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A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation
Mawson, S. Nasr, N. Parker, J. Davies, R. Zheng, H. Mountain, Gail
Mawson, S.
Nasr, N.
Parker, J.
Davies, R.
Zheng, H.
Mountain, Gail
Publication Date
2016
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© 2016 The Authors. This is an Open Access article distributed under the Creative Commons CC-BY license (http://creativecommons.org/licenses/by/2.0/)
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Yes
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openAccess
Accepted for publication
2015-11-11
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Abstract
In the United Kingdom, stroke is the most significant cause of adult disability. Stroke survivors are frequently
left with physical and psychological changes that can profoundly affect their functional ability, independence, and social
participation. Research suggests that long-term, intense, task- and context-specific rehabilitation that is goal-oriented and
environmentally enriched improves function, independence, and quality of life after a stroke. It is recommended that rehabilitation
should continue until maximum recovery has been achieved. However, the increasing demand on services and financial constraints
means that needs cannot be met through traditional face-to-face delivery of rehabilitation. Using a participatory design methodology,
we developed an information communication technology–enhanced Personalized Self-Managed rehabilitation System (PSMrS)
for stroke survivors with integrated insole sensor technology within an “intelligent shoe.”. The intervention model was based
around a rehabilitation paradigm underpinned by theories of motor relearning and neuroplastic adaptation, motivational feedback,
self-efficacy, and knowledge transfer.
To understand the conditions under which this technology-based rehabilitation solution would most likely have an
impact on the motor behavior of the user, what would work for whom, in what context, and how. We were interested in what
aspects of the system would work best to facilitate the motor behavior change associated with self-managed rehabilitation and
which user characteristics and circumstances of use could promote improved functional outcomes.
Methods: We used a Realist Evaluation (RE) framework to evaluate the final prototype PSMrS with the assumption that the
intervention consists of a series of configurations that include the Context of use, the underlying Mechanisms of change and the
potential Outcomes or impacts (CMOs). We developed the CMOs from literature reviews and engagement with clinicians, users,
and caregivers during a series of focus groups and home visits. These CMOs were then tested in five in-depth case studies with
stroke survivors and their caregivers.
Results: While two new propositions emerged, the second importantly related to the self-management aspects of the system.
The study revealed that the system should also encourage independent use and the setting of personalized goals or activities.
Conclusions: Information communication technology that purports to support the self-management of stroke rehabilitation
should give significant consideration to the need for motivational feedback that provides quantitative, reliable, accurate,
context-specific, and culturally sensitive information about the achievement of personalized goal-based activities.
Version
Published version
Citation
Mawson S, Nasr N, Parker J et al (2016) A personalized self-management rehabilitation
system with an intelligent shoe for stroke survivors: a realist evaluation. JMIR Rehabilitation and
AssistiveTechnologies. 3(1): e1.
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Article