Developing the evidence base for a mobile health intervention to promote physical activity post-stroke

Background

Physical activity (PA) is a cornerstone of secondary stroke prevention; however, people post-stroke are often inactive. Mobile health (mHealth), e.g., smartphone and app-based interventions, has been proposed as an approach to support PA post-stroke.

Aim

This thesis aimed to identify and develop evidence for an app-based intervention to support PA post-stroke.

Methods

This research, set within the development stage of Medical Research Council (MRC) guidance for developing complex interventions, adopted a mixed-methods approach. First, a systematic review and meta-ethnography synthesised users’ experiences of app-based interventions to support PA. Second, a qualitative study, guided by a published protocol, thematically analysed stakeholder perspectives toward using apps to support PA post-stroke. Third, a systematic content analysis and quality appraisal reviewed commercial apps for PA post-stroke. Fourth, a cross-sectional study, using an existing dataset, explored associations between stroke and internet use. Lastly, a co-authored systematic review and meta-analysis examined the effectiveness of physical fitness training post-stroke.

Findings

The meta-ethnography identified user-perceived value in tailoring and customisation but found no stroke-related publications. The qualitative study indicated people post-stroke and clinicians were cautiously open to app-based interventions to support PA. The app review raised quality-related concerns in commercial app development. The cross-sectional study noted a majority of people post-stroke used the internet but detected challenges for digital inclusion. The meta-analysis demonstrated the effectiveness of cardiorespiratory and mixed training for post-stroke care.

Conclusions

Stakeholder perspectives demonstrated that mHealth could augment post-stroke care, particularly following the COVID-19 pandemic. Apps were identified which may be useful to stakeholders; however, these require further evaluation and formally recommending existing apps to stroke services is premature. This thesis provides guiding principles for developing the features and content of a PA app prototype. With a prototype, future research incorporating user involvement should focus on the next stage of MRC guidance, feasibility testing.