What is the feasibility and patient acceptability of a digital system for arm and hand rehabilitation after stroke? A mixed-methods, single-arm feasibility study of the ‘OnTrack’ intervention for hospital and home use

Abstract

ObjectivesArm weakness is common after stroke; repetitive activity is critical for recovery but people struggle with knowing what to do, volume, and monitoring progress. We studied the feasibility and acceptability of OnTrack, a digital intervention supporting arm and hand rehabilitation in acute and home settings.DesignA mixed-method, single-arm study evaluating the feasibility of OnTrack for hospital and home use. An independent process evaluation assessed the intervention’s fidelity, dose and reach. Amendments to the protocol were necessary after COVID-19.SettingAcute stroke services and home settings in North West London.Participants12 adults with a stroke diagnosis <6 months previously (first or recurrent) requiring arm rehabilitation in hospital and/or home.Intervention12 weeks using the OnTrack system comprising arm tracking and coaching support for self-management.Primary and secondary outcome measuresRecruitment, retention and completion rates; compliance and adherence to the intervention; reasons for study decline/withdrawal.Intervention fidelity and acceptability, evaluated through an independent process evaluation.Patient measures including activity baseline, healthcare activation, arm function and impairment collected at baseline, week 7 and week 14 of participation to assess suitability for a randomised controlled trial (RCT).Results181 individuals screened, 37 met eligibility criteria, 24 recruited (65%); of these, 15 (63%) were recruited before COVID-19, and 9 (37%) during. 12 completed the intervention (50%). Despite COVID-19 disruptions, recruitment, retention and completion were in line with prestudy expectations and acceptable for a definitive trial. Participants felt the study requirements were acceptable and the intervention usable. Fidelity of delivery was acceptable according to predetermined fidelity markers. Outcome measures collected helped determine sample size estimates and primary outcomes for an RCT.ConclusionsThe intervention was found to be usable and acceptable by participants; study feasibility objectives were met and demonstrated that a definitive RCT would be viable and acceptable.Trial registration numberNCT03944486.

The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review

“…48 Two studies also used a smartphone app equipped with a machine learning algorithm and evaluated the effectiveness of a home-based rehabilitation system in chronic stroke survivors. 67,86 In the study authored by Fusari et al, 86 from baseline to 14 days, mean FMA-UE decreased from 37.7 to 36.4, VAS increased from 0.8 to 2.8 and EQ-5DL-5L increased from 0.462 to 0.606. While patients’ activity correlated significantly with their daily activity target ( R = 0.164), no significant correlation appeared with their weekly activity target ( R = −0.035).…”

“…Twenty-two studies 12,14,20,21,24,25,30,34,37,48,50,51,60,61,67,73–75,80,86,91,94 used a mobile technology or a mobile application as part of their intervention for home-based upper limb rehabilitation with stroke patients. Mobile technology had been used more frequently by stroke patients for information searching, and reminders in comparison to non-stroke participants.…”

“…Twenty-nine papers evaluated the use of telerehabilitation for post-stroke upper limb rehabilitation in home settings. 19,21,23,24,[26][27][28]30,[35][36][37]41,44,48,50,53,55,59,64,65,69,71,72,74,79,81,83,86,89 The recent telecommunication advancements have boosted remote delivery of rehabilitation services via the internet of things, messaging services, telephone, videoconference, and other means of communication technology. Besides the convenience and flexibility of telerehabilitation, it has been reported to be advantageous in minimizing issues such as hospital acquired infection, fatigue and travel distance.…”

“…Tele-rehabilitation Telerehabilitation can be defined as the delivery of rehabilitation services via various technologies remotely. 88 A total of 29 articles 19,21,23,24,[26][27][28]30,[35][36][37]41,44,48,50,53,55,59,64,65,69,71,72,74,79,81,83,86,89 discussed the use of telerehabilitation for upper limb in stroke clients in home settings. The majority of these articles showed a positive impact of telerehabilitation on its usability and acceptance for post-stroke upper limb rehabilitation at home.…”

Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study

“…Similar studies applying machine learning approaches to in-house activity and sleep data to monitor patients’ health have guided our sample size and monitoring period calculation 18 23 27 29. For detecting within-participant deviations, numbers of participants may be less important than the length of monitoring period for each participant.…”