The SPRINT study is the first trial in India that assesses the role of mHealth intervention in secondary stroke prevention on a large scale.
Highlights
A paper published by the Indian Council of Medical Research (ICMR) in the Lancent Group Health Journal revealed that improved lifestyle-linked behaviors that lead to the prevention of strokes can be achieved by mobile health intervention.
The study was done as a part of Secondary Prevention by SPRINT-INDIA, that is, the Structured Semi Interactive Stroke Prevention Package in India. This was a multicenter, randomized controlled trial of a mobile intervention that is semi-interactive among patients.
The study was performed across 31 stroke centers, including 13 government hospitals in India. The trial was done under a network of stroke-ready centers called, ICMR’s Indian Stroke Clinical Trial Network (INSTRuCT).
The study showed that a semi-interactive, structured stroke prevention package helped improve lifestyle, behavioral factors, and, dependency on medication.
As stated by the ICMR, this is the first randomized trial that has used a structural education package that aims to reduce stroke recurrence and mortality in stroke survivors. The package was composed of text messages (SMS), a stroke prevention workbook, and health education videos for the patients.
Mobile Intervention Messages Said
The education package was systemically formed in 12 different regional languages. The messages were primarily focused on controlling blood sugar, cholesterol, and blood pressure, eating a healthy diet, improving physical activity, and not missing taking medications to prevent stroke.
A total of 4,298 patients were allocated randomly. Of these 2,148 were incorporated into the intervention arm, and 2,150 patients were incorporated into the control arm. However, a one-year follow-up was completed by 1,536 patients in the control arm and 1,502 patients in the intervention arm.
How the Trial was Performed?
Standard care was given to the patients in the control arm, whereas patients in the intervention arm received the awareness to promote healthy living and adherence to medicines at weekly intervals.
The further step of the trial focused on reviewing the effects of the trial on the endpoint, like the recurrence of cardiovascular events and deaths. However, to show any difference between the intervention and control groups, the follow-up period was short.
Study Conclusion
According to the Principal and Professor of Neurology at the Christian Medical College, Ludhiana, Dr. Jeyaraj D Pandian, Principal investigator of the trial’s clinical coordinating center, said that the proportion of patients that quit smoking and alcohol consumption was 83% and 85% respectively for the intervention group. This was a better number as compared to the control group’s 78% and 75% respectively for quitting smoking and alcohol consumption.
He further added that events like heart attacks, strokes, and death did not differ between the two groups during the one-year follow-up, which was 5.5% vs 4.9%. He believed this might have been because the follow-up time was short and study centers were actually stroke-ready centers and were already providing sufficient care to the stroke patients.
Importance
Stroke
Brain attack or stroke is the chief cause of death and disability in India. There are two types of strokes. Ischaemic when there is a blockage in a brain artery, and, Brain Hemorrhagewhen one of the arteries which supply blood to the brain is leaking or ruptured.
High blood pressure is the leading cause of hemorrhagic and ischaemic strokes. High cholesterol, high blood sugar levels, obesity, smoking, alcohol consumption, lack of exercise, and an unhealthy diet are other significant reasons for the occurrence of strokes.
About 20%of patients in India experience a secondary stroke. This is due to the reasons mentioned above and, in addition to the discontinuation of the medicine.
Prospects
Scientist G, Dr. Meenakshi Sharma, Non-communicable Diseases Division, ICMR stated that the trial has provided hope of improving lifestyle and medical complications by using technology in a resource-constrained set-up.
She also said that in September 2022, phase 2 of the study was initiated by ICMR with four more stroke trials, which are believed to be very important to the country. This might provide the answers to important treatments for strokes in the years to come.
