Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

Abstract

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort.Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke.Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = −0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003).Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

Smartphone App in Stroke Management: A Narrative Updated Review

“…Many Apps aim to help patients manage their risk factors. The PRESTRO App [ 67 ] combines motivational support for a healthy lifestyle (physical activity, healthy nutrition, and smoking cessation), a reminder function for medication intake and blood pressure measurement and stroke education. Results from Fruhwirth et al [ 67 ], clinical trial show that patients in the intervention group reported to be physically almost twice as active (13±9 hour/week) compared to controls (7±5 hour/week; P =0.022).…”

“…The PRESTRO App [ 67 ] combines motivational support for a healthy lifestyle (physical activity, healthy nutrition, and smoking cessation), a reminder function for medication intake and blood pressure measurement and stroke education. Results from Fruhwirth et al [ 67 ], clinical trial show that patients in the intervention group reported to be physically almost twice as active (13±9 hour/week) compared to controls (7±5 hour/week; P =0.022). More intense App usage was strongly associated with higher physical activity (r=0.60, P =0.005) and lower consumption of unhealthy food (r=−0.51, P =0.023).…”

Medication self-management interventions for persons with stroke: A scoping review

“…Studies were conducted across 20 different countries, with the majority conducted in the United States (n = 14) [ 38 , 42 – 45 , 50 , 57 , 59 , 67 , 74 , 81 – 83 , 88 ] and China (n = 11) [ 40 , 46 , 73 , 76 – 80 , 84 – 86 ]. Other countries included the United Kingdom (n = 4) [ 63 , 64 , 69 , 72 ], South Korea (n = 2) [ 55 , 56 ], Australia (n = 2) [ 41 , 65 ], Belgium (n = 2) [ 54 , 75 ], Germany (n = 2) [ 49 , 60 ], Ghana (n = 2) [ 68 , 89 ], Hong Kong (n = 2) [ 70 , 71 ], India (n = 2) [ 34 , 39 ], Malaysia (n = 2) [ 35 , 87 ], New Zealand (n = 2) [ 36 , 61 ], Pakistan (n = 2) [ 52 , 53 ], Austria (n = 1) [ 47 ], Denmark (n = 1) [ 48 ], France (n = 1) [ 37 ], Israel (n = 1) [ 62 ], Japan (n = 1) [ 66 ], Thailand (n = 1) [ 58 ], and Turkey (n = 1) [ 51 ].…”

“…The majority of articles reported the sex (n = 32) [ 34 , 38 , 41 , 43 – 49 , 52 , 53 , 56 , 57 , 59 , 61 , 65 , 66 , 68 – 74 , 77 – 79 , 84 – 86 , 88 ] or gender (n = 19) [ 35 , 37 , 39 , 40 , 42 , 51 , 54 , 55 , 58 , 60 , 62 , 63 , 75 , 76 , 80 – 83 , 87 ] of participants, but no articles reported both sex and gender. Level of education was reported by 29 articles [ 35 , 36 , 39 , 42 , 45 , 47 , 50 – 53 , 55 , 58 , 59 , 62 , 68 , 70 , 71 , 73 , 74 ,…”

“…Income level (n = 12) [ 45 , 46 , 51 , 52 , 55 , 58 , 59 , 62 , 68 , 73 , 76 , 81 ] and household composition (n = 10) [ 36 , 39 , 41 , 42 , 51 , 52 , 61 , 62 , 71 , 72 ] were reported less frequently, in about one fifth of included articles. Comorbidities experienced by participants were reported in 27 articles [ 35 , 37 , 39 , 41 , 45 , 47 , 48 , 51 , 52 , 54 , 56 – 60 , 62 , 66 , 68 – 70 , 73 , 76 – 78 , 84 , 87 , 88 ], with hypertension, diabetes, and dyslipidemia being the most commonly reported.…”