Program of Rehabilitative Exercise and Education to avert Vascular Events after Non-disabling stroke or Transient ischemic attack (PREVENT trial).

Our proposed trial of a community-based Program of Rehabilitative Exercise and Education to avert Vascular Events after Non-disabling stroke and Transient ischemic attack (PREVENT Trial) is closely aligned with the objective of the Secondary Stroke Prevention Health Services and Care Initiative (SSPHSI). Whether maintenance of vascular risk reduction targets over time is sustainable in this patient population (or superior to conventional care) is not yet known, and is the focal point of our research. The timelessness of focusing on secondary prevention services for non-disabling stroke (NDS) and transient ischemic attack (TIA) is reflected in the theme of World Stroke Day 2008: ?Little stroke, big trouble.? The recent Canadian Stroke Strategy Best Practices Consensus Conference also provides unambiguous support for this focus when management of NDS/TIA was given the highest priority of 28 recommendations considered. The overarching objective of the PREVENT Trial is to determine whether the timely delivery of a comprehensive program of a secondary stroke prevention services and coordinated care can improve long-term risk-reduction and vascular health of patients after NDS/TIA. Four hindered sixty-four medically stable patients with NDS/TIA from three centres in Nova Scotia (urban and rural) will be randomly assigned to USUAL CARE (health assessment, medication revisions, counseling, education, and referral, if required, to a health professional) or a 12-week community-based program of exercise and education, plus conventional risk factor modification (PREVENT). Utilization of established community-based cardiac rehabilitation programs will contribute to the potential sustainability of the program. The trial addresses SSPHSI's objectives of increasing multidisciplinary collaborations and research capacity by creating new and innovative linkages among 16 researchers, health care providers, and decision-makers; our team extends well beyond the traditional stroke research community. Further, conducting this trial in Atlantic Canada makes sense, given that we have the highest rate of modifiable cardiovascular risk factors, cardiovascular morbidity and mortality in the country. If the PREVENT Trial is positive, it would support a policy of changing health service delivery after NDS/TIA throughout Nova Scotia (and across Canada). This anticipated end-point is consistent with a primary goal of the Canadian Stroke Strategy ? to ensure optimal outcomes for patients following stroke and TIA.