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 and 8 others
PMID 38373029WHAT IT FOUND
A 12-week text-messaging and coaching program improved stroke survivors' confidence in managing home, work, and social activities.
Retention was high, but the small sample and unblinded design mean this shows feasibility, not proven effectiveness.
Key findings
01Participants in the intervention group reported higher feasibility, acceptability, and appropriateness scores than the control group, with moderate-to-large effect sizes.
02The intervention group showed moderate-to-large improvements in self-efficacy for managing home, work, community, and communication activities compared to the control group.
03Retention was 82%, meeting the benchmark, but text message response rates were 76%, falling slightly below the 80% engagement benchmark.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size was very small (22 completers), limiting statistical power and the reliability of effect sizes. The study was not blinded, so participants knew which treatment they were receiving, which may have influenced self-reported outcomes. There was no intent-to-treat analysis; only completers were analyzed, which can bias results if dropouts differed from those who stayed. Baseline differences existed: the iSMART group had slightly more severe strokes and longer time since stroke than the control group, which could have influenced the outcomes. The study was conducted at a single institution, limiting generalizability to other settings or populations. The intervention was complex (psychoeducation, coaching, and texting), so it is impossible to know which component drove the improvements.
Declared interests
Funding and conflicts of interest declarations list research support from the NIH and various foundations for several authors. Some authors have consulting roles with pharmaceutical companies or ownership interests in health-related entities, though no direct commercial sponsor of the iSMART intervention itself is named as having designed or written the study.
The easy way to misread this
Do not interpret the large effect sizes as proof that this specific digital intervention works better than standard care. The study was a small pilot with a non-blinded design and baseline differences between groups, meaning the results are preliminary and subject to high uncertainty.