Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology

Abstract

Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology. Methods:We conducted a sequential descriptive case series study (n=5) in which communitydwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5). Conclusions:Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.

The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study

“…These dimensions are similar to those reported by Tsai et al [60], who also identified underlying dimensions related to acceptance of e-health technology that complemented CSQ-8. It should be emphasized that these observations do not underestimate CSQ-8, a validated tool that has been applied in web-based interventions (coaching, videoconferencing, and telerehabilitation) for several conditions (e.g., diabetes, chronic obstructive pulmonary disease, stroke, depression, and spinal surgery) and to evaluate preoperative patient satisfaction [60][61][62][63][64].…”

mHealth Intervention Applications for Adults Living With the Effects of Stroke: A Scoping Review

“…Thus, the novel system has potential for treatment of patients with aphasia as a supplement to face-to-face therapy. Kringle et al 26 N=5 Sequential descriptive case series United States iAdapts Cognitive skills To describe lessons learned through adaptation of a complex intervention—strategy training—for delivery via mHealth technology. Strategy training can be adapted for delivery using mHealth technology, with careful consideration to methods for training participants on new technology and the intervention delivery.…”

“…Eighteen studies (36.7%) were categorized as pilot, feasibility, or proof-of-concept trials. 9 , 10 , 12 , 13 , 14 , 17 , 24 , 30 , 33 , 36 , 37 , 38 , 42 , 45 , 47 , 52 , 56 , 57 In general, the studies had relatively small sample sizes, where 23 studies (46.9%) had ≤20 participants, 9 , 10 , 11 , 12 , 15 , 16 , 22 , 25 , 26 , 27 , 28 , 32 , 34 , 35 , 36 , 38 , 41 , 43 , 44 , 45 , 47 , 50 , 57 22 studies (44.9%) had between 21 and 100 participants, 13 , 14 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 29 , 30 , 31 , 33 , 40 , 42 , 46 , 49 , 51 , 52 , 53 , 54 and 4 studies (8.2%) had >100 participants (see table 1 ).…”

“…The 49 articles described 38 apps with content that varied in focus. The apps focused on upper extremity function (n=12; 31.5%) 9 , 12 , 17 , 18 , 23 , 24 , 27 , 28 , 29 , 36 , 43 , 44 , 49 , 50 , 51 , 55 ; lower extremity function (n=2; 5.3%) 12 , 51 ; general exercise, physical activity, and/or functional mobility (n=9; 23.7%) 12 , 31 , 37 , 39 , 41 , 42 , 46 , 47 , 51 , 54 ; trunk control (n=2; 5.3%) 51 , 53 ; medical management and secondary prevention (n=10; 26.3%) 13 , 14 , 15 , 16 , 33 , 39 , 40 , 43 , 44 , 48 , 51 , 52 , 54 , 56 ; language and speech skills (n=8; 20.5%) 19 , 20 , 21 , 22 , 23 , 24 , 25 , 34 , 35 , 38 , 45 ; cognitive skills (n=3; 7.9%) 23 , 24 , 26 ; gene...…”

Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering

“…Similar devices also exist that continuously acquire data without interference so that the patient's motor function can be evaluated in daily life [ 37 ]. The ability for patients to perform exercise assessments without a therapist makes assessments more convenient for patients and reduces the cost of medical treatment [ 38 ]. The advantages, disadvantages, and technical requirements of mHealth are summarized in Table 3 .…”