Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke) (Preprint)

Abstract

BACKGROUND Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. OBJECTIVE The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. METHODS This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. RESULTS A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic B<i>P</i><125 mm Hg (18/54, 33% vs 11/52, 21%; <i>P</i>=.16), diastolic B<i>P</i><85 mm Hg (44/54, 81% vs 37/52, 71%; <i>P</i>=.21), HbA<sub>1c</sub> level<7% (36/55, 65% vs 30/40, 75%; <i>P</i>=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; <i>P</i>=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (<i>P</i><.001). CONCLUSIONS The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. CLINICALTRIAL ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330

Aplicaciones móviles para el autoaprendizaje en el cuidador del adulto mayor con accidente cerebrovascular: Revisión integradora

“…Los estudios describen las funciones de la aplicación, el uso operativo para el acceso, manejo e implementación en el hogar, además indica los contenidos educativos que la integran. Sin embargo, de las apps que se describieron en resultados según las directrices de evaluación metodológica y nivel de evidencia, sólo el estudio de Kamalet al cuenta con bases sólidas y metodológicas diseñadas para brindar educación y cuidados a ejecutar en el hogar por cuidadores que regresan a la comunidad, con usuarios con secuelas de ACV en las dimensiones cognitivas y físicas 30,32 . Cabe resaltar que las aplicaciones digitales fueron en teléfonos inteligentes; en los resultados y conclusiones los estudios indican que la multifuncionalidad de las apps son útiles y de gran utilidad para los pacientes, cuidadores y profesionales del cuidado.…”

“…El segundo resultado fue el de Kamal 30 et al, evaluó la eficacia y seguridad de la aplicación móvil Movies4Stroke como estrategia educativa digital basada en videos para controlar la presión arterial, glucosa y colesterol en un grupo de intervención de 77 pacientes sobrevivientes de accidente cerebrovascular y sus cuidadores primarios. El estudio también buscó evaluar la efectividad de las películas de 5 minutos diseñadas localmente y distribuidas temáticamente en un programa de tres meses para brindar educación posterior al accidente cerebrovascular a las 78 personas sobrevivientes y sus cuidadores que regresan a la comunidad: una intervención educativa convencional.…”

Machine learning algorithms assisted identification of post-stroke depression associated biological features

“…Modified Rankin Scale (mRS) was used to estimate the functional disability (Liu et al, 2018). Independence and level of activities of daily life (ADL) were evaluated with the Barthel index (Kamal et al, 2020). For research purposes, a blood sample (10 ml) was taken from each subject for further ELISA assessment when they completed the HAMD assessment.…”