Encouraging arm use in stroke survivors: the impact of smart reminders during a home-based intervention.
Laura Mayrhuber, Sebastian D Andres, Mathilde L Legrand and 12 others
PMID 39707385WHAT IT FOUND
Smart reminders increased objective arm activity counts in stroke survivors but did not improve patient-reported use or clinical function scores compared to controls.
The functional gains were small and below clinically meaningful thresholds, with high data loss limiting certainty.
Key findings
01The intervention group showed significantly higher objective affected arm use counts than the control group, but this did not translate to significant improvements in patient-reported amount of use or quality of movement.
02Both groups improved slightly in clinical scores over time, but the changes were below the minimal clinically important difference and showed no significant difference between the intervention and control groups.
03Initial upper limb impairment level was a strong predictor of arm activity and clinical scores, with severely impaired participants using their affected arm significantly less than mildly impaired participants.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Recruitment was terminated early due to the pandemic and an interim analysis, resulting in 42 participants instead of the planned 62, which reduced statistical power. Nearly half of the participants (19 of 42) were excluded from the sensor data analysis due to missing data, dropout, or non-compliance with wearing the devices, limiting the generalizability of the objective findings. The intervention did not include task-specific exercises; reminders only prompted movement, which may explain the lack of functional transfer. No baseline sensor data was collected, making it impossible to determine if the intervention group's activity levels were higher than their own pre-intervention levels. The clinical improvements observed were small and below established minimal clinically important difference thresholds.
Declared interests
Tyromotion GmbH provided the activity tracking devices used in the study. The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret the significant increase in objective arm activity counts as evidence of clinical effectiveness. The primary patient-reported outcome and all functional measures showed no significant difference between the groups, and any improvements were below the threshold for clinical importance.