A mobile-based multimodal monitoring system with clinician feedback for home rehabilitation after stroke: a randomized clinical trial

Monitoring alone DOES NOTHING TO GET SURVIVORS RECOVERED! You need EXACT followup protocols and this doesn't have that, SO FUCKING USELESS! You're all fired!

A mobile-based multimodal monitoring system with clinician feedback for home rehabilitation after stroke: a randomized clinical trial

• Seung Ick Choi,
• Wonhee Lee,
• Hwi Woo Yang,
• Woo Jin Choi,
• Yejoon Kim &
• Na Young Kim 

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Abstract

Background

Wearable and mobile health-based monitoring systems are increasingly used to support home-based stroke rehabilitation. However, most monitoring systems rely on single-modality tracking focused on movement quantity, with limited assessment of gait quality and minimal integration of patient-reported data. The feasibility and clinical value of multimodal monitoring in home-based stroke rehabilitation need to be investigated. We evaluated the effectiveness of a multimodal monitoring–supported home rehabilitation system integrating wearable devices, a self-report application, and clinician feedback in community-dwelling stroke survivors.

Methods

In this single-center, assessor-blinded randomized clinical trial, adults with stroke were randomly assigned to an intervention or control group. Both groups received standardized home exercise education. The intervention group additionally received a 6-week multimodal monitoring intervention integrating smart insoles, an activity tracker, a self-report mobile application, and weekly clinician feedback based on monitoring data. The primary outcome was the change in 6-minute walk distance after the 6-week intervention. Secondary outcomes included gait parameters, physical activity, balance, muscle strength, activities of daily living, cognitive function, and psychosocial outcomes. Adherence and participant satisfaction were also evaluated.

Results

Of 120 randomized participants, 110 with data available for analysis were included in the primary analysis (55 per group), with missing post-intervention outcomes handled using multiple imputation. The intervention group demonstrated greater improvement in 6-minute walk distance than the control group (mean difference 23.15 m, 95% CI 6.70 to 39.60; p = 0.006). Greater improvements in balance and self-reported physical activity were also observed in the intervention group. No significant between-group differences were observed in gait parameters or isokinetic knee strength. Mean integrated adherence was approximately 60% during the 6-week intervention, and differences in clinical outcomes between high- and low-adherence groups were limited. Participants reported high satisfaction with the monitoring system.

Conclusions

Multimodal monitoring-supported home rehabilitation with individualized feedback was associated with greater improvement in walking endurance and selected functional outcomes in community-dwelling stroke survivors. However, sustained concurrent use of multiple monitoring modalities was limited and declined over time, highlighting the importance of considering usability and long-term sustainability when implementing multimodal monitoring in home rehabilitation.

Trial registration The project was registered at ClinicalTrials.gov (NCT06410755) on May 13, 2024 https//clinicaltrials.gov/study/NCT06410755.