JMIR Publications

ABSTRACT

Background:

Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases.

Objective:

We have developed and aimed to evaluate the effect of a smartphone-based mHealth system for health-behavior management and risk factor control in stroke patients.

Methods:

With a multifaceted stroke aftercare management system including exercise, medication, and education materials, we performed a 12-week single-arm intervention in eligible post-stroke patients in stroke clinic from September to December 2016. The intervention consisted of 1) regular blood pressure (BP), blood glucose, and physical activity measurements, 2) stroke education, 3) exercise program, 4) medication program, and 5) feedback with reviewing of records by clinicians. Clinical assessments consisted of stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences of parameters over 12 weeks were investigated with repeated-measures analyses of variance. Changes of medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with self-questionnaire using the five-level Likert scale at visit 3.

Results:

The study was approved by the Institutional Review Board in September 2016 and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 participants were included in our analyses. Stroke awareness score (baseline: 59.6±18.1; 4 weeks: 67.6±16.0, p< .001; 12 weeks: 74.7±14.0, p < .001) and BDI (baseline: 12.7±10.1; 4 weeks: 11.2±10.2, p=.011; 12 weeks: 10.7±10.2, p < .001) showed gradual improvement; however, no significant differences were found in EQ-5D score (baseline: 0.66±0.33; visit 2: 0.69±0.34, p=.011; visit 3: 0.69±0.34, p< .001). Twenty-six patients who had uncontrolled BP at baseline had a -13.92 (p=.0010) and -6.19 mmHg (p<.001) decrement on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance were ameliorated at visit 2-3 (60.9 ± 37.2%) when compared to visit 1-2 (47.8 ± 38.7%, p<.001).

Conclusions:

Awareness of stroke, depression, and BP were enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques hold potential as a new non-pharmacological secondary prevention method because of its ubiquitous access, near real-time responsiveness, and comparatively lower cost. Clinical Trial: No