Mawson Susan, Nasr Nasrin, Parker Jack, Davies Richard, Zheng Huiru, Mountain Gail
Rehabilitation and Assistive Technology Research Group, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
Computer Science Research Institute, School of Computing and Mathematics, Ulster University, County Antrim, United Kingdom.
JMIR Rehabil Assist Technol. 2016 Jan 7;3(1):e1. doi: 10.2196/rehab.5079.
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.
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. 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.
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.
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.
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, accurate, context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.
在英国，中风是导致成人残疾的最主要原因。中风幸存者常常会出现身体和心理上的变化，这些变化会深刻影响他们的功能能力、独立性和社会参与度。研究表明，长期、高强度、针对特定任务和情境、以目标为导向且环境丰富的康复训练能够改善中风后的功能、独立性和生活质量。建议康复训练应持续进行，直至达到最大程度的恢复。然而，对服务需求的不断增加以及资金限制意味着无法通过传统的面对面康复服务来满足这些需求。我们采用参与式设计方法，为中风幸存者开发了一种信息通信技术增强的个性化自我管理康复系统（PSMrS），该系统在“智能鞋”中集成了鞋垫传感器技术。干预模型基于运动再学习和神经可塑性适应、动机反馈、自我效能感和知识转移等理论支撑的康复范式。
了解这种基于技术的康复解决方案最有可能在哪些条件下对用户的运动行为产生影响，对谁有效、在何种情境下有效以及如何有效。我们关注系统的哪些方面最有助于促进与自我管理康复相关的运动行为改变，以及哪些用户特征和使用情境能够促进功能改善。
我们使用现实主义评价（RE）框架对最终的PSMrS原型进行评估，假设干预由一系列配置组成，包括使用情境、潜在的变化机制和可能的结果或影响（CMOs）。我们通过文献综述以及在一系列焦点小组和家访中与临床医生、用户和护理人员的交流来确定CMOs。然后，在对五名中风幸存者及其护理人员进行的深入案例研究中对这些CMOs进行测试。
虽然出现了两个新的命题，但第二个命题尤其与系统的自我管理方面相关。研究表明，该系统还应鼓励独立使用并设定个性化目标或活动。
旨在支持中风康复自我管理的信息通信技术应充分考虑提供动机反馈的必要性，这种反馈要提供关于基于个性化目标的活动达成情况的定量、可靠、准确、特定情境且具有文化敏感性的信息。
