JMIR Publications

ABSTRACT

Background:

Information and communication technology (ICT) has the potential to bridge the post-acute stroke care gap by facilitating home-based rehabilitation. However, evidence on usability and adoption of ICT-based rehabilitation programs in Asian health care settings is limited.

Objective:

This study aimed to evaluate the usability and satisfaction of a tablet-based comprehensive management program for post-acute stroke patients within the Korean Model for Post-Acute Comprehensive Rehabilitation (KOMPACT) project and to identify patient characteristics associated with acceptable usability.

Methods:

This multicenter prospective cohort study enrolled post-acute stroke patients discharged home within 30 days of onset from 3 university hospitals. Participants used a tablet-based program encompassing medication guidance, rehabilitation content (physical, occupational, swallowing, and language therapy), clinic scheduling, and social welfare information. The System Usability Scale (SUS), satisfaction survey (5-point Likert scale), usage patterns, and narrative feedback were assessed at 1 month post-discharge and 3 months post-onset. Mann-Whitney U tests, Cohen d effect sizes, and Firth’s penalized logistic regression were used to identify factors associated with acceptable usability (SUS ≥68).

Results:

Of 24 enrolled patients (mean age 62.5, SD 9.1 years; 17 male), 22 completed the 1-month evaluation and 8 completed the 3-month evaluation. The mean SUS score at 1 month was 60.34 (SD 17.48), below the acceptable threshold of 68. Patients younger than 65 years scored significantly higher than older patients (68.3 vs 50.8; P=.019). Only 6 of 22 participants (27%) achieved SUS ≥68. The SUS ≥68 group was younger (56.2 vs 64.2 years), had higher cognitive function (Korean Mini-Mental State Examination 27.5 vs 24.2), lower depressive symptoms (Patient Health Questionnaire-9 1.3 vs 6.0), and greater daily usage time (3.0 vs 1.8 hours; P=.03). Satisfaction scores ranged from 3.68 to 4.23 out of 5, with patients with lower ambulatory function (Functional Ambulatory Category 3) reporting significantly higher satisfaction (P=.019).

Conclusions:

This multi-domain ICT-based program demonstrated moderate but suboptimal usability and generally acceptable satisfaction. No clinical predictor of acceptable usability reached statistical significance, attributable to the critically limited sample (n=6 events; EPV=0.86); however, descriptive analyses revealed large-to-medium effect sizes for age, depressive symptoms, cognitive function and ambulatory function as clinically plausible, hypothesis-generating signals. Higher satisfaction among patients with lower ambulatory function suggests the program was most beneficial for those with greater unmet rehabilitation needs. These findings underscore the need to tailor interface design and content delivery to patients' age, cognitive, and functional levels to optimize ICT adoption in post-acute stroke rehabilitation.