mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties

Abstract

Purpose

We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice.

Materials and methods

Using Arksey and O’Malley’s framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts.

Results

Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill.

Conclusions

This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one’s individual objective.

Implications for Rehabilitation

• Rehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.

• Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.

• Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.

• Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.

Keywords:

• mHealth
• scoping review
• stroke
• wearable sensors
• smartphone applications

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

CTP is supported by FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo − 2019/05658-0; MD is supported by the Fonds de la Recherche en Santé du Québec; Dr Susanne Hempel is supported by the Gehr Family Center for Health Systems Science and Innovation.