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A Systematic Review of Randomized Controlled Trials of Medication Adherence Interventions in Adult Stroke Survivors

Wessol, Jennifer L.; Russell, Cynthia L.; Cheng, An-Lin

Journal of Neuroscience Nursing: April 2017 - Volume 49 - Issue 2 - p 120–133
doi: 10.1097/JNN.0000000000000266

ABSTRACT Background: Stroke survivors are at an increased risk for recurrent stroke. Despite recommendations to avoid recurrence from the American Heart Association/American Stroke Association, medication adherence (MA) in persons with chronic conditions such as stroke is only 50%. Purpose: The aim of this study was to synthesize randomized controlled trial intervention studies designed to increase MA in adult stroke survivors. Search Methods: The Cumulative Index of Nursing and Allied Health Literature, PsycINFO, PubMed, and Excerpta Medica database from January 1, 2009, to December 31, 2015, were searched. Study Selection: This study reviewed randomized controlled trials evaluating MA interventions in stroke survivors. Data Extraction: Two reviewers independently assessed all full-text articles, and those not meeting the inclusion criteria by both researchers were excluded. Results: This review included 18 studies involving 10 292 participants. Overall, the strength of the included studies was strong. Statistically significant results were reported in 5 of the 18 (28%) studies. Of these, 3 used cognitive/behavioral interventions to increase MA, whereas 2 studies used an educational-based intervention. Conclusions: Despite some isolated success, most MA interventions in stroke survivors do not show statistically significant improvement. Future MA research must address the lack of consistent use of objective measurement tools and focus on the long-term benefits of MA interventions.

Questions or comments about this article may be directed to Jennifer L. Wessol, BSN, at She is a PhD Student and Jonas Nurse Leader Scholar 2016-2018, School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO.

Cynthia L. Russell, PhD RN FAAN, is Professor, School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO.

An-Lin Cheng, PhD, is Associate Professor, Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO.

The authors declare no conflicts of interest.

© 2017 American Association of Neuroscience Nurses