***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives To test the feasibility of conducting a controlled trial into the effectiveness of a self-management programme integrated into stroke rehabilitation . Design A feasibility cluster-r and omised design was utilised with stroke rehabilitation teams as units of r and omisation . Setting Community-based stroke rehabilitation teams in London . Participants 78 patients with a diagnosis of stroke requiring community based rehabilitation . Intervention The intervention consisted of an individualised approach to self-management based on self-efficacy . Clinicians were trained to integrate defined self-management principles into scheduled rehabilitation sessions , supported by a patient-held workbook . Main outcomes measures Patient measures of quality of life , mood , self-efficacy and functional capacity , and health and social care utilisation , were carried out by blinded assessors at baseline , 6 weeks and 12 weeks . Fidelity and acceptability of the delivery were evaluated by observation and interviews . Results 4 community stroke rehabilitation teams were recruited , and received a total of 317 stroke referrals over 14 months . Of these , 138 met trial eligibility criteria and 78 participants were finally recruited ( 56.5 % ) .  Demographic and baseline outcome measures were similar between intervention and control arms , with the exception of age . All outcome measures were feasible to use and clinical data at 12 weeks were completed for 66/78 participants ( 85 % ; 95 % CI 75 % to 92 % ) . There was no significant difference in any of the outcomes between the arms of the trial , but measures of functional capacity and self-efficacy showed responsiveness to the intervention . Observation and interview data confirmed acceptability and fidelity of delivery according to predetermined criteria . Costs varied by site . Conclusions It was feasible to integrate a stroke self-management programme into community rehabilitation , using key principles . Some data were lost to follow-up , but overall results support the need for conducting further research in this area and provide data to support the design of a definitive trial . Trial registration number IS RCT N42534180 BACKGROUND AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease . There are no established and evidence -based stroke-specific chronic disease self-management programs . Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II r and omized-controlled clinical trial . Methods Stroke survivors are recruited from a variety of sources including : hospital stroke services , local paper advertisements . Stroke South Australia newsletter ( volunteer peer support organization ) , Divisions of General Practice , and community service providers across Adelaide , South Australia . Subjects are invited to participate in a multi-center , single-blind , r and omized , controlled trial . Eligible participants are r and omized to either ; st and ard care , st and ard care plus a six week generic chronic condition self-management group education program , or , st and ard care plus an eight week stroke specific self-management education group program .  Interventions are conducted after discharge from hospital . Participants are assessed at baseline , immediate post intervention and six months . Study Outcomes The primary outcome measures determine study feasibility and safety , measuring , recruitment , participation , compliance and adverse events . Secondary outcomes include : positive and active engagement in life measured by the Health Education Impact Question naire , improvements in quality of life measured by the Assessment of Quality of Life instrument , improvements in mood measured by the Irritability , Depression and Anxiety Scale , health re source utilization measured by a participant held diary and safety . Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged Abstract Background Depression occurs in up to 50 % of patients after stroke and limits rehabilitation and recovery . Mood disorders are also highly prevalent in carers ; their mental health intertwined with the physical and mental wellbeing of the person they are caring for . We argue that working with families , rather than patients alone may improve the treatment of depression in both patients and their carers enhancing the mental wellbeing and quality of life of both . Methods A single blind cluster r and omised controlled trial to evaluate whether families after stroke who are treated with the Depression Recognition and Treatment package ( DepReT-Stroke ) in addition to treatment as usual ( TAU )  show improved mental well being compared to those families who receive only TAU .  We aim to recruit one hundred and twenty-six families ( 63 in each group ) . The DepReT-Stroke intervention will help families to consider the various treatment options for depression , make choices about which are likely to fit best with their lives and support them in the use of self-help therapies ( e.g. computerised Cognitive Behavioural Therapy or exercise ) . An essential component of the DepReT-Stroke package will be to help people adhere to their chosen treatment(s ) . The primary outcome will be the Mental Component Subscale of the SF-36 assessed at baseline and again six months post intervention . Effectiveness of the intervention will be determined using analysis of co-variance ; comparing the mean change in MCS scores from baseline to six months follow-up adjusting for the clustering effects of baseline scores and family . An economic evaluation of the intervention will help us determine whether the intervention represents a cost-effective use of re sources . Discussion Depression both for patients and their carers is common after stroke . Our Dep ression Re cognition and T reatment package ( DepReT-stroke ) may help clinicians be more effective at detecting and managing a common co-morbidity that limits rehabilitation and recovery . Trial Registration IS RCT N : IS RCT N32451749 Research Ethics Committee Reference Number : 10/H0310/23Grant Reference Number : ( NIHR ) PB-PG-0808 - Abstract Objectives : The purpose of this study was to examine demographic variables associated with anger and well-being in patients with stroke , to investigate the hypothesis that knowledge and behavior ( K&B ) therapy improves patients ’ emotional and physical well-being , and to discover psychological variables associated with therapeutic outcomes . Methods : Seventy-seven patients with hemiplegic stroke were r and omly assigned to either a control condition ( the conventional therapy ) or an experimental condition ( K&B therapy ) . Both the experimental and control groups received physical therapy , which included prescribed medications and rehabilitation training programs for body functions . In addition , the experimental group received counseling , which consisted of a knowledge component and a behavioral training component . Results : Patients ’ gender and ratings of stressful events were related to emotional health and well-being . Compared to the control group , the experimental group generally reported greater improvements in state anger , external anger , anger control , depression , quality of life , and activities of daily living . Conclusions : Consistent with our expectations , patients with stroke who received K&B training showed greater improvements in mental and physical health . Our findings suggest that the K&B therapy effectively targeted anger and improved the well-being among patients with stroke . It is our recommendation that K&B therapy should be implemented with a hospital ’s st and ard procedure for stroke recovery OBJECTIVE There is a current need for interventions that provide information to stroke survivors in a patient-centred , interactive , personalized and flexible manner . To this purpose , a st and ardized but content-flexible patient education programme based on the International Classification of Functioning , Disability and Health ( ICF ) was developed . This study evaluated the effect of this programme on perceived self-efficacy . DESIGN Single-blind , r and omized , multi-centre controlled trial . METHODS Stroke patients undergoing neurological rehabilitation were enrolled .  Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale . Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life , measured with the WHOQOL and the Stroke Impact Scale , respectively . Data obtained at baseline , post-intervention and 6-month follow-up were analysed using multi-level models of change . RESULTS Two hundred and thirteen patients received either the ICF-based patient education ( n = 110 ) or an attention-placebo ( n = 103 ) control intervention . Over time , patients ' self-efficacy ( p < .01 ) and participation ( p < .01 ) improved , while emotional functioning ( p < .01 ) deteriorated , although no significant between-group differences were observed . Explorative analyses showed that gender , loci of control , difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy . CONCLUSION There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group . Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke , the methodology used was review ed and an up date d version proposed Background Despite lack of outward signs , most individuals after non-disabling stroke ( NDS ) and transient ischemic attack ( TIA ) have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke , hospitalization for other vascular events , or death . Most have multiple modifiable risk factors ( e.g. , hypertension , physical inactivity , hyperlipidaemia , diabetes , tobacco consumption , psychological stress ) . In addition , accelerated rates of depression , cognitive decline , and poor quality of sleep have been reported following TIA , which correlate with poor functional outcomes and reduced quality of life . Thus , NSD and TIA are important warning signs that should not be overlooked . The challenge is not unlike that facing other ' silent ' conditions - to identify a model of care that is effective in changing people 's current behaviors in order to avert further morbidity . Methods / Design A single blind , r and omized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA . 
    Output:
    
Individual studies reported benefits for health-related behaviours such as reduced use of health services , smoking , and alcohol intake , as well as improved diet and attitude .
However , there was no superior effect for such programmes in the domains of locus of control , activities of daily living , medication adherence , participation , or mood .
The current evidence indicates that self management programmes may benefit people with stroke who are living in the community .
The benefits of such programmes lie in improved quality of life and self efficacy .
These are all well-recognised goals for people after stroke .
There is evidence for many modes of delivery and examples of tailoring content to the target group .
Leaders were usually professionals but peers ( stroke survivors and carers ) were also reported - the commonality is being trained and expert in stroke and its consequences .