Multimodal Ambulatory Monitoring of Daily Activity and Health-Related Symptoms in Community-Dwelling Survivors of Stroke: Feasibility, Acceptability, and Validity

Abstract

Objective: To examine the feasibility, acceptability, and validity of multimodal ambulatory monitoring, which combines accelerometry with ecological momentary assessment (EMA), to assess daily activity and health-related symptoms among survivors of stroke.

Design: Prospective cohort study involving 7 days of ambulatory monitoring; participants completed 8 daily EMA surveys about daily activity and symptoms (mood, cognitive complaints, fatigue, pain) while wearing an accelerometer. Participants also completed retrospective assessments and an acceptability questionnaire.

Setting: Community.

Participants: Forty survivors of stroke (N=40).

Interventions: Not applicable.

Main outcome measures: Feasibility was determined using attrition rate and compliance. Acceptability was reported using the acceptability questionnaire. Convergent and discriminant validity were determined by the correlations between ambulatory monitoring and retrospective self-reports. Criterion validity was determined by the concordance between accelerometer-measured and EMA-reported daily activity.

Results: All participants completed the study (attrition rate=0%). EMA and accelerometer compliance were 93.6 % and 99.7%, respectively. Participants rated their experience with multimodal ambulatory monitoring positively. They were highly satisfied (mean, 4.8/5) and confident (mean, 4.7/5) in using ambulatory monitoring and preferred it over traditional retrospective assessments (mean, 4.7/5). Multimodal ambulatory monitoring estimates correlated with retrospective self-reports of the same and opposing constructs in the predicted directions (r=-0.66 to 0.72, P<.05). More intense accelerometer-measured physical activity was observed when participants reported doing more physically demanding activities and vice versa.

Conclusions: Findings support the feasibility, acceptability, and validity of multimodal ambulatory monitoring in survivors of mild stroke. Multimodal ambulatory monitoring has potential to provide a more complete understanding of survivors' daily activity in the context of everyday life.

Keywords: Accelerometry; Ecological momentary assessment; Outcome assessment (health care); Rehabilitation; Stroke; Telemedicine.