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

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    Authors
    Mawson, Susan
    Nasr, Nasrin
    Parker, Jack cc
    Davies, Richard
    Zheng, Huiru
    Mountain, Gail
    Affiliation
    University of Sheffield
    Ulster University, Belfast
    Issue Date
    2016-01-07
    
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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. 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. 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. 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.
    Citation
    Mawson, S., Nasr, N., Parker, J., Davies, R., Zheng, H. and Mountain, G., (2016). 'A personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation'. JMIR rehabilitation and assistive technologies, 3(1), pp. 1-12.
    Publisher
    JMIR Publications Inc.
    Journal
    JMIR Rehabilitation and Assistive Technologies
    URI
    http://hdl.handle.net/10545/624995
    DOI
    10.2196/rehab.5079
    Additional Links
    https://rehab.jmir.org/2016/1/e1/
    http://eprints.whiterose.ac.uk/119003/
    Type
    Article
    Language
    en
    EISSN
    2369-2529
    ae974a485f413a2113503eed53cd6c53
    10.2196/rehab.5079
    Scopus Count
    Collections
    School of Human Sciences

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