First experience in employing a complex digital support system accompanied by personal assistance to improve aftercare in patients with stroke or transient ischemic attack – results of the PostStroke-Manager feasibility study

TL;DR

This study tested a digital support system with personal assistance for stroke and TIA patients, showing it is feasible and beneficial for some aspects of aftercare.

Contribution

The study is the first to evaluate a complex digital support system with personal assistance for stroke and TIA aftercare.

Findings

The digital system and personal assistance received positive patient ratings, meeting feasibility criteria.

Improvements were observed in impairments, blood pressure, and LDL cholesterol levels over time.

Psychometric measurements like anxiety and depression remained stable during the study period.

Abstract

Stroke aftercare is widely acknowledged as crucial yet challenging. Digital tools offer a promising strategy to improve aftercare and, thus, patients’ quality of life. However, it has not yet been investigated whether digital tools addressing different aspects of aftercare at the same time can be utilized in stroke patients. This study was intended to gain first experience in employing a complex patient-centered digital support system (i.e., the PostStroke-Manager) in individuals with stroke or transient ischemic attack (TIA) and thus examined its feasibility accompanied by personal assistance. This cohort study was carried out to enroll patients with stroke or TIA. Digital support was realized through an application installed on a tablet, a smartwatch, and a blood pressure monitor. Trained nurses, referred to as stroke pilots, provided personal assistance. After 6 or 12 months, patients were asked to evaluate the concept with digital and personal support as a whole and concerning single components of the program for individually experienced beneficial effects. Additional descriptive analyses comprised temporal courses of stroke-related impairments, quality of life, anxiety, depression, adherence, empowerment, blood pressure, LDL cholesterol, and HbA1c levels. Between January 2022 and December 2022, 815 patients were screened, and 43 were included in the study, of whom 36 completed follow-up assessments. The study met its predefined feasibility criterion, with at least 50% of program components receiving positive ratings from at least 75% of patients. The digital system as a whole (77.8%), personal assistance (75.0%), and interactions with stroke pilots (77.8%) received particularly positive ratings. Additionally, aspects such as vital sign monitoring, platforms for communication and medical records were rated positively. Longitudinal analyses revealed improvements in patients’ impairments, blood pressure, and LDL cholesterol levels, while most psychometric measurements remained stable. These findings indicate the feasibility of employing complex digital support systems for patient-centered aftercare in selected individuals with stroke or TIA. The challenge remains in extending benefits to those patients with more severe neurological impairments, highlighting the necessity for ongoing advancement in this field.

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