School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
PLoS One. 2019 Jan 25;14(1):e0210725. doi: 10.1371/journal.pone.0210725. eCollection 2019.
Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed at delivering speech and cognitive therapy.
We recruited a convenience sample of 30 acute stroke patients to use RecoverNow for up to 3 months. Allied health professionals assigned specific applications based on standard of care assessments. Participants were encouraged to take home the RecoverNow tablets upon discharge from acute care. The study team contacted participants to return for a follow-up interview 3 months after enrollment. The primary outcome of interest was feasibility, defined using 5 facets: recruitment rate, adherence rate, retention rate, the proportion of successful follow-up interventions, and protocol deviations. We tracked barriers to tablet-based care as a secondary outcome.
We successfully recruited 30 of 62 eligible patients in 15 weeks (48% recruitment rate). Participants were non-adherent to tablet-based therapy inside and outside of acute care, using RecoverNow for a median of 12 minutes a day. Retention was high with 23 of 30 patients participating in follow-up interviews (77% retention rate) and all but 3 of the 23 interviews (87%) were successfully completed. Only 2 major protocol deviations occurred: one enrollment failure and one therapy protocol violation. Barriers to tablet-based care were frequently encountered by study participants with many expressing the assigned applications were either too easy or too difficult.
Acute stroke patients are interested in attempting tablet-based stroke rehabilitation and are easily recruited early post-stroke. However, tablet-based therapy may be challenging due to patient, device and system-related barriers. Reducing the frequency of common barriers will be essential to keeping patients engaged in tablet-based therapy.
脑卒中幸存者常经历多种卒中后缺陷。专门的卒中康复可促进恢复，尤其是在卒中后早期开始康复治疗时。然而，资源限制常常使早期康复治疗无法实现。移动技术可能为卒中幸存者提供一个平台，使他们即使在无法进行其他治疗时也能开始康复。本研究旨在展示 RecoverNow 的可行性，这是一个基于平板电脑的卒中康复平台，旨在提供言语和认知治疗。
我们招募了 30 名急性卒中患者作为便利样本，使用 RecoverNow 进行治疗，最长可达 3 个月。根据标准评估，联合健康专业人员指定特定的应用程序。鼓励参与者在急性护理出院后将 RecoverNow 平板电脑带回家。研究团队在入组后 3 个月时联系参与者进行随访访谈。主要观察指标为可行性，通过 5 个方面来定义：招募率、依从率、保留率、成功随访干预的比例和方案偏离。我们将基于平板电脑的治疗障碍作为次要结果进行跟踪。
我们在 15 周内成功招募了 62 名合格患者中的 30 名（48%的招募率）。参与者在急性护理期间和之外均不依从基于平板电脑的治疗，每天使用 RecoverNow 的中位数为 12 分钟。保留率较高，30 名患者中有 23 名参加了随访访谈（77%的保留率），除 3 名外，其余 23 名访谈（87%）均成功完成。仅发生 2 例主要方案偏离：1 例入组失败和 1 例治疗方案违反。研究参与者经常遇到基于平板电脑的治疗障碍，许多人表示分配的应用程序要么太简单，要么太难。
急性卒中患者有兴趣尝试基于平板电脑的卒中康复，并且在卒中后早期很容易招募。然而，由于患者、设备和系统相关障碍，基于平板电脑的治疗可能具有挑战性。减少常见障碍的频率对于保持患者对基于平板电脑的治疗的参与至关重要。
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