way. METHODS Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied to meta-analyses demonstrating statistically significant effect sizes to establish the certainty of existing evidence. Electronic databases MEDLINE, Embase, Epistemonikos and the Cochrane Library of Systematic Reviews were systematically searched, current to March 2023. RESULTS Fifteen systematic reviews were identified following screening, with moderate overlap of primary studies demonstrated (5.84% degree of corrected covered area). Interventions identified could be broadly categorised as Multimodal; Behavioural change; Self-management; Psychological talk therapies, albeit with overlap between some theoretical domains . Seventy-two meta-analyses addressing twenty-one preventive outcomes of interest were reported. Best-evidence synthesis identifies that for primary outcomes of mortality and future cardiovascular events post-stroke, moderate certainty GRADE evidence supports multimodal interventions to reduce cardiac events, with no available evidence for outcomes of mortality (all-cause or cardiovascular) or recurrent stroke events. For secondary outcomes addressing risk-reducing behaviours, best-evidence synthesis identifies moderate certainty GRADE evidence for multimodal lifestyle-based interventions to increase physical activity participation, and low certainty GRADE evidence for behavioural change interventions to improve healthy eating post-stroke. Similarly low certainty GRADE evidence supports self-management interventions to improve preventive medication adherence. For mood self-management post-stroke, moderate GRADE evidence supports psychological therapies for remission and/or reduction of depression and Low/Very low certainty GRADE evidence for reduction of psychological distress and anxiety. Best-evidence for outcomes addressing proxy physiological measures identified Low GRADE evidence supporting multimodal interventions to improve blood pressure, waist circumference and LDL cholesterol. DISCUSSION/CONCLUSION Effective strategies to redress risk-related health behaviours are required in stroke survivors to complement current pharmacological secondary prevention. Inclusion of multimodal interventions and psychological talk therapies in evidence-based stroke secondary prevention programmes is warranted given the moderate GRADE of evidence that supports their role in risk reduction. Given the overlap in primary studies across reviews, often with overlapping theoretical domains between broad intervention categories, further research is required to identify optimal intervention behavioural change theories and techniques employed in behavioural/self-management interventions.

中文翻译：

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卒中二级预防中行为改变和风险自我管理的干预措施：综述概述。

引言 卒中后推荐包括改变生活方式在内的优化二级预防策略。虽然多项系统评价涉及行为改变干预措施，但干预措施定义和相关结果在评价之间有所不同。这篇评论概述解决了为基于生活方式、行为和/或自我管理干预措施综合高水平证据的迫切需要，以以结构化、一致的方式降低中风二级预防的风险。方法 将建议分级评估、制定和评估 (GRADE) 标准应用于荟萃分析，证明具有统计学意义的影响大小，以确定现有证据的确定性。系统地搜索了电子数据库 MEDLINE、Embase、Epistemonikos 和 Cochrane 系统评价图书馆，目前截止到 2023 年 3 月。结果 筛选后确定了 15 项系统评价，初步研究显示出适度的重叠（校正覆盖区域的程度为 5.84%）。确定的干预措施可大致归类为多模式；行为改变；自我管理; 心理谈话疗法，尽管在某些理论领域之间存在重叠。报告了针对 21 个感兴趣的预防性结果的 72 个荟萃分析。最佳证据综合表明，对于卒中后死亡率和未来心血管事件的主要结局，中等质量的 GRADE 证据支持多模式干预以减少心脏事件，但没有死亡率（全因或心血管）或复发性卒中事件结局的可用证据. 对于解决降低风险行为的次要结果，最佳证据综合确定了基于多模式生活方式的干预措施以增加身体活动参与的中等确定性 GRADE 证据，以及行为改变干预措施改善中风后健康饮食的低确定性 GRADE 证据。同样低质量的 GRADE 证据支持自我管理干预，以提高预防性药物依从性。对于中风后的情绪自我管理，中度 GRADE 证据支持心理治疗缓解和/或减轻抑郁，低/极低确定性 GRADE 证据支持减轻心理困扰和焦虑。解决代理生理措施的结果的最佳证据确定了支持多模式干预以改善血压的低等级证据，腰围和低密度脂蛋白胆固醇。讨论/结论 中风幸存者需要有效的策略来纠正与风险相关的健康行为，以补充目前的药物二级预防。考虑到支持多模式干预和心理谈话疗法在降低风险方面作用的适度证据等级，将多模式干预和心理谈话疗法纳入循证卒中二级预防计划是必要的。鉴于跨评论的主要研究存在重叠，通常在广泛的干预类别之间存在重叠的理论领域，因此需要进一步研究以确定行为/自我管理干预中采用的最佳干预行为改变理论和技术。讨论/结论 中风幸存者需要有效的策略来纠正与风险相关的健康行为，以补充目前的药物二级预防。考虑到支持多模式干预和心理谈话疗法在降低风险方面作用的适度证据等级，将多模式干预和心理谈话疗法纳入循证卒中二级预防计划是必要的。鉴于跨评论的主要研究存在重叠，通常在广泛的干预类别之间存在重叠的理论领域，因此需要进一步研究以确定行为/自我管理干预中采用的最佳干预行为改变理论和技术。讨论/结论 中风幸存者需要有效的策略来纠正与风险相关的健康行为，以补充目前的药物二级预防。考虑到支持多模式干预和心理谈话疗法在降低风险方面作用的适度证据等级，将多模式干预和心理谈话疗法纳入循证卒中二级预防计划是必要的。鉴于跨评论的主要研究存在重叠，通常在广泛的干预类别之间存在重叠的理论领域，因此需要进一步研究以确定行为/自我管理干预中采用的最佳干预行为改变理论和技术。考虑到支持多模式干预和心理谈话疗法在降低风险方面作用的适度证据等级，将多模式干预和心理谈话疗法纳入循证卒中二级预防计划是必要的。鉴于跨评论的主要研究存在重叠，通常在广泛的干预类别之间存在重叠的理论领域，因此需要进一步研究以确定行为/自我管理干预中采用的最佳干预行为改变理论和技术。考虑到支持多模式干预和心理谈话疗法在降低风险方面作用的适度证据等级，将多模式干预和心理谈话疗法纳入循证卒中二级预防计划是必要的。鉴于跨评论的主要研究存在重叠，通常在广泛的干预类别之间存在重叠的理论领域，因此需要进一步研究以确定行为/自我管理干预中采用的最佳干预行为改变理论和技术。