Adcock Amelia K, Haggerty Treah, Crawford Anna, Espinosa Cristal
Cerebrovascular Division, West Virginia University, Morgantown, WV, USA.
Obesity Medicine, West Virginia University, Morgantown, WV, USA.
Mhealth. 2022 Apr 20;8:19. doi: 10.21037/mhealth-21-27. eCollection 2022.
A fundamental gap between clinical prevention and self-management awareness heightens the risk for stroke recurrence in approximately one-fourth of the highest risk stroke survivors annually. Secondary stroke prevention has the potential to be promoted by mobile health (mHealth) applications for effective real-world adoption of vascular risk factor mitigation. This scoping review aims to evaluate the impact of mHealth interventions and their effectiveness to reduce recurrent stroke rates among stroke survivors in randomized controlled trials (RCTs).
Scoping review in Ovid Medline, Cochrane Library, CINAHL, and Scopus for RCT literature employing mHealth among stroke populations published in English from 2010 to November 19, 2020. Small or pilot studies that included randomized design were included.
A total of 352 abstracts met inclusion criteria; 31 full-text articles were assessed and 18 unique RCTs involving 1,453 patients ultimately fulfilled criteria. Twelve of 18 met the pre-defined primary outcome measure, including 2 studies evaluating feasibility. Eight of 18 only addressed recovery from index stroke deficits. Most outcomes focused on self-reported functional status, mood, quality of life or compliance with intervention; primary outcome was an objective metric in 4/18 (blood pressure readings, step number, obstructive sleep apnea support compliance). Intervention duration 2-12 months, with a median 9 weeks.
No high-quality evidence supporting mHealth applications to reduce recurrent stroke was found in this scoping review. Overall, most studies were relatively small, heterogenous, and employed subjective primary outcome measures. mHealth's potential as an effective tool for stroke stakeholders to reduce recurrent stroke rates has not been sufficiently demonstrated in this review. Future randomized studies are needed that explicitly evaluate stroke recurrence rate.
临床预防与自我管理意识之间的根本差距使约四分之一的高风险卒中幸存者每年面临卒中复发风险增加的问题。移动健康（mHealth）应用程序有可能促进二级卒中预防，从而在现实世界中有效降低血管危险因素。本综述旨在评估mHealth干预措施在随机对照试验（RCT）中对卒中幸存者降低卒中复发率的影响及其有效性。
在Ovid Medline、Cochrane图书馆、CINAHL和Scopus中进行综述，以查找2010年至2020年11月19日以英文发表的在卒中人群中采用mHealth的RCT文献。纳入包括随机设计的小型或试点研究。
共有352篇摘要符合纳入标准；评估了31篇全文文章，最终有18项涉及1453名患者的独特RCT符合标准。18项研究中有12项达到了预先定义的主要结局指标，包括2项评估可行性的研究。18项研究中有8项仅涉及首次卒中后功能缺损的恢复情况。大多数结局指标集中在自我报告的功能状态、情绪、生活质量或对干预的依从性；18项研究中有4项（血压读数、步数、阻塞性睡眠呼吸暂停支持依从性）的主要结局指标是客观指标。干预持续时间为2至12个月，中位数为9周。
在本综述中未发现支持mHealth应用程序降低卒中复发的高质量证据。总体而言，大多数研究规模相对较小、异质性较大，且采用主观的主要结局指标。本综述中尚未充分证明mHealth作为卒中相关人员降低卒中复发率的有效工具的潜力。未来需要进行明确评估卒中复发率的随机研究。
