Encouraging arm use in stroke survivors: the impact of smart reminders during a home-based intervention

Background: Upper limb impairment post-stroke often leads to a predominant use of the less affected arm and consequent learned disuse of the affected side, hindering upper limb outcome. Wearable sensors such as accelerometers, combined with smart reminders (i.e., based on the amount of arm activity), offer a potential approach to promote increased use of the affected arm to improve upper limb use during daily life. This study aimed to evaluate the efficacy of wrist vibratory reminders during a six-week home-based intervention in chronic stroke survivors.

Methods: We evaluated the impact of the home-based intervention on the primary outcome, the Motor Activity Log-14 Item Version scores Amount of Use (MAL-14 AOU), and the secondary outcomes MAL-14 Quality of Movement (QOM) and sensor-derived activity metrics from the affected arm. A randomized controlled trial design was used for the study: the intervention group received personalized reminders based on individualized arm activity goals, while the control group did not receive any feedback. Mixed linear models assessed the influence of the group, week of the intervention period, and initial impairment level on MAL-14 and arm activity metrics.

Results: Forty-two participants were enrolled in the study. Overall, participants exhibited modest but not clinically relevant increases in MAL-14 AOU (+ 0.2 points) and QOM (+ 0.2 points) after the intervention period, with no statistically significant differences between the intervention and control group. Feasibility challenges were noted, such as adherence to wearing the trackers and sensor data quality. However, in participants with sufficiently available sensor data (n = 23), the affected arm use extracted from the sensor data was significantly higher in the intervention group (p < 0.05). The initial impairment level strongly influenced affected arm use and both MAL-14 AOU and QOM (p < 0.01).

Conclusions: The study investigated the effectiveness of incorporating activity trackers with smart reminders to increase affected arm activity among stroke survivors during daily life. While the results regarding the increased arm use at home are promising, patient-reported outcomes remained below clinically meaningful thresholds and showed no group differences. Further, it is essential to acknowledge feasibility issues such as adherence to wearing the trackers during the intervention and missing sensor data.

Trial registration: NCT03294187.