F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology – a feasibility study

Abstract

Background Globally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people’s daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention. Methods Three teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks. Results All of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44–100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation. Conclusion The results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as “a positive obligation”.

Telehealth Interventions to Support Self-Management in Stroke Survivors: A Systematic Review

“…Messaging was the most common in the selected studies, provided through short message service (SMS), email, in-home messaging devices (IHMDs), and smartphone push notification. All but one study [ 20 ] using messaging services combined with phone calls or web-based [ 29 ] or app-based interventions [ 23 ]. Four studies used phone calls [ 21 , 22 , 27 , 28 ], while four others used web-based intervention, such as video conferencing [ 24 , 25 , 26 ] or a web platform [ 24 , 29 ].…”

“…The frequency of intervention varied according to the characteristics of the intervention sessions. Messaging was used at a frequency of once a day [ 20 , 21 , 22 , 29 ] or twice a day [ 28 ], or once a week [ 23 ]. Telephone sessions were once a week [ 27 ], twice a week [ 28 ], or five times throughout the course of the intervention [ 21 , 22 ].…”

“…Three studies reported the duration of each phone call or video conferencing session as 5–15 min [ 27 ], 20 min [ 24 ], and 2 h [ 25 ]. In some studies, the exact duration of the intervention was not mentioned [ 20 , 21 , 22 , 28 , 29 ]. The length of interventions ranged from 1 to 6 months ( Table 3 ).…”

“…Cadilhac et al [ 20 ] and Kamoen et al [ 24 ] focused on lifestyle behavior changes and disease management. The remaining studies explored the relief of depressive symptoms after stroke [ 27 ], physical activity and participation [ 25 , 26 ], functional mobility [ 21 , 22 ], obesity management [ 23 ], and ADL [ 28 , 29 ] ( Table 3 ). Most studies excluded stroke survivors with severe aphasia and cognitive decline, but one study included participants with cognitive decline if they could participate in the intervention with the help of their caregiver.…”

“…In our review, goal achievement ( n = 5), SM skills ( n = 1), ADL ( n = 1), participation ( n = 5), and medication adherence ( n = 1) were found to be the outcomes of SM behavior. In studies using goal achievement as an outcome [ 20 , 25 , 26 , 28 , 29 ], only one study showed statistically significant improvement in group comparative studies [ 28 ], and one group of pre-and post-test studies reported an improvement in the TH-SM group, although this was not significant [ 26 , 29 ]. The results of goal achievement in various areas, such as function, participation, and environment, are shown [ 20 , 25 ].…”