What is Important in E-health Interventions for Stroke Rehabilitation? A Survey Study among Patients, Informal Caregivers, and Health Professionals.

Manon M. Wentink, Leti van Bodegom-Vos, Berber Brouns, Henk J. Arwert, Thea P.M. Vliet Vlieland, Arend J. de Kloet, Jorit J. L. Meesters


Incorporating user requirements in the design of e-rehabilitation interventions facilitates their implementation. However, insight into requirements for e-rehabilitation after stroke is lacking. This study investigated which user requirements for stroke e-rehabilitation are important to stroke patients, informal caregivers, and health professionals. The methodology consisted of a survey study amongst stroke patients, informal caregivers, and health professionals (physicians, physical therapists and occupational therapists). The survey consisted of statements about requirements regarding accessibility, usability and content of a comprehensive stroke e-health intervention (4-point Likert scale, 1=unimportant/4=important). The mean with standard deviation was the metric used to determine the importance of requirements. Patients (N=125), informal caregivers (N=43), and health professionals (N=105) completed the survey. The mean score of user requirements regarding accessibility, usability and content for stroke e-rehabilitation was 3.1 for patients, 3.4 for informal caregivers and 3.4 for health professionals.  Data showed that a large number of user requirements are important and should be incorporated into the design of stroke e-rehabilitation to facilitate their implementation.



Blacquiere, D., Lindsay, M. P., Foley, N., Taralson, C., Alcock, S., Balg, C., .... Ghanem, A. (2017). Canadian stroke best practice recommendations: Telestroke best practice guidelines update 2017. International Journal of Stroke, 12, 886-895.

Brewer, B. R., McDowell, S. K., & Worthen-Chaudhari, L. C. (2007). Poststroke upper extremity rehabilitation: A review of robotic systems and clinical results. Topics in stroke rehabilitation, 14, 22-44. http://www.tandfonline.com/doi/abs/10.1310/tsr1406-22

Casaubon, L. K., Boulanger, J. M., Blacquiere, D., Boucher, S., Brown, K., Goddard, T., ... Lavoie, P. (2015). Canadian stroke best practice recommendations: Hyperacute stroke care guidelines, update 2015. International Journal of Stroke, 10, 924-940. https://www.ncbi.nlm.nih.gov/pubmed/26148019

Ehn, M., Hansson, P., Sjölinder, M., Boman, I. L., Folke, M., Sommerfeld, D., ... Palmcrantz, S. (2015). Users perspectives on interactive distance technology enabling home-based motor training for stroke patients. pHealth, 2015(5),145-152.

Feigin, V. L., Roth, G. A., Naghavi, M., Parmar, P., Krishnamurthi, R., Chugh, S., ... Estep, K. (2016). Global burden of stroke and risk factors in 188 countries, during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet Neurology, 15, 913-924. http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(16)30073-4/fulltext

Goldstein, D. H., Phelan, R., Wilson, R., Ross-White, A., VanDenKerkhof, E. G., Penning, J. P., & Jaeger, M. (2014). Brief review: Adoption of electronic medical records to enhance acute pain management. Canadian Journal of Anesthesia/Journal Canadien d'Anesthésie, 61, 164-179. https://www.ncbi.nlm.nih.gov/pubmed/24233770

Hochstenbach-Waelen, A., & Seelen, H. A. (2012). Embracing change: Practical and theoretical considerations for successful implementation of technology assisting upper limb training in stroke. Journal of Neuroengineering and Rehabilitation, 9(1), 52. doi: https://doi.org/10.1186/1743-0003-9-52

Lange, B., Flynn, S., Proffitt, R., Chang, C. Y., & Rizzo, A. (2010). Development of an interactive game-based rehabilitation tool for dynamic balance training. Topics in Stroke Rehabilitation, 17, 345-352. https://www.ncbi.nlm.nih.gov/pubmed/21131259

Lu, E.C., Wang, R.H., Hebert, D., Boger, J., Galea, M.P., & Mihailidis, A. (2011). The development of an upper limb stroke rehabilitation robot: identification of clinical practices and design requirements through a survey of therapists. Disability and Rehabilitation: Assistive Technology, 6, 420-431. https://www.ncbi.nlm.nih.gov/pubmed/21184626

Lum, P., Reinkensmeyer, D., Mahoney, R., Rymer, W.Z., & Burgar, C. (2002). Robotic devices for movement therapy after stroke: Current status and challenges to clinical acceptance. Topics in stroke rehabilitation, 8, 40-53. https://www.ncbi.nlm.nih.gov/pubmed/14523729

Matthew-Maich, N., Harris, L., Ploeg, J., Markle-Reid, M., Valaitis, R., Ibrahim, S., ... Isaacs, S. (2016). Designing, implementing, and evaluating mobile health technologies for managing chronic conditions in older adults: A scoping review. Journal of Medical Internet Research, mHealth and uHealth, 4(2). https://www.ncbi.nlm.nih.gov/pubmed/27282195

Mawson, S., Nasr, N., Parker, J., Zheng, H., Davies, R., & Mountain, G. (2014). Developing a personalised self-management system for post stroke rehabilitation; utilising a user-centred design methodology. Disability and Rehabilitation: Assistive Technology, 9, 521-528. https://www.ncbi.nlm.nih.gov/pubmed/24131371

McKevitt, C., Redfern, J., Mold, F., & Wolfe, C. (2004). Qualitative studies of stroke: A systematic review. Stroke, 35, 1499-1505. https://www.ncbi.nlm.nih.gov/pubmed/15105517

Mountain, G. W. P. M., Ware, P., Hammerton, J., Mawson, S., Zheng, H., Davies, R., ... Eccleston, C. (2006). The SMART project: A user led approach to developing applications for domiciliary stroke rehabilitation. Designing Accessible Technology, 135-144. http://opus.bath.ac.uk/6402/

Murray, J., Ashworth, R., Forster, A., & Young, J. (2003). Developing a primary care-based stroke service: A review of the qualitative literature. British Journal of General Practice, 53, 137-142. https://www.ncbi.nlm.nih.gov/pubmed/12817361

Nasr, N., Leon, B., Mountain, G., Nijenhuis, S. M., Prange, G., Sale, P., & Amirabdollahian, F. (2016). The experience of living with stroke and using technology: Opportunities to engage and co-design with end users. Disability and Rehabilitation: Assistive Technology, 11, 653-660. https://www.ncbi.nlm.nih.gov/pubmed/25879304

Pagliari, C. (2007). Design and evaluation in eHealth: Challenges and implications for an interdisciplinary field. Journal of Medical Internet Research, 9(2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913937/

Parke, H. L., Epiphaniou, E., Pearce, G., Taylor, S. J., Sheikh, A., Griffiths, C. J., ... Pinnock, H. (2015). Self-management support interventions for stroke survivors: a systematic meta-review. PLoS One, 10(7), e0131448. https://www.ncbi.nlm.nih.gov/pubmed/26204266

Parker, J., Mawson, S., Mountain, G., Nasr, N., Davies, R., & Zheng, H. (2014). The provision of feedback through computer-based technology to promote self-managed post-stroke rehabilitation in the home. Disability and Rehabilitation: Assistive Technology, 9, 529-538. https://www.ncbi.nlm.nih.gov/pubmed/24131369

Peoples, H., Satink, T., & Steultjens, E. (2011). Stroke survivors' experiences of rehabilitation: A systematic review of qualitative studies. Scandinavian Journal of Occupational Therapy, 18, 163-171. URL: https://www.ncbi.nlm.nih.gov/pubmed/20701431

Reed, M. C., Wood, V., Harrington, R., & Paterson, J. (2012). Developing stroke rehabilitation and community services: A meta-synthesis of qualitative literature. Disability and Rehabilitation, 34(7), 553-563. https://www.ncbi.nlm.nih.gov/pubmed/21985186

Ross, J., Stevenson, F., Lau, R., & Murray, E. (2016). Factors that influence the implementation of e-health: A systematic review of systematic reviews (an update). Implementation Science, 11(1), 146. https://www.ncbi.nlm.nih.gov/pubmed/27782832

Salter, K., Hellings, C., Foley, N., & Teasell, R. (2008). The experience of living with stroke: A qualitative meta-synthesis. Journal of Rehabilitation Medicine, 40, 595-602. https://www.ncbi.nlm.nih.gov/pubmed/19020691

Sivan, M., Gallagher, J., Holt, R., Weightman, A., Levesley, M., & Bhakta, B. (2014). Investigating the international classification of functioning, disability, and health (ICF) framework to capture user needs in the concept stage of rehabilitation technology development. Assistive Technology, 26, 164-173. https://www.ncbi.nlm.nih.gov/pubmed/26131797

Truelsen, T., Piechowski‐Jóźwiak, B., Bonita, R., Mathers, C., Bogousslavsky, J., & Boysen, G. (2006). Stroke incidence and prevalence in Europe: A review of available data. European journal of Neurology, 13, 581-598. https://www.ncbi.nlm.nih.gov/pubmed/16796582

van Gemert-Pijnen, J. E., Nijland, N., van Limburg, M., Ossebaard, H. C., Kelders, S.M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4). https://www.ncbi.nlm.nih.gov/pubmed/22155738

Wentzel, M.J., Beerlage-de Jong, N., Sieverin,K.F., & van Gemert-Pijnen, J.E.W.C. (2014). Slimmer e-health ontwikkelen en implementeren met de CeHRes Roadmap. In: C Politiek & R Hoogendijk (Eds.), CO-CREATIE E-HEALTHBOEK e-health, technisch kunstje of pure veranderkunde? https://www.utwente.nl/en/bms/ehealth/documents/workshop-2014/eHealth-Research_in_Beeld.pdf

Winstein, C.J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S.C., ... Lang, C.E. (2016). Guidelines for adult stroke rehabilitation and recovery. Stroke, 47(6), e98-e169

Zheng, H., Davies, R., Zhou, H., Hammerton, J., Mawson, S. J., Ware, P., ... Mountain, G. A. (2006). SMART project: Application of emerging information and communication technology to home-based rehabilitation for stroke patients. International Journal on Disability and Human Development, 5, 271-276. http://citeseerx.ist.psu.edu/viewdoc/download?doi=

DOI: https://doi.org/10.5195/ijt.2018.6247



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