Satisfaction, user experiences, and initial efficacy of a technology-supported self-management intervention (iSMART) to improve post-stroke functioning: a remoted randomized controlled trial.
Yating Lei, Zhaoying Li, Quoc Bui and 8 others
PMID 39792597WHAT IT FOUND
Stroke survivors found this remote self-management program satisfying and helpful, especially the coaching and goal-setting.
They improved on hand function and participation measures, but the small sample meant no significant differences versus controls. Text messages were often rated as too frequent.
Key findings
01Participants rated the overall program and its coaching component as highly satisfying, with 100% endorsing satisfaction with coach contact and 88.9% satisfied with the program overall.
02The iSMART group showed medium-to-large improvements in hand function, participation, and reintegration, but these did not reach statistical significance against controls due to the small sample size.
03Text messaging was the least helpful component, with only 55.6% rating it helpful and participants reporting messages were too numerous and interruptive.
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 study was a pilot with a very small sample size (22 completers), which limited statistical power and makes the effect sizes preliminary. No intent-to-treat analysis was performed; only completers were analyzed, which may bias effectiveness estimates. Participants were recruited from a single institution, limiting generalizability. The iSMART group had a trend toward longer post-stroke duration and higher stroke severity than the control group, which could influence outcomes. Blinding of participants and staff was not possible, which may introduce performance bias.
Declared interests
Funding sources included NIH, HRSA, Barnes Jewish Hospital Foundation, Washington University McDonnell Center, Mallinckrodt Institute, and Usona Institute. Some authors reported consulting fees from pharmaceutical companies (Otsuka, Alkermes, Sunovion, CarelonRx) and ownership interests in health technology companies (Adaptive Health, Infinite Arms).
The easy way to misread this
Do not interpret the medium-to-large effect sizes as proof that iSMART is more effective than standard care. The study was underpowered, and no statistical differences between groups were found. The primary finding is feasibility and user satisfaction, not efficacy.
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