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We developed an online program (Prevent 2nd Stroke) providing easily accessible, interactive, tailored healthy lifestyle and behaviour change information that encouraged users to set goals and monitor progress across 6 core modules: (1) smoking, (2) alcohol, (3) activity, (4) nutrition, (5) feelings and mood, and (6) blood pressure.The main limitation of the study is that the sample comprises mostly вЂwellвЂ™ stroke survivors with limited to no disability. There were no significant differences between groups on all other secondary outcomes. Significantly higher proportions of people in the intervention group reported no problems with personal care (OR 2.17, 95% CI 1.05вЂ“4.48, p = 0.0359) and usual activities (OR 1.66, 95% CI 1.06вЂ“2.60, p = 0.0256) than in the control group. The results were robust to the assumption the data were missing at random however, the results were not robust to the assumption that the difference in HRQoL between those with complete versus missing data was at least 3 points.

At 6 months, median EQ-VAS HRQoL score was significantly higher in the intervention group than the control group (85 vs 80, difference 5, 95% CI 0.79вЂ“9.21, p = 0.020). All outcomes included the variable вЂstroke event (stroke/transient ischaemic attack/other)вЂ™ as a covariate, and analysis was intention-to-treat. Secondary outcomes were HRQoL as measured by the EQ-5D (descriptive health state), diet quality, physical activity, alcohol consumption, smoking status, mood, physical functioning, and independent living. The primary outcome was HRQoL as measured by the EuroQol Visual Analogue Scale (EQ-VAS self-rated global health) the outcome was assessed for differences between treatment groups at follow-up, adjusting for baseline measures. The control group were emailed and posted a list of internet addresses of generic health websites ( n = 200 n = 15 lost at follow-up). The intervention group received remote access for a 12-week period to the online-only P2S program ( n = 199 n = 28 lost at follow-up). Randomisation occurred at the end of the baseline survey CATI assessors and independent statisticians were blind to group allocation. At baseline the sample had an average age of 66 years (SD 12), and 65% were male. Participants completed baseline ( n = 399) and 6-month follow-up ( n = 356 89%) outcome assessments via computer-assisted telephone interviewing (CATI). Adult stroke survivors between 6 and 36 months post-stroke with capacity to use the intervention (determined by a score of в‰Ґ4 on the Modified Rankin Scale) and who had access and willingness to use the internet were recruited via mail-out invitations from 1 national and 1 regional stroke registry. A prospective, blinded-endpoint randomised controlled trial, with stroke survivors as the unit of randomisation, was conducted between March 2018 and November 2019.

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