Multimodal Ambulatory Monitoring of Daily Activity and Health-Related Symptoms in Community-Dwelling Survivors of Stroke: Feasibility, Acceptability, and Validity

  • Stephen C.L. Lau
    Corresponding author Stephen C.L. Lau, BS, Program in Occupational Therapy, Washington University School of Medicine, 600 S Taylor Ave 00163, St Louis, MO 63110.
    Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO
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  • Lisa Tabor Connor
    Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO

    Department of Neurology, Washington University School of Medicine, St Louis, MO
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  • Allison A. King
    Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO

    Department of Medicine, Washington University School of Medicine, St Louis, MO

    Department of Pediatrics, Washington University School of Medicine, St Louis, MO

    Department of Surgery, Washington University School of Medicine, St Louis, MO

    Department of Education, Washington University School of Medicine, St Louis, MO
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  • Carolyn M. Baum
    Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO

    Department of Neurology, Washington University School of Medicine, St Louis, MO

    Brown School of Social Work, Washington University in St Louis, St Louis, MO
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      To examine the feasibility, acceptability, and validity of multimodal ambulatory monitoring, which combines accelerometry with ecological momentary assessment (EMA), to assess daily activity and health-related symptoms among survivors of stroke.


      Prospective cohort study involving 7 days of ambulatory monitoring; participants completed 8 daily EMA surveys about daily activity and symptoms (mood, cognitive complaints, fatigue, pain) while wearing an accelerometer. Participants also completed retrospective assessments and an acceptability questionnaire.




      Forty survivors of stroke (N=40).


      Not applicable.

      Main Outcome Measures

      Feasibility was determined using attrition rate and compliance. Acceptability was reported using the acceptability questionnaire. Convergent and discriminant validity were determined by the correlations between ambulatory monitoring and retrospective self-reports. Criterion validity was determined by the concordance between accelerometer-measured and EMA-reported daily activity.


      All participants completed the study (attrition rate=0%). EMA and accelerometer compliance were 93.6 % and 99.7%, respectively. Participants rated their experience with multimodal ambulatory monitoring positively. They were highly satisfied (mean, 4.8/5) and confident (mean, 4.7/5) in using ambulatory monitoring and preferred it over traditional retrospective assessments (mean, 4.7/5). Multimodal ambulatory monitoring estimates correlated with retrospective self-reports of the same and opposing constructs in the predicted directions (r=−0.66 to 0.72, P<.05). More intense accelerometer-measured physical activity was observed when participants reported doing more physically demanding activities and vice versa.


      Findings support the feasibility, acceptability, and validity of multimodal ambulatory monitoring in survivors of mild stroke. Multimodal ambulatory monitoring has potential to provide a more complete understanding of survivors’ daily activity in the context of everyday life.


      List of abbreviations:

      EMA (ecological momentary assessment), MET (metabolic equivalent), Neuro-QoL (Quality of Life in Neurological Disorders), PHQ-9 (Patient Health Questionnaire-9), PIEL (Participation in Everyday Life), PSQI (Pittsburgh Sleep Quality Index)
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