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As stroke mortality has declined, a growing number of stroke survivors are returning to the community. Most survivors continue to experience functional limitations in their day-to-day lives. Research has focused on neurocognitive impairment (NCI) as an important driver of functional limitation. However, the contribution of NCI to functional limitation is not well characterized, with existing research showing no consistent relationships.
The researchers will use Ecological Momentary Assessment (EMA) as a technology-based ambulatory assessment to prospectively measure daily life activities and behavioral factors among 115 stroke survivors. In comparison to standard clinic-based assessments, EMA allows for real-time, repeated, within-person sampling of daily function, including participation in cognitive, social, physical, and passive leisure activities in real-world environments. EMA also assesses time spent in, and performance appraisals of, daily activities, as well as time-varying behaviors to understand dynamic relationships among study constructs and uncover within-person trends over time. The researchers will focus on variability in depressed mood and quality of life among stroke survivors, and social support, a protective factor with a potential buffering effect on daily function and mood.
Their pilot study has demonstrated strong support for the acceptability of mobile device use for stroke rehabilitation, and the researchers have developed an EMA daily function survey tailored for stroke survivors which they will use in this study to establish the most pertinent future treatment targets. Goals of this study are to determine both treatment targets and how and when to intervene to enhance stroke survivors’ daily function.
There are two main aims:
Aim 1: Use EMA to compare patters of daily function between survivors with and without NCI, and determine which aspects of NCI have greater effects on daily function.
Aim 2: Determine the impact of EMA-measured depressed mood and social support in explaining the temporal associations between NCI and daily function.
This research is funded by a K01 Research Scientist Development Award from the National Institutes of Health to Alex Wong, PhD, CROR Research Scientist and Research Associate Professor in Physical Medicine and Rehabilitation at Northwestern University’s Feinberg School of Medicine.
Publications
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- Yun Shi, Mandy W.M. Fong, Christopher L. Metts, Sherri L. LaVela, Charles Bombardier, Lu Hu, Alex W.K. Wong,
Dynamics of perceived social isolation, secondary conditions, and daily activity patterns among individuals with stroke: A network analysis of ecological momentary assessment data. Archives of Physical Medicine and Rehabilitation,
2024, ISSN 0003-9993.
- Alex W.K. Wong, Rachel Tomazin, Kim Walker, Rachel Heeb Desai, Holly Hollingsworth, Pamela K. Newland, Kerri A. Morgan, Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study. Disability and Health Journal, 2023, 101549, ISSN 1936-6574.
- Shi Y, Lenze EJ, Mohr DC, Lee JM, Hu L, Metts CL, Fong MWM, Wong AWK. Post-stroke depressive symptoms and cognitive performances: A network analysis. Arch Phys Med Rehabil. 2023 Oct 24:S0003-9993(23)00592-0. doi: 10.1016/j.apmr.2023.10.006. Epub ahead of print. PMID: 37884084.
- Bui, Q., Kaufman, K.J., Pham, V., Lenze, E.J., Lee, J., Mohr, D.C., Fong, M.W.M., Metts, C.L., Tomazin, S.E., & Wong, A.W.K. (2022). Ecological momentary assessment of real-world functional behaviors in individuals with stroke: A longitudinal observational study. Archives of Physical Medicine and Rehabilitation, 103(7), 1327-1337.
- Bui, Q., Kaufman, K.J., Munsell, E.G.S.^, Lenze, E.J., Lee, J., Mohr, D.C., Fong, M.W.M., Metts, C.L., Tomazin, S.E., Pham, V., & Wong, A.W.K. (2022). Smartphone assessment uncovers real-time relationships between depressed mood and daily functional behaviors after stroke. Journal of Telemedicine and Telecare, 1-14.
- Neff, A.J., Lee, Y., Metts, C.L., & Wong, A.W.K. (2021). Ecological momentary assessment of social interactions: Associations with depression, anxiety, pain, and fatigue in individuals with mild stroke. Archives of Physical Medicine and Rehabilitation, 102(3), 395-405.
- A Digital Intervention to Promote Self-Management Self-Efficacy Among Community-Dwelling Individuals With Stroke: Pilot Randomized Controlled Trial. Zhaoying Li, Yating Lei, Quoc Bui, Olivia DePaul, Ginger Nicol, David Mohr, Sunghoon Lee, Mandy Fong, Christopher Metts, Stephanie Tomazin, Alex Wong. JMIR Rehabilitation Assistive Technology. Feb., 2024.
- Intraindividual Variability in Post-Stroke Cognition and its Relationship with Activities of Daily Living and Social Functioning: An Ecological Momentary Assessment Approach. Elizabeth Munsell, Quoc Bui, Katherine Kaufman, Stephanie Tomazin, Bridget Regan, Eric Lenze, Jin-Moo Lee, David Mohr, Mandy Fong, Christopher Metts, Vy Pham, Alex Wong. Topics in Stroke Rehabilitation. Jan., 2024.
- Using Intervention Mapping Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study. Alex Wong, Mandy Fong, Elizabeth Munsell, Christopher Metts, Sunghoon Lee, Ginger Nicol, Olivia DePaul, Stephanie Tomazin, Katherone Kaufman, David Mohr. JMIR Human Factors. July 24, 2023.
- Lee, Y., Walsh, R.J., Fong, M.W.M., Sykora, M., Doering, M.M., & Wong, A.W.K. (2021). Heart rate variability as a biomarker of functional outcomes in persons with acquired brain injury: Systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 131, 737-754. PMID: 34626686
- Lau, S.C.L., Judycki, S., Mix, M., DePaul, O., Tomazin, R., Hardi, A., Wong, A.W.K., & Baum, C.M. (2022). Theory-based self-management interventions for community-dwelling stroke survivors: A systematic review and meta-analysis. American Journal of Occupational Therapy, 76(4). PMID: 35772070