| Objectives:(1)To analyze and summarize the risk factors for ischemic stroke recurrence by Meta-analysis;(2)A risk prediction model of stroke recurrence was constructed and risk score table was drawn for clinical verification.(3)Furthermore,the developed risk prediction model in the health education of clinical stroke patients under the guidance of health belief model was applied to explore its effects on improving life style change and compliance with medication and prognosis of stroke patients.Methods:(1)The risk factors of recurrent ischemic stroke and their corresponding relative risk(RR)were extracted from 21 cohort studies,and then the coefficient of each risk factor was calculated according to the combined RR and its corresponding 95% confidence interval(CI).(2)logistic regression was used to construct the prediction model of ischemic stroke recurrence risk,and a scoring table was made according to the β regression coefficient;Patients with ischemic stroke who were hospitalized for the first time in a Class ⅲ Grade A hospital in Nanning from January 2020 to December 2021 were retrospectively collected for the model validation.The area under the ROC curve,sensitivity,specificity,Youden index and Hosmer-Lemeshow were used to test the discriminant validity(discrimination degree)and consistency(calibration degree)of the model.(3)In a quasi-experimental non-concurrent study,171 patients with first-ever ischemic stroke hospitalized in the Department of Neurology of the Second Nanning People’s Hospital from January 2022 to June 2022 were selected as the subjects,with 85 cases in the experimental group and 86 cases in the control group.The control group carried out routine health education,and the experimental group carried out health education based on HBM model combined with risk prediction model.The lifestyle compliance,medication compliance,m Rs Score and recurrence rate were compared between the two groups for 6 months after the discharged from hospital.Results:(1)21 cohorts including 30 202 patients with ischemic stroke were included in meta-analysis.Among them,age,smoking,drinking,hypertension,diabetes,atrial fibrillation,coronary heart disease,TIA,Hhcy,regular exercise,antithrombotic therapy was statistically significant.(2)The significant factors combined in the Meta-analysis were included in the model,and each factor was scored according to the weight,with a total score of 20.The model was verified in the external cohort,and the selected cut-off value was 7.The area under the ROC curve of the model was0.909,95% CI(0.838--0.980).Youden index,sensitivity and specificity values were 0.68,0.826 and 0.854 respectively.Hosmer-Leme show test showed P = 0.195.(3)After 6 months of discharge,compliance of the intervention group was significantly higher than that of the control group(P<0.001).Parameters like smoking abstinence,alcohol abstinence,fat intake control,regular monitoring of blood pressure,regular monitoring of blood glucose,and adequate exercise compliance were higher in the intervention group than those in the control group(P < 0.05),while stress control parameter was higher in control group that the intervention group.The medication compliance score was significantly(P<0.05)higher in the intervention group than the control group.Furthermore,no significant difference(P>0.05)was found in m Rs scores and recurrence rate between the two groups.Conclusions:(1)Through meta-analysis,11 influencing factors of ischemic stroke recurrence were screened,including 2 protective factors: regular exercise and antithrombotic therapy.and 7 risk factors such as age,smoking,drinking,diabetes,hypertension,atrial fibrillation,coronary heart disease,TIA and Hhcy.(2)The prediction model and scoring table for the recurrence risk of ischemic stroke have been established.The model has been clinically verified and the prediction effect is good.It can be used as a simple tool for screening high-risk groups of recurrence in patients with ischemic stroke and early identification of high-risk groups for clinical medical staff.(3)Health education based on HBM theory combined with risk prediction model can effectively improve the lifestyle compliance and medication compliance of patients with ischemic stroke up to 6 months.However,further follow-up observation is needed to improve the prognosis of patients after 6 months. |
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