Title
Measuring activity recovery at home in the post-acute phase of stroke rehabilitation by means of a novel computerised system.

Lead researcher
Dr Robert van Deursen, School of Healthcare Studies, Cardiff University

Research questions

  1. Can functional activities of people recovering from stroke be measured reliably and validly at home on a continuous basis using unobtrusive sensor technology?
  2. What are the main characteristics of recovery in the home environment and what are the main differences compared to recovery in the stroke unit?

Hypothesis
Activity and functional recovery can be successfully measured (in terms of reliability and validity) on a continuous basis in the home environment.
Aims:

  1. Reliability Study in Home Environment of an Automated Sensor-Based System.
  2. Validity Study in Home Environment of an Automated Sensor-Based System.
  3. Developing Analytic Tools & Testing for Activity Recovery in the Home.
  4. Exploratory Study to Answer the Second Research Question.

Background
“An estimated 10,000 to 11,000 people in Wales suffer a stroke each year. Of those, a third will die from the severity of the stroke; a third will be left permanently disabled; and the final third will recover with proper rehabilitation and support”. According to the National Service Framework in order to improve mobility, patients require longer access to rehabilitation services after discharge. Because patients are getting discharged earlier with early supported discharge schemes being utilised more frequently, it is important to understand how to best support recovery in the home environment.
Our understanding of recovery of movement related to activities of daily living (functional recovery) is still inadequate but previous research indicates that patients seem to recover better at home compared to the hospital. Subsequently to understand this difference as well as to give patients feedback and motivate them to continue exercises at home, there is a need to have quantifiable information about aspects of home recovery and rehabilitation such as exercise type, frequency, duration and adherence. For various reasons, the current method of keeping a log/diary record has been of limited use. Therefore automated technology is being explored to meet this need.

Study design summary
At present we know that the system is reliably running at the RSU in Cardiff. The aim of this study is to replicate this setup in patients’ homes in order to continuously measure their mobility, after they get discharged from hospital. In this observational study, there are 4 main stages. The study is designed to cyclically develop, test and deploy the automated system which will predominantly be carried out by Pete Woznowski. In the 1st stage of the project the system used in the RSU is to be installed in a patient’s home in order to perform a scenario-based data collection and explore additional requirements in the home setting. This stage shall be repeated for 10 patients measured at home in order to determine how reliable the system is in different settings. With collected data further refinements to the system can be made to maximise its reliability. The Validity Study will follow the same cycle, i.e. set-up, testing, analysis of results and further development and will include a comparison with data from Step Activity Monitors. In the 3rd stage, analytic software tools will be designed to satisfy rehabilitation requirements (e.g. day/week summaries of mobility/activity profiles and therapy/exercise time) and tested. Requirements are determined through structured meetings of the project team and service user participation (Involving People). Finally the results from data collection at the RSU will be compared to the home-based measurements to identify differences in the activities that should be recorded in these locations to address Research Question 2.

Total awarded
£17,777