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    A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation

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    Publication date
    2016
    Author
    Mawson, S.
    Nasr, N.
    Parker, J.
    Davies, R.
    Zheng, H.
    Mountain, Gail
    Keyword
    Stroke; Self-management; Design; Realist evaluation; Sensor technology; Equipment design; Telehealth; Self-care
    Rights
    ©Susan Mawson, Nasrin Nasr, Jack Parker, Richard Davies, Huiri Zheng, Gail Mountain. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 07.01.2016. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Rehabilitation and Assistive Technology, is properly cited. The complete bibliographic information, a link to the original publication on http://rehab.jmir.org/, as well as this copyright and license information must be included.
    Peer-Reviewed
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    Abstract
    Background: 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. Objective: 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.
    URI
    http://hdl.handle.net/10454/11036
    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.
    Link to publisher’s version
    http://dx.doi.org/10.2196/rehab.5079
    Type
    Article
    Collections
    Health Studies Publications

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