Abstract
Background: Digital interventions provided through smartphones or the internet that are guided by a coach have been proposed as promising solutions to support the self-management of chronic conditions. However, digital intervention for poststroke self-management is limited; we developed the interactive Self-Management Augmented by Rehabilitation Technologies (iSMART) intervention to address this gap. Objective: This study aimed to examine the feasibility and initial effects of the iSMART intervention to improve self-management self-efficacy in people with stroke. Methods: A parallel, 2-arm, nonblinded, randomized controlled trial of 12-week duration was conducted. A total of 24 participants with mild-to-moderate chronic stroke were randomized to receive either the iSMART intervention or a manual of stroke rehabilitation (attention control). iSMART was a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. Feasibility measures included retention and engagement rates in the iSMART group. For both the iSMART intervention and active control groups, we used the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure to assess the feasibility, acceptability, and appropriateness, respectively. Health measures included the Participation Strategies Self-Efficacy Scale and the Patient-Reported Outcomes Measurement Information System’s Self-Efficacy for Managing Chronic Conditions. Results: The retention rate was 82% (9/11), and the engagement (SMS text message response) rate was 78% for the iSMART group. Mean scores of the Feasibility of Intervention Measure, Acceptability of Intervention Measure, and Intervention Appropriateness Measure were 4.11 (SD 0.61), 4.44 (SD 0.73), and 4.36 (SD 0.70), respectively, which exceeded our benchmark (4 out of 5), suggesting high feasibility, acceptability, and appropriateness of iSMART. The iSMART group showed moderate-to-large effects in improving self-efficacy in managing emotions (r=0.494), symptoms (r=0.514), daily activities (r=0.593), and treatments and medications (r=0.870), but the control group showed negligible-to-small effects in decreasing self-efficacy in managing emotions (r=0.252), symptoms (r=0.262), daily activities (r=0.136), and treatments and medications (r=0.049). In addition, the iSMART group showed moderate-to-large effects of increasing the use of participation strategies for management in the home (r=0.554), work (r=0.633), community (r=0.673), and communication activities (r=0.476). In contrast, the control group showed small-to-large effects of decreasing the use of participation strategies for management in the home (r=0.567), work (r=0.342, community (r=0.215), and communication activities (r=0.379). Conclusions: Our findings support the idea that iSMART was feasible to improve poststroke self-management self-efficacy. Our results also support using a low-cost solution, such as SMS text messaging, to supplement traditional therapeutic patient education interventions. Further evaluation with a larger sample of participants is still needed.
| Original language | English (US) |
|---|---|
| Article number | e50863 |
| Journal | JMIR Rehabilitation and Assistive Technologies |
| Volume | 11 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2024 |
Funding
The authors would like to thank graduate students, staff, and faculty members at Washington University and Shirley Ryan AbilityLab for their research assistantship, in-kind resource sharing, mentorship, and involvement in different aspects of the research. The contents of this publication and the writing effort of the last author were supported by grants from the American Occupational Therapy Foundation (AOTFIRG20Wong) and the National Center for Medical Rehabilitation Research (K01HD095388). The research reported in this publication was also supported by the National Institute of Mental Health (R34 MH118395) and the Washington University Mobile Health Research Core, part of the Institute of Clinical and Translational Sciences, funded by the National Center for Advancing Translational Sciences (UL1TR002345). The content is solely the authors’ responsibility and does not necessarily represent the official view of funding agencies. GEN has received research support from the National Institutes of Health (NIH), the Health Resources and Services Administration, the Barnes Jewish Hospital Foundation, the Washington University McDonnell Center for Systems Neuroscience, the Mallinckrodt Institute of Radiology, and the Usona Institute (drug only) and has served as a consultant for Alkermes, Inc, CarelonRx, Otsuka, and Sunovion. DCM reported research support from the NIH. He has served as a consultant for Otsuka Pharmaceuticals, Optum Behavioral Health, the Centerstone Research Institute, and the OneMind Foundation. He receives royalties from Oxford Press and has an ownership interest in Adaptive Health. SIL reported on research support from the NIH. MWMF has served as an independent contractor for Isaac Ray Forensic Group and Michigan Avenue Neuropsychologists. CLM has an ownership interest in Infinite Arms. He reported on subcontracts from the NIH and VA Headache Centers of Excellence. AWKW reported on research support from the NIH, the National Institute on Disability, Independence, and Rehabilitation Research, and the Craig H Neilsen Foundation. No other disclosures were reported.
Keywords
- digital intervention
- feasibility
- mobile health
- participation
- rehabilitation
- self-efficacy
- self-management
- stroke
- technology
- telehealth
- telemedicine
- text messaging
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Rehabilitation