JMIR Publications

ABSTRACT

Background:

Stroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. MHealth solutions can help fill this gap. MRehab was designed to guide individuals with stroke through a home program and provide performance feedback.

Objective:

To examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments.

Methods:

MRehab consists of a smartphone coupled with three-dimensional printed household items: mug, bowl, key and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task oriented activities were categorized as 1) object transportation, 2) prehensile grip with supination/pronation, 3) fractionated finger movement, 4) walking with object. Eighteen individuals with stroke enrolled in the single-subject experimental design study consisting of pre-testing, a six-week mRehab home program and post-testing. Pre and post testing included both in-lab clinical assessments and in-home mRehab recorded samples of task performance. During the six week home program, mRehab recorded performance data. A System Usability Scale assessed user’s perception of mRehab.

Results:

Sixteen participants completed the study and are represented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t(15)=2.555, P=.022) and smoothness (t(15)=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t(15)=2.675, P=.017) and hand dexterity (t(15)=2.629, P=.019). Participant’s perception of mRehab was positive.

Conclusions:

Despite heterogeneity in participants’ use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes. Clinical Trial: NCT04363944 (retrospectively assigned)