Searching for the missing element of rehabilitation - the influence of multimedia self-management intervention on selected psychological and functional aspects, and physical activity in non-ambulatory stroke patients in the early rehabilitation phase

Project aim will be realized with three-arm parallel group randomized controlled trial. The study will be conducted during a 7-week period of the conventional, early post-stroke rehabilitation phase in two rehabilitation hospitals. All groups will obtain the same rehabilitation with a one hour of physiotherapy for 5 days a week for 7 weeks and other usual care provided in rehabilitation centres. One week of rehabilitation will be dedicated to 3 measurement timepoints (each for two days). Multimedia self-management intervention will not be an additional therapy, but rather a tool to support standard rehabilitation during the normal course of rehabilitation. In this way, the total duration of the intervention in each group will be the same. The experimental intervention (multimedia self-management intervention) will be implemented in two groups with a different onset, and the control group will receive only usual care, as below: Arm 1: Control Group - will receive usual care during whole 6 weeks of rehabilitation; Arm 2: Mixed Group (self-controlled) – usual care in first half (3 weeks) of rehabilitation and multimedia self-management intervention in the second half (3 weeks); Arm 3: Experimental Group will receive multimedia self-management intervention (MSMI) - during whole 6 weeks of rehabilitation. MSMI will be provided with a special, original mobile application. The application will be operated by physiotherapists on the tablets. MSMI will consist of three multimedia components. 1) Educational and motivational films These films will integrally present both the mechanism of stroke, subsequent stages of improvement and neuroplasticity in combination with authentic rehabilitation recordings, whiteboard animation, interviews with professionals and stroke survivors. The movies through a simple message will show the importance of own activity from the neuroplasticity perspective. The films will also encourage the pursuit of independence at the current rehabilitation stage and gradual involvement in achieving once more difficult functional goals. The movies will be individually tailored to patient’s possibility as not to providing false hope. The patients will watch three videos on the tablet during the first two weeks of the experimental phase. The duration of the films will be from 5 to 15 minutes. Watched movies will be marked to monitor adherence. 2) Multimedia active goal-setting The patient with the physiotherapist will firstly create the rehabilitation plan by dragging and dropping selected mobility activities icons as rolling to side, sitting up, standing up, walking or 20 others to the middle fields. Then they will set short and long term goal related to mobility that they want to achieve by proper designation of icons with flags. It will occur at the beginning of the fourth week in the Arm 2, and at the beginning of the first week of rehabilitation in the Arm 3. The plan will be established only once and possibly changed if necessary. The goal-setting will be multimedia presented in the context of the subsequent stages of rehabilitation. The application will allow setting up to 20 activity icons in the rehabilitation plan so that the patient will be able to monitor even the smallest progress and experience success more often. The multimedia goal-setting will be conducted in a face-to-face session of approximately 20 minutes. Application data including the number of steps and marked goals will be analyzed to monitor adherence and fidelity of MSMI. 3)Motivating multimedia self-monitoring. Physiotherapists will record activities with the tablet (at least one recording per week) and record again when it will seem to improve. The patient with the physiotherapist will watch the comparative films. If they notice significant improvement, they will point the activity as successively achieved and the application will generate positive sounds and confetti. The physiotherapist will award in the application a MEDAL if the patient will perform the activity with minimal active help or assist, or a TROPHY if the patient will perform the activity safety and independently. In this way, participants will be able to reflect on their own personal successes, by achieving more and more advanced activity step by step. Application data including the number of recording and awards will be analyzed to monitor adherence and fidelity of MSMI.