Stroke
Conditions
Keywords
home programs, assistive technology, rehabilitation
Brief summary
Interventions promoting optimum motor performance across the lifespan are a priority after a neurological insult such as stroke. The proposed research incorporates smart devices and 3D printing to create a patient-centered rehabilitation device, mRehab. This innovative blend of technology and principles of neuroplasticity can advance standards of practice in healthcare. In this feasibility study, it is hypothesized that individuals with chronic stroke can successfully use the portable rehabilitation unit, mRehab, at home with minimal oversight from the research team. Use of mRehab in a home based setting and functional changes in upper limb movement will be assessed.
Detailed description
Impairments following stroke make it one of the leading causes of disability. Many individuals with stroke do not recover complete function of the upper limb at time of discharge from clinical services. Moreover, early stage improvements may wane following the cessation of formal therapies. Regaining as much upper limb function as possible is important, as even mild impairments are associated with limitations in daily function and lower health-related quality of life. The overarching purpose of this project is to use portable technology, affordable for home use, to provide objective feedback on performance of upper limb motor tasks to individuals with residual deficits following chronic conditions such as stroke. Objective feedback serves to better inform the participant of their progress and actively engage them in their rehabilitation, thus encouraging self-management of rehabilitation. Results from a recent survey shows therapists predominantly provide patients with stroke written home exercise programs at time of discharge from therapies. With this static approach, patients have a limited capacity to evaluate their motor performance and no encouragement to refine their movement. Smartphones were coupled with three-dimensional (3D) printed objects to create a home rehabilitation system, mRehab. The built-in sensors in smartphones and a custom app can quantify characteristics of movement and provide actionable feedback to users during in-home rehabilitation. It was hypothesized that 1) participants with stroke could use mRehab in a home program with minimal oversight and 2) use of mRehab would result in changes in functional movement. Methodology: A single-subject experimental design with multiple baselines was used. A strength of the single-subject study design is that participants serve as their own control. Each participant had a varying length of the baseline and follow-up periods to establish that the intervention, rather than time, was the primary reason for any observed change in performance. Participants completed baseline measurements, a six-week mRehab home program, and follow-up measurements. Baseline measurements consisted of both in-lab and in-home measurements. Participants attended two lab visits prior to starting the home program to establish baselines on clinical assessments and to learn how to use mRehab. MRehab collected limited preliminary performance data without providing feedback during baseline. Participants then used mRehab in a six week home program receiving feedback on their performance each time they completed practice of an activity. At the completion of the home program participants completed follow up assessments that were similar to the baseline measurements. In addition, usability of mRehab was assessed.
Interventions
DEVICEmRehab
mRehab (mobile Rehab) was created to better support in-home upper limb rehabilitation programs. It incorporates a task-oriented approach and immediate performance-based feedback. mRehab consists of 3D-printed household items (a mug, bowl, key, and doorknob) integrated with a smartphone and an app. The app guides participants through practice of activities of daily living (ADL), for example, sipping from a mug. It can also consistently measure time to complete an activity and quality of movement (smoothness/accuracy) during the performance of ADLs. In each session of exercise participants receive feedback on the number of repetitions they complete for each activity, the average time to complete the activity and the average smoothness to perform the activity. Participants were trained in use of mRehab in lab visits and then took mRehab home to use the system. mRehab recorded longitudinal data.
Sponsors
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
State University of New York at Buffalo
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
The purpose of the intervention was to provide proof of concept that it is feasible for individuals with stroke to use mRehab in a home program and to examine if changes in motor function were enhanced following the home program.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Individuals in the intervention all had a history of stroke. Inclusion Criteria for feasibility study: 1. at least 18 years of age and living in the community 2. had a history of one stroke six or more months previous 3. had a minimum score of 124 on the Mattis Dementia Rating Scale (MDRS).
Exclusion criteria
for feasibility study: 1. acute or chronic pain that would interfere with participation 2. severely limited range of motion or contractures of shoulder, elbow, wrist or hand, 3. absent or severely impaired proprioception of the upper limb 4. musculoskeletal or circulatory conditions affecting the upper limb such as vascular disease, tendonitis, cellulitis, Raynaud's syndrome, or severe osteoarthritis or rheumatoid arthritis 5. spasticity graded as 3 or greater for upper extremity movement on the Modified Ashworth Scale (MAS) 6. botulinum toxin injections for spasticity management within three months of starting the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Repetitions Completed for Each Activity in the mRehab Home Program | 6 week in-home program | The total number of repetitions each participant completed for each activity in mRehab during the 6 week home program was recorded. The average total number of repetitions completed for each activity is reported. |
| Time to Complete Activity in the mRehab Home Program | last day of the 6 week in home program | average time to complete an activity in the mRehab home program |
| Average Smoothness Per Activity in the mRehab Home Program | last day of the 6 week in-home program | The average smoothness per activity in mRehab on the first day of the 6 week home program. Using the acceleration readings from the inertial measurement unit embedded in the smartphone, a normalized jerk score which is dimensionless, allowing comparisons of movements that vary in duration and/or amplitude, can be computed. There are no set upper bounds for the score, as it is dependent on the smoothness. The minimum score is 0, which would indicate no jerk, or perfectly smooth movement. This measurement provides relative information for each movement as a normal range has not been established for each of the movements in this study. Overall, a lower score indicates smoother movement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Systems Usability Scale (SUS) | within 1-3 weeks of completion of home program | A reliable tool for measuring usability. The Systems Usability Scale (SUS) consists of 10 questions, each rated on a 5-point Likert scale ranging from Strongly agree to Strongly disagree. The SUS was used to assess the participant's satisfaction with the mRehab system. A higher score represents a more positive perception of the device. A score of 50 would represent the strongest agreement that mRehab is a usable system. A score of 10 would represent the strongest disagreement that mRehab is a usable system. |
| Wolf Motor Function Test | within 1 week of the completion of the in-home program | The Wolf Motor Function Test (WMFT) is used to assess function of the upper extremity. The 17 item version of the WMFT was used. Tasks in the WMFT include tasks that assess gross motor activity (such as lifting hand/arm and placing it on a box), fine motor activity (such as picking up a paper clip) and strength. One timed task is a bilateral task (folding a towel). For timed tasks, participants are given up to 120 seconds to complete the task. If they cannot successfully complete it in that time they are given the max score of 120 seconds. In our papers we only use the timed tasks in the WMFT in our analyses. We report the average time to complete a task in the WMFT. A lower score indicates less time is required to complete the task. |
| mRehab Acceptance Questionnaire | within 1-3 weeks of completion of the 6 week in-home program | The mRehab (mobile Rehab) acceptance questionnaire was designed to assess the participants perception of the mRehab system we designed for this study. The questionnaire is based upon the Technology Acceptance model using a seven-point Likert scale - highly disagree (1) to highly agree (7)- for each question. Participants responded to 16 questions that probed the user's perceception of how they interacted with technology (3 questions) and their perceived usefulness, perceived ease of use, and behavioral intention to use the mRehab system in the future (13 questions). The total score is calculated as the sum of the response to each question. A score demonstrating the participant highly agreed that they would interact with technology and that they found mRehab useful, easy to use and that they would use in in the future would be 112. The minimum total score would be 16 (with a rating of highly disagree for each question). Higher scores would indicate better acceptance/interaction. |
| Nine Hole Peg Test | within 1 week of the end of the in-home program | A timed clinical assessment used to measure finger dexterity. Lower times represent better performance. Participants place 9 pegs in 9 holes and then remove the pegs and place them in a container. The stop watch starts when the participant touches the first peg and stops when they place the last peg in the container. If participants could not complete placing the pegs in the holes they were given a score of 300 seconds. |
| Difficulty Rating Scale | within 1 - 3 weeks of the end of the program | A scale used to elicit user opinions on ease of use of the 3D printed objects (mug, bowl, key, and doorknob). It was a 7 point likert scale ranging from Very Difficult to Very Easy. The range was -3 to 3. A score of -3 represented the three-dimensional printed object was very difficult to use and a score of 3 representing the object was easy to use. The scores for the mug, bowl, key and door knob are included in the mean score given below. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Use of mRehab in a Home Program mRehab incorporates a task-oriented approach and immediate performance-based feedback. mRehab consists of 3D-printed household items integrated with a smartphone and an app. The app guides participants through practice of activities of daily living. In each session of exercise participants receive feedback on the number of repetitions they complete for each activity, the average time to complete the activity and the average smoothness to perform the activity. Participants were trained in use of mRehab in lab visits and then took mRehab home to use the system. mRehab recorded longitudinal data. Participants included in this group demonstrate the ability to complete mRehab tasks unilaterally. | 16 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally Participant completed all activities in data collection and in the six week in home mRehab program bilaterally. | 1 |
| Total | 17 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 2 | 0 |
Baseline characteristics
| Characteristic | Use of mRehab in a Home Program Completing All Activities Bilaterally | Total | Use of mRehab in a Home Program |
|---|---|---|---|
| Age, Continuous | 22 years | 60.32 years STANDARD_DEVIATION 15.62 | 62.82 years STANDARD_DEVIATION 13.22 |
| Average smoothness per activity in the mRehab home program Horizontal bowl transfer | 1015.74 jerk score | 510.13 jerk score STANDARD_DEVIATION 332.1 | 478.53 jerk score STANDARD_DEVIATION 315.49 |
| Average smoothness per activity in the mRehab home program Horizontal mug transfer | 485.56 jerk score | 579.93 jerk score STANDARD_DEVIATION 227.69 | 585.83 jerk score STANDARD_DEVIATION 233.81 |
| Average smoothness per activity in the mRehab home program Simulate sip from mug | 385 jerk score | 393.63 jerk score STANDARD_DEVIATION 231.86 | 394.17 jerk score STANDARD_DEVIATION 239.46 |
| Average smoothness per activity in the mRehab home program Vertical bowl transfer | 1727.74 jerk score | 583.51 jerk score STANDARD_DEVIATION 412.1 | 511.99 jerk score STANDARD_DEVIATION 297.33 |
| Average smoothness per activity in the mRehab home program Vertical mug transfer | 1254.94 jerk score | 731.93 jerk score STANDARD_DEVIATION 339.46 | 699.24 jerk score STANDARD_DEVIATION 321.74 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1 Participants | 17 Participants | 16 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Nine hole peg test average time to complete over 2 testing sessions | 300 seconds STANDARD_DEVIATION 0 | 144.18 seconds STANDARD_DEVIATION 118.79 | 135.52 seconds STANDARD_DEVIATION 115.91 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 1 Participants | 16 Participants | 15 Participants |
| Region of Enrollment United States | 1 participants | 17 participants | 16 participants |
| Sex: Female, Male Female | 0 Participants | 6 Participants | 6 Participants |
| Sex: Female, Male Male | 1 Participants | 11 Participants | 10 Participants |
| Time to complete activity in the mRehab home program Enter phone number | 38.22 seconds | 31.29 seconds STANDARD_DEVIATION 25.5 | 30.86 seconds STANDARD_DEVIATION 26.28 |
| Time to complete activity in the mRehab home program Horizontal bowl transfer | 4.87 seconds | 5.02 seconds STANDARD_DEVIATION 1.28 | 5.03 seconds STANDARD_DEVIATION 1.32 |
| Time to complete activity in the mRehab home program Horizontal mug transfer | 5.19 seconds | 4.97 seconds STANDARD_DEVIATION 1.18 | 4.96 seconds STANDARD_DEVIATION 1.22 |
| Time to complete activity in the mRehab home program quick tap | 8.78 seconds | 16.56 seconds STANDARD_DEVIATION 9.34 | 17.05 seconds STANDARD_DEVIATION 9.42 |
| Time to complete activity in the mRehab home program Simulate sip from mug | 9.38 seconds | 9.50 seconds STANDARD_DEVIATION 4.64 | 9.51 seconds STANDARD_DEVIATION 4.71 |
| Time to complete activity in the mRehab home program Vertical bowl transfer | 6.63 seconds | 5.13 seconds STANDARD_DEVIATION 0.97 | 5.04 seconds STANDARD_DEVIATION 0.91 |
| Time to complete activity in the mRehab home program Vertical mug transfer | 5.39 seconds | 5.23 seconds STANDARD_DEVIATION 1.09 | 5.22 seconds STANDARD_DEVIATION 1.22 |
| Wolf Motor Function Test- Ave time to complete a task over 2 testing sessions using the WMFM | 96.28 seconds STANDARD_DEVIATION 0 | 19.90 seconds STANDARD_DEVIATION 27.96 | 17.62 seconds STANDARD_DEVIATION 22.16 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 19 |
| other Total, other adverse events | 0 / 19 |
| serious Total, serious adverse events | 0 / 19 |
Outcome results
Primary
Average Smoothness Per Activity in the mRehab Home Program
The average smoothness per activity in mRehab on the first day of the 6 week home program. Using the acceleration readings from the inertial measurement unit embedded in the smartphone, a normalized jerk score which is dimensionless, allowing comparisons of movements that vary in duration and/or amplitude, can be computed. There are no set upper bounds for the score, as it is dependent on the smoothness. The minimum score is 0, which would indicate no jerk, or perfectly smooth movement. This measurement provides relative information for each movement as a normal range has not been established for each of the movements in this study. Overall, a lower score indicates smoother movement.
Time frame: last day of the 6 week in-home program
Population: 16 participants with chronic stroke performing the in-home rehabilitation unilaterally
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Use of mRehab in a Home Program | Average Smoothness Per Activity in the mRehab Home Program | Horizontal bowl transfer | 375.39 jerk score | Standard Deviation 137.23 |
| Use of mRehab in a Home Program | Average Smoothness Per Activity in the mRehab Home Program | Horizontal mug transfer | 431.23 jerk score | Standard Deviation 159.97 |
| Use of mRehab in a Home Program | Average Smoothness Per Activity in the mRehab Home Program | Vertical mug transfer | 492.70 jerk score | Standard Deviation 226.6 |
| Use of mRehab in a Home Program | Average Smoothness Per Activity in the mRehab Home Program | simulating sipping from mug | 331.11 jerk score | Standard Deviation 61.77 |
| Use of mRehab in a Home Program | Average Smoothness Per Activity in the mRehab Home Program | Vertical bowl transfer | 410.66 jerk score | Standard Deviation 128.81 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Average Smoothness Per Activity in the mRehab Home Program | simulating sipping from mug | 347.17 jerk score | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Average Smoothness Per Activity in the mRehab Home Program | Vertical bowl transfer | 768.17 jerk score | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Average Smoothness Per Activity in the mRehab Home Program | Horizontal bowl transfer | 732.16 jerk score | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Average Smoothness Per Activity in the mRehab Home Program | Vertical mug transfer | 1869.6 jerk score | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Average Smoothness Per Activity in the mRehab Home Program | Horizontal mug transfer | 531.8 jerk score | — |
Comparison: mRehab task vertical bowl transfer- moving bowl vertically up and downp-value: =0.228t-test, 2 sided
Comparison: mRehab task horizontal bowl- bowl moved horizontallyp-value: 0.196t-test, 2 sided
Comparison: mRehab task Vertical Mug- Mug moved vertically and then placed on counterp-value: =0.024t-test, 2 sided
Comparison: mRehab task horizontal mug transfer- moving the mug horizontallyp-value: =0.038t-test, 2 sided
Comparison: mRehab task simulate sipp-value: =0.306t-test, 2 sided
Primary
Repetitions Completed for Each Activity in the mRehab Home Program
The total number of repetitions each participant completed for each activity in mRehab during the 6 week home program was recorded. The average total number of repetitions completed for each activity is reported.
Time frame: 6 week in-home program
Population: 16 participants with chronic stroke that completed mRehab in-home training with their paretic hand.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Vertical mug transfer | 283.69 repetitions | Standard Deviation 227.94 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Simulate sip from mug | 202.19 repetitions | Standard Deviation 151.48 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Horizontal bowl transfer | 289.44 repetitions | Standard Deviation 223.34 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Enter phone number | 153.13 repetitions | Standard Deviation 131.05 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Horizontal mug transfer | 292.31 repetitions | Standard Deviation 224.02 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Quick tap | 177.20 repetitions | Standard Deviation 141.26 |
| Use of mRehab in a Home Program | Repetitions Completed for Each Activity in the mRehab Home Program | Vertical bowl transfer | 282.06 repetitions | Standard Deviation 210 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Quick tap | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Vertical bowl transfer | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Horizontal bowl transfer | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Vertical mug transfer | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Horizontal mug transfer | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Simulate sip from mug | NA repetitions | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Repetitions Completed for Each Activity in the mRehab Home Program | Enter phone number | NA repetitions | — |
Primary
Time to Complete Activity in the mRehab Home Program
average time to complete an activity in the mRehab home program
Time frame: last day of the 6 week in home program
Population: Participants with chronic stroke that completed the mRehab training using their paretic hand.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Horizontal bowl transfer | 4.01 seconds | Standard Deviation 0.6 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Simulate sip from mug | 9.62 seconds | Standard Deviation 1.39 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Vertical mug transfer | 5.22 seconds | Standard Deviation 1.22 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Enter phone number | 22.35 seconds | Standard Deviation 14.05 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Vertical bowl transfer | 4.03 seconds | Standard Deviation 0.46 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Quick tap | 14.75 seconds | Standard Deviation 7.54 |
| Use of mRehab in a Home Program | Time to Complete Activity in the mRehab Home Program | Horizontal mug transfer | 4.00 seconds | Standard Deviation 0.58 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Quick tap | 8.76 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Horizontal bowl transfer | 4.71 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Vertical mug transfer | 9.28 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Horizontal mug transfer | 4.69 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Simulate sip from mug | 9.33 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Enter phone number | 25.53 seconds | — |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Time to Complete Activity in the mRehab Home Program | Vertical bowl transfer | 4.17 seconds | — |
Comparison: mRehab task vertical bowl transfer- moving the bowl vertically up and downp-value: <0.001t-test, 2 sided
Comparison: mRehab task horizontal bowl transfer- moving the bowl horizontallyp-value: =0.001t-test, 2 sided
Comparison: mRehab task vertical mug transfer- moving the mug vertically up and downp-value: =0.003t-test, 2 sided
Comparison: mRehab task horizontal mug transfer- moving the mug horizontallyp-value: =0.009t-test, 2 sided
Comparison: mRehab task simulate sip- bring mug within one inch of mouth as if taking a drinkp-value: =0.933t-test, 2 sided
Comparison: mRehab task enter phone numberp-value: =0.136t-test, 2 sided
Comparison: mRehab task quick tap- tapping a moving object on the phone screenp-value: =0.005t-test, 2 sided
Secondary
Difficulty Rating Scale
A scale used to elicit user opinions on ease of use of the 3D printed objects (mug, bowl, key, and doorknob). It was a 7 point likert scale ranging from Very Difficult to Very Easy. The range was -3 to 3. A score of -3 represented the three-dimensional printed object was very difficult to use and a score of 3 representing the object was easy to use. The scores for the mug, bowl, key and door knob are included in the mean score given below.
Time frame: within 1 - 3 weeks of the end of the program
Population: Participants with stroke that participated in a 6 week home program using mRehab.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Use of mRehab in a Home Program | Difficulty Rating Scale | 1.07 units on a scale | Standard Deviation 1.07 |
Secondary
mRehab Acceptance Questionnaire
The mRehab (mobile Rehab) acceptance questionnaire was designed to assess the participants perception of the mRehab system we designed for this study. The questionnaire is based upon the Technology Acceptance model using a seven-point Likert scale - highly disagree (1) to highly agree (7)- for each question. Participants responded to 16 questions that probed the user's perceception of how they interacted with technology (3 questions) and their perceived usefulness, perceived ease of use, and behavioral intention to use the mRehab system in the future (13 questions). The total score is calculated as the sum of the response to each question. A score demonstrating the participant highly agreed that they would interact with technology and that they found mRehab useful, easy to use and that they would use in in the future would be 112. The minimum total score would be 16 (with a rating of highly disagree for each question). Higher scores would indicate better acceptance/interaction.
Time frame: within 1-3 weeks of completion of the 6 week in-home program
Population: Participants with stroke that used mRehab in a 6 week home program.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Use of mRehab in a Home Program | mRehab Acceptance Questionnaire | 91.56 units on a scale | Standard Deviation 11.79 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | mRehab Acceptance Questionnaire | 106 units on a scale | — |
Secondary
Nine Hole Peg Test
A timed clinical assessment used to measure finger dexterity. Lower times represent better performance. Participants place 9 pegs in 9 holes and then remove the pegs and place them in a container. The stop watch starts when the participant touches the first peg and stops when they place the last peg in the container. If participants could not complete placing the pegs in the holes they were given a score of 300 seconds.
Time frame: within 1 week of the end of the in-home program
Population: Participants with stroke that participated in a home rehabilitation program using mRehab.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Use of mRehab in a Home Program | Nine Hole Peg Test | 136.36 seconds | Standard Deviation 108.96 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Nine Hole Peg Test | 300 seconds | — |
Comparison: Compared pre and post intervention data for participants using mRehab for a 6 week home program.p-value: =0.019t-test, 2 sided
Secondary
Systems Usability Scale (SUS)
A reliable tool for measuring usability. The Systems Usability Scale (SUS) consists of 10 questions, each rated on a 5-point Likert scale ranging from Strongly agree to Strongly disagree. The SUS was used to assess the participant's satisfaction with the mRehab system. A higher score represents a more positive perception of the device. A score of 50 would represent the strongest agreement that mRehab is a usable system. A score of 10 would represent the strongest disagreement that mRehab is a usable system.
Time frame: within 1-3 weeks of completion of home program
Population: Participants with stroke that completed a 6 week home program using mRehab.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Use of mRehab in a Home Program | Systems Usability Scale (SUS) | 31.25 units on a scale | Standard Deviation 3.8 |
Secondary
Wolf Motor Function Test
The Wolf Motor Function Test (WMFT) is used to assess function of the upper extremity. The 17 item version of the WMFT was used. Tasks in the WMFT include tasks that assess gross motor activity (such as lifting hand/arm and placing it on a box), fine motor activity (such as picking up a paper clip) and strength. One timed task is a bilateral task (folding a towel). For timed tasks, participants are given up to 120 seconds to complete the task. If they cannot successfully complete it in that time they are given the max score of 120 seconds. In our papers we only use the timed tasks in the WMFT in our analyses. We report the average time to complete a task in the WMFT. A lower score indicates less time is required to complete the task.
Time frame: within 1 week of the completion of the in-home program
Population: Participants with chronic stroke that performed mRehab activities unilaterally.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Use of mRehab in a Home Program | Wolf Motor Function Test | 15.25 seconds | Standard Deviation 21.31 |
| Use of mRehab in a Home Program Completing All Activities Bilaterally | Wolf Motor Function Test | 96.27 seconds | — |
p-value: =0.017t-test, 2 sided