Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol

Abstract

Context: Stroke has several consequences on survivors’ daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients.Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants’ self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures.Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge.Trial registration: European Clinical Trials Database Number 2014-A01937-40

Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon

“…Many studies indicated the persistence and mutuality of post-stroke anxiety (Cumming et al, 2016). Through our investigation, the frequency of anxiety (51.7%) was not consistent with other studies that demonstrated lower frequency after 3 months of stroke, with an estimated prevalence ranging between 18 and 38% (Barker-Collo, 2007;Ayerbe et al, 2014;Vansimaeys et al, 2017). The high level of anxiety in Lebanon could be related to the lack of rehabilitative services following stroke, the lack of social and psychological support for the survivor, and the high burden of physical disability on them.…”

“…Classically, a score of eight or more for each subscale is used as a cut-off score in studies to distinguish between cases of depression and anxiety and the unharmed. This cut-off point is also frequently used in the population of stroke and has adequate specificity and sensitivity in recognition of depression and anxiety disorders after stroke (Vansimaeys et al, 2017 ). The Arabic validated version of HADS was used in our study (Al Aseri et al, 2015 ).…”

“…It is associated with disorders affecting attention, memory, psychomotor speed, orientation, language, and executive/motor functions (Bolla-Wilson et al, 1989 ; Kauhanen et al, 1999 ). It was demonstrated that the reported prevalence of PSD ranges between ~20 and 40% (Barker-Collo, 2007 ; De Wit et al, 2008 ; Ayerbe et al, 2011 , 2013 ; Vansimaeys et al, 2017 ).…”

A Library of Analytic Indicators to Evaluate Effective Engagement with Consumer mHealth Apps for Chronic Conditions: Scoping Review

“…We coded studies reporting unrestricted data collection as number of measures and coded studies reporting restricted data collection as number of modules . A range of studies measured the number of outcome surveys completed from those assigned [45,68,75]. Others assessed the number of videos watched from a playlist [36,55], educational modules completed [52], or self-care advice accessed [69].…”

A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

“…To date, seven studies used EMA across acute to chronic stroke survivors to study post-stroke depressive symptoms, 16,[33][34][35][36][37][38] two other studies report about fatigue, 39,40 and one focuses on the interaction between social interactions, pain, fatigue, and mood. 41 EMA provides insights on the fluctuation of mood in daily life, 34,42,43 the behavioral risk factors for depression, 16,35,36 and the impact of early social contact and support on longterm depression and daily life functioning. 33 EMA was also used in combination with magnetic resonance imaging (MRI) to characterize the association between depressive symptoms in daily life and cerebellar volume.…”