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Researchers led by Center for Rehabilitation Outcomes Research (CROR) Assistant Director, Alex Wong, PhD and former CROR post-doc, Elizabeth Munsell, PhD, OT, have published new findings in Topics in Stroke Rehabilitation. The researchers used an ecological momentary assessment (EMA) approach to examine cognitive variability in people who had experienced a stroke as they engaged in activities of daily living, including socializing. The researchers identified unique subgroups of people with more problems with daily and social activities. They believe this subgroup would benefit from interventions focused on self-regulation.
EMA uses smartphone prompts to collect information on an individual's mood, cognition, and behavior as they go about their daily lives. Over time, it can help give healthcare providers valuable information on patients' status after they leave the hospital. EMA can also be used to deliver interventions – such as reminders to exercise or educational information to help patients manage their conditions. Wong has used EMA to track and support patient engagement in exercise and self-management programs in people with neurological disorders.
About 80% of people with a stroke experience mild cognitive impairments that interfere with daily living. Often, these impairments are transitory, can come and go over time, and may be affected by other health-related symptoms, such as pain and fatigue. Tracking changes in cognition after stroke is important to evaluate recovery, but because cognitive deficits or problems can fluctuate, it can be hard to get a good handle on the cognitive status of stroke survivors.
Wong and colleagues enrolled 202 people with mild to moderate stroke in the study. Participants responded to five EMA surveys daily for 14 days to assess cognition.
The EMA surveys included questions about physical and social context, activities, and other health-related symptoms. Participants also completed measures during two lab visits: the Neuro-QoL short forms for activities of daily living, ability to participate in social roles and function, and satisfaction with social roles and activities, as well as the PROMIS short form for social isolation.
The researchers found that participants with greater variability in their responses to the EMA survey questions over the 14-day period had more problems with activities of daily living and social functioning than participants with lower variability in their responses.
"Using digital health monitoring to assess cognitive or functional problems in the real world may be a potential complementary tool to use together with clinic-based tests to identify individuals who may benefit from additional interventions,” Wong said.
Katherine Kaufman, Stephanie Tomazin, and Bridget Regan of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab; Quoc Bui, Eric Lenze, Jin-Moo Lee, and Vy Pham of the Washington University School of Medicine; David Mohr of the Northwestern University Feinberg School of Medicine and Christopher Metts of the Medical University of South Carolina are co-authors on the paper.
This study was funded by the National Center for Medical Rehabilitation Research (grant K01HD095388) and the Center for Smart Use of Technologies to Assess Real-world Outcomes (grant P2CHD101899).
