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Mawson S.1, Parker J.1, Nasr N.1, Zheng H.2, Davies R.2, Mountain G.3
1University of Sheffield, ScHARR, Sheffield, United Kingdom, 2Ulster University, Computer Science Research Institute, Belfast, United Kingdom, 3University of Bradford, School of Dementia Studies, Bradford, United Kingdom
Background: In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently left with physical and psychological changes that can profoundly affect their functional ability, independence, and social participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology, we developed an information communication technology-enhanced Personalized Self-Managed rehabilitation System (PSMrS) for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback, self-efficacy, and knowledge transfer.
Purpose: To understand the conditions under which this technology-based rehabilitation solution would most likely have an impact on the motor behavior of the user, what would work for whom, in what context, and how. The aim of this aspect of the research programme was to understand the conditions under which this technology based rehabilitation solution would most likely have an impact (outcome) on the motor behaviour of the user, what would work for whom, in what context, and in what respects We were interested in what aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and which user characteristics and circumstances of use could promote improved functional outcomes.
Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users, and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with stroke survivors and their caregivers.
Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system.
The study revealed that the system should also encourage independent use and the setting of personalized goals or activities.
Conclusion(s): Information communication technology that purports to support the self-management of stroke rehabilitation should give significant consideration to the need for motivational feedback that provides quantitative, reliable, and accurate context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.
Implications: Radical innovation and the adoption of a self-management paradigm need to be considered as a way of delivering home-based post-stroke rehabilitation.
A hybrid of health and social sciences research and user-centred design methods are required to ensure that technology for post-stroke rehabilitation has been driven by the needs of the stroke survivors and their carers.
Personalised technology systems for self-managed post-stroke rehabilitation have the potential to change motor behaviour and promote the achievement of life goals for stroke survivors.
Funding acknowledgements: Funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber
Topic: Neurology: stroke
Ethics approval: Ethics approval was obtained through Leeds Ethics committee number [08/H1306/46] Yorkshire and Humber, UK
All authors, affiliations and abstracts have been published as submitted.
