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Feelings of worthlessness after a stroke are predictive of present and future perceived social isolation, and leaving the house helps alleviate perceived social isolation and negative emotions. The results are published in the Archives of Physical Medicine and Rehabilitation.
Researchers used smartphones to conduct ecological momentary assessments of 202 people who had experienced mild to moderate stroke. Ecological momentary assessment is a sampling method, usually delivered via smartphone apps, that can gather real-time information about people’s behaviors and experiences in their natural environments.
“Using smartphones makes sense because we can better assess people’s health status or functional changes outside the hospital,” says Alex Wong, PhD, OT, assistant director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and corresponding author on the paper. “We used this to try to figure out how concepts like perceived isolation, health-related symptoms, and day-to-day functioning are related among our patients after transitioning to home and community living.”
Wong and colleagues sent alerts to participants asking about their mood, social isolation, anxiety, pain, fatigue, worthlessness, and daily functioning five times a day for 2 weeks. They also asked where participants were when they got the “ping” and with whom.
They used a network approach to analyze the data to look for patterns in single moments of time in individual participants and how different factors (i.e., anxiety, pain, feelings of isolation) at one time period predict how a participant feels at a later time.
The researchers found that participants who reported feelings of worthlessness were more likely to experience perceived social isolation at the same time and later, and that leaving the house helped to alleviate feelings of isolation.
“Based on our findings, we believe that interventions designed to address negative thoughts, schedule outdoor activities, or deliver caring messages can help patients with stroke feel better,” says Wong. “We can provide personalized strategies, such as tailored text messages based on their answers from ecological momentary assessments. For example, we can send messages to prompt people to get out of the house if someone reports feeling isolated.”
Wong and colleagues reported in a recent paper in JMIR Rehabilitation and Assistive Technologies that a smartphone-based program they developed is effective in helping people stick to healthy behaviors in stroke recovery, including engaging in social activities, managing emotions, and ongoing symptoms.
Wong developed iSMART, a coach-guided, technology-supported self-management intervention designed to support people in managing chronic conditions and maintaining active participation in daily life after stroke. A coach provides educational materials through the iSMART smartphone app, and texting allows the coach to encourage and motivate participants to engage in valued activities to promote recovery and wellness.
“We continue to gather evidence on the power of ecological momentary assessment as a research tool, but also as a way to deliver interventions in real-time to people where they are. We hope to adapt iSMART to provide “just-in-time” interventions based on the dynamic needs of our patients,” says Wong.
Yun Shi, PhD and Lu Hu, PhD of NYU Langone Health; Mandy W.M. Fong, PhD and Sherri LaVela, PhD, MPH, of Northwestern University Feinberg School of Medicine; Christopher Metts, MD of the Medical University of South Carolina and Charles Bombardier, PhD of the University of Washington, Seattle are co-authors on the paper.
This research was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Center for Medical Rehabilitation Research (NICHD/ NCMRR) (K01HD095388) and the NICHD and National Institute of Neurological Disorders and Stroke (NINDS)-funded Center for Smart Use of Technologies to Assess Real-world Outcomes (C-STAR) (P2CHD101899).
