Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study.

BACKGROUND: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users' physical activity is visualized by fish swimming. OBJECTIVE: To evaluate the potential effectiveness of STARFISH in stroke survivors. METHOD: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index. RESULTS: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group-time interactions for other outcome measures. CONCLUSION: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.

Motor priming to enhance the effect of physical therapy in people with spinal cord injury.

CONTEXT: Brain-Computer Interface (BCI) is an emerging neurorehabilitation therapy for people with spinal cord injury (SCI). OBJECTIVE: The study aimed to test whether priming the sensorimotor system using BCI-controlled functional electrical stimulation (FES) before physical practice is more beneficial than physical practice alone. METHODS: Ten people with subacute SCI participated in a randomized control trial where the experimental (N = 5) group underwent BCI-FES priming (∼15 min) before physical practice (30 min), while the control (N = 5) group performed physical practice (40 min) of the dominant hand. The primary outcome measures were BCI accuracy, adherence, and perceived workload. The secondary outcome measures were manual muscle test, grip strength, the range of motion, and Electroencephalography (EEG) measured brain activity. RESULTS: The average BCI accuracy was 85%. The experimental group found BCI-FES priming mentally demanding but not frustrating. Two participants in the experimental group did not complete all sessions due to early discharge. There were no significant differences in physical outcomes between the groups. The ratio between eyes closed to eyes opened EEG activity increased more in the experimental group (theta Pθ = 0.008, low beta Plß = 0.009, and high beta Phß = 1.48e-04) indicating better neurological outcomes. There were no measurable immediate effects of BCI-FES priming. CONCLUSION: Priming the brain before physical therapy is feasible but may require more than 15 min. This warrants further investigation with an increased sample size.

Validation of smartphone step count algorithm used in STARFISH smartphone application.

BACKGROUND: Smartphone sensors are underutilised in rehabilitation. OBJECTIVE: To validate the step count algorithm used in the STARFISH smartphone application. METHODS: Twenty-two healthy adults (8 male, 14 female) walked on a treadmill for 5 minutes at 0.44, 0.67, 0.90 and 1.33 m⋅s-1. Each wore an activPALTM and four Samsung Galaxy S3TM smartphones, with the STARFISH application running, in: 1) a belt carrycase, 2) a trouser or skirt pocket), 3a) a handbag on shoulder for females or 3b) shirt pocket for males and 4) an upper arm strap. Step counts of the STARFISH application and the activPALTM were compared at corresponding speeds and Bland-Altman statistics used to assess level of agreement (LOA). RESULTS: The LOA between the STARFISH application and activPALTM varied across the four speeds and positions, but improved as speed increased. The LOA ranged from 105-177% at 0.44 m⋅s-1; 50-98% at 0.67 m⋅s-1; 19-67% at 0.9 m⋅s-1 and 8-53% at 1.33 m⋅s-1. The best LOAs were at 1.33 m⋅s-1 in the shirt pocket (8%) and upper arm strap (12%) positions. CONCLUSIONS: Step counts measured by the STARFISH smartphone application are valid in most body positions especially at walking speeds of 0.9 m⋅s-1 and above.

Increasing physical activity in older adults using STARFISH, an interactive smartphone application (app); a pilot study.

BACKGROUND: Increasing physical activity in older adults has preventative and therapeutic health benefits. We have developed STARFISH, a smartphone application, to increase physical activity. This paper describes the features of STARFISH, presents the views of older users on the acceptability and usability of the app and reports the results of a six week pilot study of the STARFISH app in older adults. METHODS: The operationalisation of the behaviour change techniques (BCTs) within the STARFISH app was mapped against the BCT Taxonomy of Michie et al. Sixteen healthy older adults (eight women and eight men; age 71.1 ± 5.2 years) used the app, in groups of four, for six weeks. Focus groups explored the user experience and objective measure of steps per day recorded. RESULTS: Participants were very positive about using the STARFISH app, in particular the embedded BCTs of self-monitoring, feedback and social support (in the form of group rewards). Objective step data, available for eight participants, showed that step counts increased by an average of 14% (p = 0.077, d = 0.56). CONCLUSION: The STARFISH app was acceptable and straightforward to use for older adults. STARFISH has potential to increase physical activity in older adults; however, a fully powered randomised controlled trial is required.

Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study.

PURPOSE: To measure and compare physical activity profiles and sedentary time between community dwelling stroke survivors and healthy volunteers. METHODS: Twenty-two stroke survivors (10 men, age 55.3 ± 9.9 years; 4.2 ± 4.0 years since their stroke) were recruited from local stroke support groups, and 22 controls were matched for sex, age and body mass index (BMI). All participants wore an ActivPAL™ physical activity monitor for seven days and from these data activity profiles, including the number of steps per day, time spent sedentary and time in different cadence bands, were recorded. RESULTS: Stroke survivors took significantly fewer steps per day than the controls (4035 ± 2830 steps/day versus 8394 ± 2941 steps/day, p < 0.001) and sedentary time (including sleep time) was significantly higher for stroke participants compared to the controls (20.4 ± 2.7 h versus 17.5 ± 3.8 h, p < 0.001). People with stroke spent a significantly higher proportion of their walking time in lower self-selected cadences compared to the controls. CONCLUSIONS: Community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence. Interventions to increase walking and reduce sedentary time following stroke are required which may have the added benefit of reducing cardiovascular risk in this group. Implications for Rehabilitation Stroke survivors are predisposed to reduced physical activity and increased cardiovascular risk. This study showed that community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence. Interventions are required which focus on reducing sedentary time as well as increasing step counts in people following stroke.