Abstract
Objective
To validate and characterize real-world functional behaviors in individuals after
stroke.
Design
Longitudinal observational study using ecological momentary assessment (EMA) as a
real-time assessment of functional behaviors in natural contexts. Wilcoxon rank-sum
tests, Fisher exact tests, and Spearman correlations were used to analyze data.
Setting
Community.
Participants
Individuals with mild to moderate stroke (N=212).
Interventions
Not applicable.
Main Outcome Measures
Individuals were assessed 5 times daily for 14 days with EMA surveys to determine
what, with whom, and where individuals were doing activities and appraise mental,
somatic, and cognitive symptoms. Individuals also completed standardized assessments
during laboratory visits, including Lawton Instrumental Activities of Daily Living
Scale, Activity Card Sort, Patient-Reported Outcome Measurement Information System,
and Quality of Life in Neurological Disorders.
Results
Most individuals (median age, 60 years; 55% male) were ischemic stroke (90%) and had
mild stroke severity (median National Institutes of Health Stroke Scale, 2). A total
of 14,140 EMA surveys were analyzed. Individuals were home 78% of the time; primarily
participated in passive, unproductive activities (27%), especially watching television
and resting; and participated least in physical activities (4%). EMA was sensitive
to indicators of poststroke disability; unemployed individuals reported fewer vocational
activities but more activities of daily living (ADL) and passive activities than employed
counterparts. Users of mobility devices and individuals with cognitive problems spent
significantly less time on vocational activities and more on ADL than nonusers and
those without cognitive problems. Our data supported the validity of EMA methods in
stroke, with small to moderate correlations of EMA with in-laboratory measures of
daily functioning (r=−0.30 to 0.35, P<.05) and very large correlations between EMA and in-laboratory measures of symptoms,
especially those measuring same constructs (r=−0.64 to 0.79, P<.0001).
Conclusions
Our findings reveal that EMA tracked poststroke functioning precisely. EMA may be
beneficial in examining poststroke functional recovery, in monitoring patients for
home-based interventions, and for longitudinal research.
Keywords
List of abbreviations:
ADL (Activities of Daily Living), EMA (Ecological Momentary Assessment), HIV+ (Human Immunodeficiency Virus Infection), IADL (Instrumental Activities of Daily Living), IQR (Interquartile Range), mRS (Modified Rankin Scale), NeuroQoL (Quality of Life in Neurological Disorders), NIHSS (National Institutes of Health Stroke Scale), PROMIS (Patient-Reported Outcome Measurement Information System), TBI (Traumatic Brain Injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 08, 2022
Accepted:
February 14,
2022
Received in revised form:
January 25,
2022
Received:
November 22,
2021
Footnotes
Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Center for Medical Rehabilitation Research (NICHD/ NCMRR) (K01HD095388) and the NICHD and National Institute of Neurological Disorders and Stroke (NINDS)–funded Center for Smart Use of Technologies to Assess Real-world Outcomes (C-STAR) (P2CHD101899). The American Occupational Therapy Foundation (AOTFIRG20Wong) supported a portion of Dr Wong's effort for developing the manuscript.
Disclosures: none
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
