Background Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.

BACKGROUND Web-based interventions have shown promise for chronic disease management, but have not been widely applied to stroke populations. Barriers exist that may inhibit the adoption of web-based interventions in stroke survivors and necessitate informal caregiver involvement. However, limited information is known about internet accessibility and usability in stroke survivors and their caregivers. The purpose was to investigate internet access and usage in stroke survivors and their caregivers. OBJECTIVE To investigate internet access and usage in a cohort of stroke survivors and caregivers of stroke survivors. METHODS A cross-sectional survey of 375 participants (stroke survivors, 248; caregivers, 127). Descriptive statistics were generated through cross-tabulations. Comparisons with categorical data were conducted with the chi-square test, while Mann-Whitney U test was used for comparisons involving ordinal variables. RESULTS Eighty-five percent of the participants reported internet access. Caregivers were more likely than stroke survivors to access the internet X2 (1, N = 375) = 18.5, p < .001 and use text messaging X2 (1, N = 321) = 14.74, p < .001. Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were Non-Hispanic Whites. Smart phones were the most common device used to access the Internet. Email was the most common type of internet usage reported. The number of stroke survivors with internet access was higher in survivors more than12 months compared to survivors less than 3 months (p < .001) after the stroke event. The number of hours per week spent using the Internet was higher for caregivers than stroke survivors (p < .001). CONCLUSIONS Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone applications, email and text correspondence, and the amount of time since the stroke event in the design and implementation of web-based interventions for stroke populations.

Background and Purpose: Web-based interventions have shown promise as a cost-effective and convenient delivery platform for supporting chronic disease self-management. However, studies suggest that web-based interventions are not widely available. The purpose of this study was to describe access and usage of web-based electronics in a cohort of stroke survivors (SS) and their informal caregivers (IC). Methods: A 14-question electronic usage survey was created with input from experts in neurology, nursing and bioinformatics. Two urban sites recruited participants from inpatient stroke centers, outpatient stroke clinics and stroke support groups. Surveys were completed in person or via telephone. Descriptive data were generated to evaluate internet access and usage. Results: Data were analyzed from 251 SS and 127 IC. Participants were primarily recruited from outpatient settings, with inpatient recruits constituting 15%. Internet users were on average 8 years younger than non-users in both groups. African Americans constituted a third in each group and 1 out of 8 were Hispanic. Compared to an estimate that 89% of American adults have internet access, 200 (81%) SS (p < .001) and 123 (97%) IC (p = .005) had internet access. Conclusions: In our diverse cohort of relatively young SS, we found IC had more internet access than SS, and more so than the general population. This study is an important step towards delineating the potential use of web-based environments as a platform for interventions to improve stroke risk factor management and stroke recovery.

BACKGROUND Web-based telehealth interventions have shown promise for chronic disease management but have not been widely applied to stroke populations. Limited information is known about the accessibility and usability of web-based electronics post-stroke. The purpose was to explore internet access and use of web-based electronics in stroke survivors (SS) and their informal caregivers (IC). OBJECTIVE To describe access and usage of web-based electronics in a cohort of SS and IC. METHODS A cross-sectional survey of 378 participants (SS=251; IC=127). Descriptive statistics were generated. RESULTS Internet-users were on average 8 years younger than non-users (Mean years; SS 59; IC 51) and the majority were Non-Hispanic White men. Two hundred (81%) stroke survivors reported internet access compared to 123 (97%) caregivers (p<0.001). Smart phones were the most common device used to access the internet. CONCLUSIONS Web-based telehealth stroke interventions should consider participant age and race/ethnicity, the role of the IC to positively impact SS internet accessibility and usability, and the use of smartphone applications.

Finding optimal blood pressure (BP) target and BP treatment after acute ischemic or hemorrhagic strokes is an area of controversy and a significant unmet need in the critical care of stroke victims. Numerous large prospective clinical trials have been done to address this question but have generated neutral or conflicting results. One major limitation that may have contributed to so many neutral or conflicting clinical trial results is the “one-size fit all” approach to BP targets, while the optimal BP target likely varies between individuals. We address this problem with the Acute Intervention Model of Blood Pressure (AIM-BP) framework: an individualized, human interpretable model of BP and its control in the acute care setting. The framework consists of two components: one, a model of BP homeostasis and the various effects that perturb it; and two, a parameter estimator that can learn clinically important model parameters on a patient by patient basis. By estimating the parameters of the AIM-BP model for a given patient, the effectiveness of antihypertensive medication can be quantified separately from the patient’s spontaneous BP trends. We hypothesize that the AIM-BP is a sufficient framework for estimating parameters of a homeostasis perturbation model of a stroke patient’s BP time course and the AIM-BP parameter estimator can do so as accurately and consistently as a state-of-the-art maximum likelihood estimation method. We demonstrate that this is the case in a proof of concept of the AIM-BP framework, using simulated clinical scenarios modeled on stroke patients from real world intensive care datasets.