Daily Functional Activities in Context After Stroke: A Large-Scale Ecological Momentary Assessment (EMA) Study

Abstract

<h3>Research Objectives</h3> To describe where, with whom, and how time was spent daily, to characterize these daily activity patterns as a function of employment, mobility device use, and cognitive functioning, and to validate EMA methods of daily activities and symptoms in people with stroke. <h3>Design</h3> Longitudinal observational study using EMA to assess real-time daily functional activities in natural contexts. <h3>Setting</h3> Home and community. <h3>Participants</h3> 212 participants with mild-to-moderate chronic stroke (55% males, 90% ischemic stroke; median age = 60 years). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Participants responded to a smartphone app five times daily for two weeks. The app queried activities, environmental contexts, and concurrent post-stroke symptoms. Participants also completed standardized assessments of daily activities and symptoms during lab visits. <h3>Results</h3> Participants spent the most time at home. They participated most in passive, unproductive activities (27%) but least in physical activities (4%). Unemployed individuals reported fewer vocational activities but more activities of daily living (ADL) and passive activities than employed counterparts. Mobility device users and those with cognitive problems spent less time on vocational activities and more on ADL than non-users and those without cognitive problems. Our data showed small-to-moderate correlations of EMA with in-lab measures of daily functioning (r=-0.30 to 0.35, p-value < 0.05) and large correlations between EMA and in-lab measures of symptoms (r= -0.64 to 0.79, p-value < 0.0001). <h3>Conclusions</h3> EMA can provide context-dependent information of daily functional activities in people after stroke. Clinicians may consider using EMA to examine post-stroke functional recovery and monitor patients for home- and community-based programs. <h3>Author(s) Disclosures</h3> None disclosed.