Abstract TMP48: Understanding Optimal Dosage Frequency and Patient Engagement on Improving Outcomes Using Digital Therapy

Abstract

Research suggests more intense therapy may facilitate improvements in stroke patients. Technological advances provide opportunities for stroke patients to practice more intensely and consistently than the typical weekly/biweekly clinic visits. Constant Therapy (CT) is a personalized treatment tool for people with cognitive-communication disorders designed for home practice. The current study investigates the relationship between intensity of CT practice and change on in-app domain scores. Data was anonymously aggregated and analyzed from 1195 CT users with stroke (median age=67; 720 survivors <6 months post onset). Users consented that their data be analyzed for research purposes. CT’s tasks are grouped into one of 12 domains and arranged by difficulty. Progress through a domain is represented by a domain score. As a user demonstrates recovery by succeeding in exercises they previously struggled with, more difficult exercises are presented, and their domain score increases. Users engaged in CT at any frequency they desired and were divided into 5 dosage groups based on the median days per week they used CT for 10 weeks. Improvement rate was calculated as the change in domain score relative to baseline. A linear mixed effects model was applied to examine the relationship between dosage group and change in domain score (controlling for baseline domain score, time, age, and months since stroke). Across all domains, results revealed significant improvement over time (p<.001) as well as significant effects of dosage group (all p<.001). Specifically, 2 (p<.001), 3 (p<.001) , 4 (p<.001) , and 5-7x/week (p<.001) groups showed greater improvement rates compared to 1x/week. Furthermore, 3, 4, and 5-7x/week were all significantly significantly different from 2x/week. Per current practice, 86.5% of stroke patients receive <2 sessions per week (ASHA NOMS, 2017). After 10 weeks of activity, our results show that users that engaged in CT more than 2x/week had significantly faster progress compared to 1-2x/week, which provides support to the idea that increased treatment dosage results in improved outcomes. Computerized rehabilitation programs can increase the opportunity for increased therapy dosage and thus a greater rate of improvement and recovery.