Mobile health to promote physical activity in people post stroke or transient ischemic attack – study protocol for a feasibility randomised controlled trial

Abstract

Background Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden. Methods One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments. Discussion We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA. Trial registration ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Acceptability of two mobile applications to support cross-sectoral, person-centred and empowering stroke rehabilitation – a process evaluation

“…Prescribed video recorded exercises are to our knowledge mostly generic recordings performed by healthy individuals without any deficits, which can affect stroke survivors’ motivation and make it hard to relate to as mentioned in this study. Although, a recent study protocol describe the use of people with stroke-related disabilities in their prescribed instructional generic video recordings to promote physical activity among stroke survivors [ 62 ], the results from our study indicate that recordings of the stroke survivor themselves support the experience of ‘clarity’, ‘necessity’, ‘ableness’, and a sense of progress.…”

Motivational strategies used by health care professionals in stroke survivors in rehabilitation: a scoping review of experimental studies

“…Among the included studies ( Table 2 ), five were conducted in Australia ( 35 , 36 , 42 , 44 , 45 ) two in China ( 47 , 48 ), two in Israel ( 43 , 50 ), one in the Netherlands ( 37 ) one in Norway ( 38 ), one in France ( 40 ) one in Denmark ( 39 ), one in Spain ( 41 ) one in Thailand ( 46 ), one in Ghana ( 49 ), and one in Sweden ( 51 ).…”

“…These past performances can serve as potent influences in cultivating self-efficacy. In this context, several studies have been identified that applied strategies such as the establishment of a therapeutic alliance ( 39 , 41 , 44 , 47 , 48 , 50 ), enhancing health literacy ( 35 – 37 , 40 – 42 , 44 – 49 , 51 ), setting achievable goals ( 38 , 40 – 42 , 44 – 48 , 50 , 51 ), personalizing rehabilitation programs ( 37 – 42 , 44 , 46 – 49 , 51 ), and honing problem-solving skills ( 39 , 42 – 47 , 50 , 51 ).…”

“…One study used computer-generated personalized written information to create a tailored booklet based on the patient’s informational needs ( 35 ). Furthermore, Tangnitipong et al ( 46 ) and Thurston et al ( 51 ) complemented stroke education with educational videos ( Table 3 ).…”

“…Various strategies directed toward persuasion and encouragement have been identified. Studies described the benefits of engaging in physical activities, informing individuals about the consequences of their actions (or inaction), and encouraging them to consider the costs and benefits of their behavior carefully ( 36 , 38 , 39 , 41 , 44 – 49 , 51 ).…”