Adult Stroke Survivors Research Articles

Measuring Exercise Self-Efficacy After Stroke: Validity and Reliability of Current Measures.

Many physically capable stroke survivors are insufficiently active, with low self-efficacy considered an important contributor. However, validity and reliability of self-efficacy measures in stroke survivors have not been established. This research aims to evaluate the test-retest reliability and construct validity of 3 self-efficacy measures: Self-Efficacy for Exercise Scale (SEE), Spinal Cord Injury Exercise Self-Efficacy Scale (SCI-ESES), and Participation Strategies Self-Efficacy Scale (PS-SES). A repeated measures study with community-dwelling, independently mobile adult stroke survivors (n=51, mean age 74years, 45% female, median 22months poststroke) was completed. Test-retest reliability was assessed using intraclass correlation coefficients and Bland-Altman analyses. Construct validity was assessed using 8 pre-determined hypotheses concerning physical activity level (subjective and objective), comorbidities, work and volunteering, and measures of function. Retest reliability was established for the SEE (intraclass correlation coefficient, ICC=0.77) and PS-SES (ICC=0.78) but not for the SCI-ESES (ICC=0.68). Bland-Altman analysis showed participants consistently scored higher on the second test for all measures. The SEE achieved construct validity by meeting 75% of hypotheses, whereas the PS-SES and SCI-ESES did not. Self-efficacy was positively related to steps/day, functional capacity, self-reported activity levels, and work or volunteering participation. The SEE was found to be the most appropriate tool to measure exercise self-efficacy in independently mobile chronic stroke survivors in terms of retest reliability and validity. N/A. for more insights from the authors (see the Video, Supplemental Digital Content 1 "Espernberger-JNPT-Video-Abstract," available at: http://links.lww.com/JNPT/A489).

Challenges in Accessing Community-Based Rehabilitation and Long-Term Care for Older Adult Stroke Survivors and Their Caregivers: A Qualitative Study.

While extensive research has examined the rehabilitation challenges faced by stroke survivors, there is limited literature addressing the difficulties encountered by older adult stroke survivors and their caregivers in accessing rehabilitation and long-term care within the Chinese community. This study aimed to investigate the specific challenges related to access, quality, and coordination of rehabilitation and long-term care experienced by older adult stroke survivors and their caregivers within the Chinese community. A qualitative phenomenological design was employed to explore the lived experiences of stroke survivors and their caregivers within the Chinese community. A purposive sampling method was used to recruit participants from June to August 2023. Participants engaged in face-to-face semi-structured interviews. The data were analyzed using an inductive thematic analysis approach to identify and understand key themes and sub-themes. The study involved 38 participants, consisting of 21 older adult stroke survivors (13 males, 8 females) and 17 family caregivers (7 males, 10 females), recruited from five Chinese community health service stations. The analysis identified four distinct themes and 11 sub-themes that encapsulated the challenges faced by participants. These themes include (1) Difficulties in accessing medical services (insufficient medical resources, lack of rehabilitation resources, and time-consuming processes), (2) Challenges in daily life (inconvenience in daily mobility, inadequate financial support, and difficulties in applying for home care services), (3) Psychosocial stress (loneliness, powerlessness, and worry about burdening others), (4) Insufficient information (lack of awareness of available community services, and limited public health education activities). Older adult stroke survivors and their caregivers in Chinese communities face significant challenges. To improve their well-being and quality of life, it is crucial to address these challenges through enhanced access to healthcare, better support for daily living, and more effective information dissemination. Meeting these needs requires a coordinated effort from healthcare providers, community stakeholders, and policymakers to develop and implement effective, long-term care solutions.

“I just kept asking and asking and there was nothing”: re-thinking community resources & supports for young adult stroke survivors

Purpose Stroke is often regarded as a disease of the elderly. However, 10–15% of strokes occur in people aged 18 to 50, and rates continue to rise. Young stroke survivors face unique challenges due to their occupational, family and personal commitments, which current stroke rehabilitation services may not fully address. Our qualitative study aimed to identify gaps in patient care and resources for young stroke survivors. We used these findings to develop recommendations to inform clinical care, healthcare system design, and health policy. Methods Using Interpretive Description, we conducted semi-structured interviews with 19 stroke survivors aged 18–55 living in British Columbia, Canada, to explore their experiences during stroke recovery and assess current gaps in support and resources. We applied broad-based coding and thematic analysis to the transcripts. Results Key themes included: (1) the need for longitudinal medical follow-up and information provision, (2) the need for psychological/psychiatric care, (3) the need to adapt community supports and resources to young survivors, and (4) the need to centralize and integrate community stroke services and resources. Conclusion Young stroke survivors experience unique challenges and lack appropriate services and resources. Many of our findings may be representative of remediable gaps that persist nationally and internationally.

Factors related to health literacy of recurrent stroke prevention among older adult stroke survivors

Factors related to health literacy of recurrent stroke prevention among older adult stroke survivors

Effectiveness of Virtual Reality in Occupational Therapy for Post-Stroke Adults: A Systematic Review.

Background: In recent years, there has been a growing use of technological advancements to enhance the rehabilitation of individuals who have suffered from cerebrovascular accidents. Virtual reality rehabilitation programs enable patients to engage in a customized therapy program while interacting with a computer-generated environment. Therefore, our goal was to investigate the effectiveness of virtual reality in occupational therapy for people's rehabilitation after a cerebrovascular accident. Methods: We systematically searched databases (Pubmed/Medline, Scopus, Web of Science, and Science Direct) for randomized controlled trials published within the last 10 years. Studies involving adult stroke survivors undergoing virtual reality-based interventions aimed at improving upper-extremity motor function were included. The quality assessment followed PRISMA guidelines, with the risk of bias assessed using the Cochrane tool (version 6.4) and methodological quality evaluated using GRADEpro. Results: We selected sixteen studies that met the main criteria for the implementation of virtual reality technology. The interventions described in the articles focused mainly on the upper extremities and their fine motor skills. Conclusions: When used in conventional treatments to improve people's motor and cognitive functions after a cerebrovascular accident, virtual reality emerges as a beneficial tool. Additionally, virtual reality encourages adherence to the interventional process of rehabilitation through occupational therapy.

Retrospective review of food insecurity screening in an outpatient stroke clinic using electronic and paper-based surveys

ObjectiveTo assess the feasibility of administrating an electronic and paper-based food insecurity screener among patients presenting to a stroke clinic during the study period. We aimed to ensure a consecutive sample for our retrospective analysis and evaluate the prevalence and characteristics of food insecurity in this population. Materials and methodsWe conducted a retrospective review of patients with an initial telemedicine or in-person appointment to a stroke outpatient clinic between February 1 and July 31, 2021. Prior to their initial visit, patients were sent an electronic questionnaire to screen for food insecurity using the 2-item Hunger Vital Sign™ and to collect socio-demographic characteristics. Patients who were evaluated in-person were given a paper questionnaire if the electronic version was not completed upon clinic appointment. We collected data on patient demographics, screener completion rates, and the prevalence of food insecurity. The feasibility was evaluated by comparing the amount of missing data between electronic and paper-based screeners. ResultsAmong 406 adult stroke survivors, 365 (89.9 %) completed the food insecurity screener, with 234 (64.1 %) completing it electronically and 131 (35.9 %) by paper. Overall, 14.3 % of the stroke patients experienced food insecurity. A higher prevalence of food insecurity was observed among patients who completed paper-based compared to electronic questionnaires (21.4 % vs 10.2 %, p = 0.004). Hispanic patients were more likely to complete paper-based questionnaires (32.1 %) compared to electronic questionnaires (18.0 %, p = 0.011). Patients with a 12th grade education or less were more likely to complete paper-based (49.5 %) vs. electronic questionnaires (36.4 %, p = 0.029). Feasibility was evaluated by comparing the amount of missing data between the screener delivery modalities. A higher percentage of socio-demographic characteristics was missing in the paper-based questionnaires compared to electronic questionnaires (105.3 % vs. 14.11 %). ConclusionsSample characteristics differ based on the mode of questionnaire delivery, suggesting that different screening modalities may be necessary to identify patients at the highest risk for food insecurity. Our study provides detailed insights into the feasibility of using electronic and paper-based screeners in a clinical setting, highlighting the importance of considering delivery methods in food insecurity assessments. It is important to note that the Spanish language electronic survey was only available during the last two months of the study, which may affect the findings regarding Hispanic patients' preference for paper surveys.

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada.

Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. We included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (-4.79%; -7.86 to -1.72) or have visits to a specialist (-1.68%; -3.12 to -0.24). There was minimal variation by region of origin or time since immigration in immigrants. Compared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors.

Exploring Stroke Patients' Needs: A Cultural Adaptation and Validation of the Modified Needs Assessment Questionnaire in a Greek Context.

Stroke survivors often face diverse unmet needs highlighting the significance of identifying and addressing these needs to enhance rehabilitation outcomes and overall quality of life. This study aimed to validate the modified Needs Assessment Questionnaire (mNAQ) as a reliable and valid tool for assessing the needs of stroke patients in the Greek context. Additionally the research sought to identify potential differences in the assessment of stroke patients' needs based on their stroke phase and National Institutes of Health Stroke Scale (NIHSS) scores. A sample of 71 adult stroke survivors adhering to World Health Organization guidelines and providing autonomous consent participated in the study. The mNAQ comprising 141 items across 12 domains was utilized to evaluate stroke patients' needs. The NIHSS and Barthel Index (BI) were employed for functional independence and mobility assessment. Data analysis incorporated confirmatory factor analysis, exploratory factor analysis and Cronbach's reliability analysis to establish construct validity and internal consistency. Concurrent and known-groups validity analyses were conducted; and Spearman's rho correlation explored the relationship between mNAQ and BI scores. Non-parametric analyses were applied to identify differences based on stroke phase and NIHSS scores. The study revealed that the mNAQ initially lacked satisfactory psychometric properties in the Greek context. Subsequent modifications guided by confirmatory and exploratory factor analyses resulted in a refined three-factor scale encompassing 31 items in the domains of communication, mobility, and social functioning needs. This adapted measure effectively differentiated between acute and chronic stroke patients and those with minor and moderate strokes. In conclusion, the validated 31-item Greek mNAQ emerges as a crucial tool for comprehensively assessing the needs of stroke patients. Its application holds promise for optimizing post-stroke care improving functional outcomes and ultimately enhancing the overall well-being and quality of life for stroke survivors.

Care model selection for older adult stroke survivors with disabilities: insights from the eighth wave of CLHLS data and influencing factors.

Analyzing the differences in caregiving models for disabled older adult individuals after stroke and the influencing factors, to provide a basis for addressing relevant social demographic issues. The older adult diagnosed with stroke were screened from the Chinese Geriatric Health Survey (CLHLS), and were further divided into subgroups of disability, which was based on their ability of or whether they need help in performing activities such as dressing, bathing, eating, toileting or bowel and bladder control using the international common Katz scale. The care model was divided into formal care, informal care and home care. Multivariate logistic regression was used to screen the influencing factors of the choice of care model for the disabled older adult after stroke. The results of univariate analysis showed that there were statistical differences in the choice of care mode among different ages, household registration types, number of children, years of education, degree of disability, community services, retirement pension, marital status and medical insurance. Multiple logistic regression showed that, The rural older adult with more children, shorter education years, living with spouse and no help from community tend to choose informal care. Older adult people with higher levels of education, urban household registration, and access to community services are more likely to choose formal care. Older adult women with multiple children are more likely to receive care from their children. In the future, vigorous support for the development of formal caregiving institutions and the improvement of the management system of formal caregiving will help enhance the subjective initiative of disabled older adult individuals in choosing caregiving models and alleviate the burden of family caregiving.

CSP2023: 469 - 'Caged in hell or unable to escape': the lived experiences of adult stroke survivors in rural Nigeria

CSP2023: 469 - 'Caged in hell or unable to escape': the lived experiences of adult stroke survivors in rural Nigeria

The link between insurance and blood pressure control in U.S. stroke survivors

BackgroundAfter a stroke, poorly controlled blood pressure (BP) is associated with a higher risk of recurrent vascular events. Despite the importance of controlling BP to avert recurrent vascular events, fewer than half of stroke survivors in the United States achieve BP control. It is unclear to what extent insurance status affects BP levels after stroke. MethodsWe assessed BP control among adults with a history of stroke who participated in the National Health and Nutrition Examination Surveys from 1999 through 2016. The relationship between insurance type and BP level (low normal: <120/80 mmHg and normal: <140/90 mmHg) were evaluated using logistic regression before and after adjusting for sociodemographic characteristics and medical comorbidities for those <65 years and ≥ 65 years. ResultsAmong 1646 adult stroke survivors (weighted n = 5,586,417), 30% had BP in the low normal range while 64% had BP in the normal range. Among 613 stroke survivors <65 years (weighted n = 2,396,980), only those with other government insurance (CHAMPVA, CHAMPUS/TRICARE) had better BP control than the uninsured (adjusted HR 2.68, 95% CI 0.99–7.25). Among 1033 participants ≥65 years (weighted n = 3,189,437), those with private insurance plus Medicare trended toward better normal BP compared to Medicare alone (adjusted HR 1.34, 95% CI 0.94–1.90). ConclusionsOnly stroke survivors with CHAMPVA, CHAMPUS/TRICARE government insurance in the United States have lower odds of controlled BP compared to no insurance among those <65 years. Insurance alone does not improve BP control among stroke survivors.

Social Networks and Communication Impairment: Racial Differences Among Stroke Survivors

Purpose: Recent evidence highlights the importance of social networks—the composition of social relationships—and their characteristics in stroke recovery. This study explores the relationship between social networks and poststroke communication outcomes. Method: A cohort of 30 non-Hispanic Black ( n = 12) and non-Hispanic White ( n = 18) adult stroke survivors completed the Stroke Impact Scale (SIS) Communication subtest and the Stroke Social Network Scale (SSNS). The SSNS captures elements of social networks including satisfaction and contact with friends, relatives, children, and groups. The relationship between the SIS Communication subtest scores and SSNS scores was explored using ordinal Bayesian regression estimation models adjusting for sex, age, time postonset, marital status, and stroke type. Results: Average SIS Communication scores differed ( t = 2.07, p = .335) between White ( M = 81.75, SD = 22.90) and Black ( M = 95.71, SD = 4.95) participants, but SSNS Comprehensive scores were similar between the two groups ( t = −0.89, p = 1.00). SSNS children subtest scores were higher among the Black than the White ( t = −1.73, p = .0473) participants. Similarly, satisfaction subtest scores were comparatively higher among Black than White participants ( t = 1.85, p = .451). SSNS Satisfaction, Friends, and Groups subtest scores were positively associated with SIS Communication, indicating strong associations with lower impairment. SSNS Children subtest scores were negatively related to SIS, indicating higher impairment. Although most subtest associations were similar for both groups, the associations with SSNS Children and Friends subtests differed between racial groups. Conclusions: Levels of communication impairment were correlated with child, friendship, and group attachments among participants. However, strong social ties to children and friends had different associations among racial groups.

Introducing the Tele-OCS: Preliminary evidence of validity for a remotely administered version of The Oxford Cognitive Screen

Background Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors. Methods 40 stroke survivors (M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen’s d estimates were used to compare performance between modalities. Results We found that the proportion of OCS subtasks impaired did not differ across modalities (d &lt;.001). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (&lt;1 point difference on average). These statistical differences did not affect impairment classifications. Conclusions The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.

Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention.

Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important. To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions. Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study. Community. Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr). Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth. Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs. Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers. Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions. Plain-Language Summary: This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

Understanding Occupational Therapists' Knowledge and Confidence When Assessing for Spatial Neglect: A Special Issue Review.

Spatial neglect (SN)-failure to respond to stimuli on the side of the body contralateral to a poststroke lesion-is one of the most disabling impairments for stroke survivors, and 80% of stroke survivors may have undetected SN. Occupational therapists' evaluations should include determining the impact of poststroke SN. To investigate occupational therapists' confidence, knowledge, current practices, barriers, and facilitators when assessing for SN in adult stroke survivors. A 30-item survey was created with guidance from stroke rehabilitation occupational therapists who reviewed the survey for face and content validity. Online survey. Occupational therapist survey responders (N = 76). Self-report assessments were used to measure occupational therapists' confidence in identifying SN, SN assessment practices, and barriers to and facilitators of SN assessment. Knowledge of SN signs and symptoms, neuroanatomy, and clinical presentation were measured with a three-question quiz. Eighty-one percent of the respondents reported a high level of confidence in identifying SN, and 70% reported routinely assessing for SN, with 81% using clinical observation rather than standardized tools as the primary assessment method. Barriers to SN assessment included time and resources. Most respondents, despite reporting high levels of confidence with routine SN assessments, did not use standardized SN measures and demonstrated suboptimal knowledge of SN. These results emphasize the need to increase clinical education about SN and its assessments. Plain-Language Summary: This study gathered baseline information on an underinvestigated topic-occupational therapists' education, confidence, current practices, barriers, and facilitators when assessing for spatial neglect in adult stroke survivors. The study results also contribute to future research on occupational therapists' current confidence and knowledge when assessing for spatial neglect.

A predictive model for social participation of middle-aged and older adult stroke survivors: the China Health and Retirement Longitudinal Study.

This study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors. The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA). A total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631-0.707) and 0.635 (95% CI 0.573-0.698), respectively. Hosmer-Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance. The nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

Feasibility of a self-management intervention to improve mobility in the community after stroke (SIMS): A mixed-methods pilot study.

To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.

MHealth App to improve medication adherence among older adult stroke survivors: Development and usability study.

Effective medication adherence is vital for older adult stroke survivors, yet 20-33% cease treatment within a year post-discharge, increasing risks of recurrent strokes and mortality. A mobile health (mHealth) app could be a novel tool to improve medication adherence among stroke survivors because of its potential to increase patient empowerment. A few stroke-related apps provide information and support to stroke survivors. However, none have focused on medication adherence and documented their development and evaluation process, particularly those focused on this older population. This study aims to design and develop a smartphone app called OASapp to improve medication adherence among older adult stroke survivors and evaluate its usability. OASapp was developed in a three-phase development process. Phase 1 is the exploration phase (including a cross-sectional survey, a systematic review, a search for stroke apps on the app stores of Apple App Store and Google Play Store, and a nominal group technique). In phase 2, a prototype was designed based on the Health Belief Model and Technology Acceptance Model. In phase 3, Alpha and Beta testing was conducted to validate the app. Twenty-five features for inclusion in the app were collected in round one, and 14 features remained and were ranked by the participants during nominal group technique. OASapp included five core components (medication management, risk factor management, health information, communication, and stroke map). Users of OASapp were satisfied based on reports from Alpha and Beta testing. The mean Usability Metric for User Experience (UMUX) score was 71.4 points (SD 14.6 points). OASapp was successfully developed using comprehensive, robust, and theory-based methods and was found to be highly accepted by users. Further research is needed to establish the clinical efficacy of the app so that it can be utilized to improve clinically relevant outcomes.

The Effectiveness of Constraint-Induced Movement Therapy versus Traditional Occupational Therapy on Upper Limb Function after Stroke

Background: Stroke significantly impacts upper limb function, necessitating effective rehabilitation strategies. Constraint-Induced Movement Therapy (CIMT) and Traditional Occupational Therapy (OT) are widely used, yet their comparative effectiveness in improving upper limb function remains to be fully established. Objective: The aim was to compare the effectiveness of CIMT and traditional OT in enhancing upper limb function in stroke survivors. The comparison was based on changes in the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and the Stroke Impact Scale (SIS). Methods: This randomized clinical trial involved 40 adult stroke survivors, who were assigned to either CIMT (n=20) or traditional OT (n=20). Assessments using FMA-UE and SIS were conducted before and after the intervention. Data analysis was conducted using SPSS 22.0, included within-group and between-group comparisons using repeated-measures ANOVA and paired t-tests. Results: Both CIMT and traditional OT groups showed significant improvements in FMA-UE and SIS scores. The CIMT group's FMA-UE scores improved from a mean of 43.26 to 47.36 (p=0.006), and SIS scores from 43.99 to 49.03 (p=0.009). The traditional OT group displayed more substantial improvements, with FMA-UE scores increasing from 42.71 to 48.89 (p=0.001), and SIS scores from 44.31 to 50.04 (p=0.007). Between-group analysis revealed no significant differences at baseline, but post-intervention, traditional OT showed significantly better outcomes compared to CIMT. Conclusion: Both CIMT and traditional OT are effective in improving upper limb function and reducing stroke impact. Traditional OT, however, demonstrated a slightly greater improvement. These findings underscore the importance of incorporating diverse therapeutic approaches in stroke rehabilitation, tailored to individual patient needs.

Head-Mounted Displays for Upper Limb Stroke Rehabilitation: A Scoping Review

Upper extremity (UE) paresis is one of the most frequent and disabling clinical consequences after stroke. Head-Mounted Displays (HMDs) are wearable virtual reality devices that seem effective in promoting the recovery of functional abilities by increasing adherence levels in this population. This scoping review is aimed at collecting available evidence on the use of HMD-based immersive virtual reality systems for UE rehabilitation treatment in stroke survivors. Four electronic bibliographic databases were consulted from inception until 18 January 2023. A total of 19 clinical trials in which HMDs were used as a clinical tool for increasing UE functioning, as a single intervention or in adjunct to other rehab treatments, were included; no restrictions were applied for UE paresis severity or stroke onset. The large majority of the clinical trials involved chronic stroke patients (15 out of 19), with a wide range of UE impairments. Overall, HMD use seemed to be well-tolerated and promising for increasing UE motor function in adult chronic stroke survivors, with benefits in subjects’ arm use and independence. The possibility of executing highly realistic and task-oriented movements appears to be promising in enhancing gesture relevance, thus promoting new motor strategies in a “virtual ecological way”. Across studies, we found a high heterogeneity in protocol design and a lack of reporting that prevents us drawing conclusions regarding potential subgroups of patients that could benefit more from HMD-based interventions or suggested treatment modalities.