Population-level recurrent stroke rates remain high, and recurrent strokes are associated with substantial morbidity and mortality. In this issue of Stroke Dr. Barker-Collo and colleagues test the effectiveness of motivational interviewing (MI) in ultimately reducing the risk of recurrent stroke in patients with stroke in New Zealand.

The trial was designed as a single-blind, prospective trial of 386 patients with stroke assigned to MI versus usual care. The MI treatment consisted of 4 sessions at 1, 3, 6 and 9 months after stroke. These outcomes were assessed at the same interval: change in systolic blood pressure, change in LDL, self-reported adherence, recurrent stroke/MI risk, quality of life and mood.

193 patients were in each group. The age of patients is not reported. Otherwise, the patients were similar at baseline. Notably, ~80% had completed high school.

The rate of blood pressure and cholesterol medication prescription was >97% at all time points. Unfortunately, anti-thrombotic prescription rates are not reported. The self-reported adherence rates were very high and marginally better in the MI group at only the 9 month time-point. Otherwise, there were no differences in rate of death, stroke, TIA, MI. Blood pressure and cholesterol changes were not significantly different, either.

The bottom line
Cerebrovascular outcome rates are low in contemporary stroke trials that ensure optimal vascular risk factor management in both arms. Efforts, such as this trial, to help real-world populations realize the benefits of secondary prevention research are important. Motivational interviewing may be a fruitful way to improve secondary prevention adherence.

However, it is difficult to generalize this study to other countries (such as the United States), where secondary prevention prescription rates are far lower than the 97% reported in this study. In most parts of the world, first educating physicians to prescribe adequate secondary prevention drugs may be an easier and more effective approach.