A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

Abstract

Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237

Topics Mentioned by Stroke Patients during Supportive Phone Calls—Implications for Individualized Aftercare Programs

“…This finding might indicate that patients are aware of these topics, which could be seen as a success since these elements became part of the patients’ knowledge. The hypothesis that patients are particularly interested in their health might be supported by an observation made in another study looking at stroke patients supported by a message system, where most of them chose their health as a significant goal domain to be addressed in stroke aftercare [ 35 ]. On the other hand, the results of this study could also suggest that problems in these areas arose during aftercare.…”

Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies

“…Bowman [ 22 ] argued that assessing whether a documented goal is achievable/attainable or relevant/realistic required knowledge of the service-user’s circumstances and context and, as such, could not be accurately assessed by reviewing documentation alone. Instead, activity-based and review were included to reflect the importance of important goal aspects including clearly specifying behaviours and providing regular feedback [ 23 ]. The SMART-GEM does not assess how the goals were determined but instead assumes that a clear understanding of key needs and a collaborative approach to goal planning is undertaken [ 24 ].…”

Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial

“…Therefore, hospital staff, participants, outcome assessors, and trial biostatisticians are unaware of group allocation. To ensure that blinding of participants to group allocation is maintained, the trial is described in the patient information and consent form in general terms as “providing post-hospital discharge support” [ 8 ]. Specifically, intervention approaches were broadly described in the patient information and consent form as including the “setting of specific recovery goals with trained clinicians, receiving electronic self-management information sent via SMS or email, and participation in follow-up assessments”.…”