Effects of in home high dose accelerometer-based feedback on perceived and actual use in participants chronic post-stroke

Whitford, Maureen; Schearer, Eric M.; Rowlett, Maria

doi:10.1080/09593985.2018.1493759

Cited by 21 publications

(23 citation statements)

References 55 publications

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“…Previous studies have demonstrated that, in stroke patients, movement counts, as measured with accelerometers, are associated with the use of the affected arm-hand (Motor Activity Log score) [36, 37] and, at function level, with the Fugl-Meyer Assessment [38]. Next to quantifying paretic arm-hand use, accelerometers have also been used to provide feedback to further enhance the use of the affected hand in home-based situations [39]. Most studies consist of relatively small [27, 30, 40–44] and highly selected study populations [45] with short time intervals between baseline and follow-up measurements.…”

Section: Introductionmentioning

confidence: 99%

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

2019

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Introduction Improvement of arm-hand function and arm-hand skill performance in stroke patients is reported by many authors. However, therapy content often is poorly described, data on actual arm-hand use are scarce, and, as follow-up time often is very short, little information on patients’ mid- and long-term progression is available. Also, outcome data mainly stem from either a general patient group, unstratified for the severity of arm-hand impairment, or a very specific patient group. Objectives To investigate to what extent the rate of improvement or deterioration of actual arm-hand use differs between stroke patients with either a severely, moderately or mildly affected arm-hand, during and after rehabilitation involving a well-defined rehabilitation program. Methods Design: single–armed prospective cohort study. Outcome measure: affected arm-hand use during daily tasks (accelerometry), expressed as ‘Intensity-of arm-hand-use’ and ‘Duration-of-arm-hand-use’ during waking hours. Measurement dates: at admission, clinical discharge and 3, 6, 9, and 12 months post-discharge. Statistics: Two-way repeated measures ANOVAs. Results Seventy-six patients (63 males); mean age: 57.6 years (sd:10.6); post-stroke time: 29.8 days (sd:20.1) participated. Between baseline and 1-year follow-up, Intensity-of-arm-hand-use on the affected side increased by 51%, 114% and 14% (p < .000) in the mildly, moderately and severely affected patients, respectively. Similarly, Duration-of-arm-hand-use increased by 26%, 220% and 161% (p < .000). Regarding bimanual arm-hand use: Intensity-of-arm-hand-use increased by 44%, 74% and 30% (p < .000), whereas Duration-of-arm-hand-use increased by 10%, 22% and 16% (p < .000). Conclusion Stroke survivors with a severely, moderately or mildly affected arm-hand showed different, though (clinically) important, improvements in actual arm-hand use during the rehabilitation phase. Intensity-of-arm-hand-use and Duration-of-arm-hand-use significantly improved in both unimanual and bimanual tasks/skills. These improvements were maintained until at least 1 year post-discharge.

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Section: Introductionmentioning

confidence: 99%

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

2019

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“…The median ARAT scores for both groups showed an improvement during the four-week study intervention phase with the intervention group continuing to improve up to the eight-week follow-up outcome. The amount of use of the impaired arm as measured by the MAL and the accelerometers also indicated an increase for both groups, which continued up to the week eight out- 15 (10)(11)(12)(13)(14)(15)(16)(17)(18) 19 (16)(17)(18)(19) 19 (17)(18)(19)(20) 12 (10)(11)(12)(13)(14)(15)(16) 17 (12)(13)(14)(15)(16)(17)(18)(19) 15 (15)(16)(17)(18) ARAT: Action Research Arm Test; IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale. come for the intervention group but not for the control group.…”

Section: Resultsmentioning

confidence: 95%

“…15 Although participants reported that they thought they had used their impaired arm more, the accelerometer data did not show an actual increase in the amount of arm use. 15 In another study, 16 arm activity was measured by an actometer worn on the wrist which prompted arm movement with a vibration cue every five minutes over a three-hour period. This study found that the sensory cueing led to more arm movements for the intervention group, but there was no impact upon functional performance.…”

Section: Introductionmentioning

confidence: 86%

Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial

et al. 2019

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Objective: To evaluate the feasibility of a multicentre, observer-blind, pilot randomized controlled trial (RCT) of a wristband accelerometer with activity-dependent vibration alerts to prompt impaired arm use after stroke. Design: Parallel-group pilot RCT. Setting: Four English stroke services. Participants: Patients 0–3 months post stroke with a new arm deficit. Intervention: Participants were randomized to wear a prompting or ‘sham’ wristband during a four-week self-directed therapy programme with twice-weekly therapy review. Main outcomes: Recruitment, retention and adherence rates, safety and completion of assessments were reported. Arm recovery was measured by Action Research Arm Test (ARAT) and Motor Activity Log (MAL) without statistical comparison. Results: In total, 33 patients were recruited (0.6 per month/site; median time post stroke: 26 days (interquartile range (IQR):15.5–45)). Baseline, four-week and eight-week median (IQR) ARAT for the control group ( n = 19) were 15 (2–35), 35 (15–26) and 31 (21–55) and those for the intervention group (n = 14) were 37 (16–45), 57 (29–57) and 57 (37–57), respectively; for MAL Amount of Use, the corresponding values in the control group were 0.2 (0.0–1.2), 1.1 (0.3–2.9) and 1.2 (0.7–2.9) and in the intervention group were 1.4 (0.5–2.6), 3.8 (1.9–4.5) and 3.7 (2.1–4.3). Four participants withdrew from the study. Wristbands were worn for 79% of the recommended time. The intervention and control group participants received a median of 6.0 (IQR: 4.3–8.0) and 7.5 (IQR: 6.8–8.0) therapy reviews. A median of 8 (IQR: 6–10) prompts were delivered per intervention participant/day. Research assessments were completed for 28/29 and 25/28 patients at four and eight weeks. Eight serious adverse events were reported, all unrelated to the intervention. Conclusion: A multicentre RCT of wristband accelerometers to prompt arm activity early after stroke is feasible. A total sample of 108 participants would be required.

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“…While not labeled as EMI, a few studies have used mHealth technologies to deliver feedback about movement behavior or physical activity levels outside clinical settings. [60][61][62][63][64] The provision of quantitative feedback from activity monitors can include objective measures of activity (e.g. movement or step count, time spent in moderate intensity activity), graphs of daily activity, or encouragement of activity goals (e.g.…”

Section: Ecological Momentary Intervention For Behavior Change In Strmentioning

confidence: 99%

“…Another study investigated the impact of delivering feedback collected through wrist-worn activity monitors on perceived and actual paretic arm use. 62 During a 3-week period, feedback was provided during seven follow-up sessions and consisted of discussions and graphs about the amount of use of the paretic arm.…”

Section: Ecological Momentary Intervention For Behavior Change In Strmentioning

confidence: 99%

A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

Demers

Winstein

2020

Topics in Stroke Rehabilitation

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Effects of in home high dose accelerometer-based feedback on perceived and actual use in participants chronic post-stroke

Cited by 21 publications

References 55 publications

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

Wristband Accelerometers to motiVate arm Exercises after Stroke (WAVES): a pilot randomized controlled trial

A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

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