Feasibility of an iterative rehabilitation intervention for stroke delivered remotely using mobile health technology

Abstract

Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology.

Methods: We conducted a sequential descriptive case series study (n = 5) in which community-dwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).

Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5).

Conclusions: Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.

Implications for rehabilitation

• Translating the strategy training intervention from face-to-face to remote delivery required thoughtful adaptation of the intervention protocol.

• Strategies for training clients to use mobile health technology during intervention may be important when designing remotely delivered mHealth intervention protocols.

• Client safety should be considered within the design of the intervention protocol for a complex intervention designed to be delivered remotely.

• Future studies should examine the efficacy of complex rehabilitation interventions such as strategy training on clinical outcomes (e.g., community participation).

Keywords:

• mHealth
• stroke rehabilitation
• strategy training
• community participation
• CO-OP

Acknowledgements

Devra Alper, MOT, OTR/L; Lauren Byrnes, BA; Christine Daeschner, MOT, OTR/L; Traci Herc, MOT, OTR/L; Stephanie Rouch, MOT, OTR/L; Chao-Yi Wu, PhD, MS, COT

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (90RE5018, Dr. Parmanto) and the National Institutes of Health (R01 HD074693, Dr. Skidmore), and the National Center for Medical Rehabilitation Research (Dr. Skidmore).