Ecological Momentary Assessment of Real-World Functional Behaviors in Individuals With Stroke: A Longitudinal Observational Study.

The sample was restricted to individuals with mild to moderate stroke who could provide self-reports and use digital devices, excluding those with severe stroke, significant communication difficulties, or severe cognitive impairment. No laboratory-based physical or vocational measures were administered, preventing direct comparison of EMA-reported physical activity with clinical capacity. The survey instruments lacked adequate sensitivity to detect subgroup differences in physical, cognitive, and social activities. A small subset of participants completed the study during the COVID-19 pandemic, which may have influenced daily activity patterns. Participants who dropped out or were excluded had lower cognitive function, potentially biasing the sample toward higher-functioning individuals.

The authors declared no conflicts of interest. The study was supported by NIH and non-U.S. government funding. The EMA app (Status/Post) was modified from a validated survey with developer approval, but no commercial ties to the app developer were reported.

Do not assume that low correlations between EMA and in-laboratory functioning measures indicate poor validity of EMA. The authors suggest these discrepancies reflect the difference between capacity (what a patient can do in a barrier-free clinic) and performance (what they actually do in the real world), not measurement error.