Cargando…
A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation
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, int...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications Inc.
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454551/ https://www.ncbi.nlm.nih.gov/pubmed/28582250 http://dx.doi.org/10.2196/rehab.5079 |
_version_ | 1783240847954804736 |
---|---|
author | Mawson, Susan Nasr, Nasrin Parker, Jack Davies, Richard Zheng, Huiru Mountain, Gail |
author_facet | Mawson, Susan Nasr, Nasrin Parker, Jack Davies, Richard Zheng, Huiru Mountain, Gail |
author_sort | Mawson, Susan |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5454551 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | JMIR Publications Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-54545512017-06-07 A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation Mawson, Susan Nasr, Nasrin Parker, Jack Davies, Richard Zheng, Huiru Mountain, Gail JMIR Rehabil Assist Technol Original Paper 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. JMIR Publications Inc. 2016-01-07 /pmc/articles/PMC5454551/ /pubmed/28582250 http://dx.doi.org/10.2196/rehab.5079 Text en ©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. http://creativecommons.org/licenses/by/2.0/ 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. |
spellingShingle | Original Paper Mawson, Susan Nasr, Nasrin Parker, Jack Davies, Richard Zheng, Huiru Mountain, Gail A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title | A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title_full | A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title_fullStr | A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title_full_unstemmed | A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title_short | A Personalized Self-Management Rehabilitation System with an Intelligent Shoe for Stroke Survivors: A Realist Evaluation |
title_sort | personalized self-management rehabilitation system with an intelligent shoe for stroke survivors: a realist evaluation |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454551/ https://www.ncbi.nlm.nih.gov/pubmed/28582250 http://dx.doi.org/10.2196/rehab.5079 |
work_keys_str_mv | AT mawsonsusan apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT nasrnasrin apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT parkerjack apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT daviesrichard apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT zhenghuiru apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT mountaingail apersonalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT mawsonsusan personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT nasrnasrin personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT parkerjack personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT daviesrichard personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT zhenghuiru personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation AT mountaingail personalizedselfmanagementrehabilitationsystemwithanintelligentshoeforstrokesurvivorsarealistevaluation |