Co-designed digital device for tracking rehabilitation dosage in a clinical environment after stroke : mixed methods validity and feasibility study

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Boyd, Fiona and Sweeney, Gillian and Barber, Mark and Forrest, Elaine and Dunlop, Mark and Kerr, Andrew (2025) Co-designed digital device for tracking rehabilitation dosage in a clinical environment after stroke : mixed methods validity and feasibility study. JMIR Rehabilitation and Assistive Technologies, 12. e68129. ISSN 2369-2529 (https://doi.org/10.2196/68129)

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Abstract

Background: In 2023, the National Clinical Guidelines for Stroke revised the recommended daily multidisciplinary therapy dose from 45 minutes per therapy to 3 hours of therapy overall. To monitor the achievement of these guidelines, there is a need for accurate measurement. This study introduces a novel co-designed digital dosage tracking system that uses Near Field Communication technology to log rehabilitation activities and demonstrates its feasibility and accuracy in a clinical setting through comparison with the current clinical method of manual recording. Objective: This study aimed to assess the validity, feasibility, and usability of a novel co-designed digital tracker using Near Field Communication technology to automatically log rehabilitation dosage in people with stroke history, providing an objective and low-burden solution for clinical environments. Methods: This pilot mixed methods study included 2 phases. Phase 1 involved a usability trial with 9 participants conducted at a university research center, assessing usability with the System Usability Scale (SUS) and Intrinsic Motivation Inventory (IMI). Phase 2 consisted of a clinical trial in a National Health Service stroke ward with 15 inpatients, comparing the digital tracker with manual therapist recordings for validity and feasibility using paired t tests, Cohen d, and Bland-Altman plots. An acceptable discrepancy range was set at ±5%‐10%. Results: The digital tracker demonstrated high usability with a mean SUS score of 91.43 (SD 9.53) and strong user satisfaction (IMI score 6.29/7, SD 1.50). Clinical trial results showed a strong agreement between the digital and manual methods (t206=−1.60; P=.11; Cohen d=−0.06), with a small mean time discrepancy of 1.23 (SD 11.01) minutes across 207 activities. The Bland-Altman plot indicated good accuracy and consistency between methods, with limits of agreement within the clinically acceptable range. Conclusions: The co-designed digital tracker has been shown to agree with a manual method for recording rehabilitation dosage. This development presents the opportunity for objective, automated, and low-burden recording of rehabilitation dose to support prescription, monitoring, and research.

ORCID iDs

Boyd, Fiona ORCID logoORCID: https://orcid.org/0009-0007-8901-7296, Sweeney, Gillian, Barber, Mark, Forrest, Elaine, Dunlop, Mark ORCID logoORCID: https://orcid.org/0000-0002-4593-1103 and Kerr, Andrew ORCID logoORCID: https://orcid.org/0000-0002-7666-9283;
CORE (COnnecting REpositories)