Smartphone-Based Ecological Momentary Assessment as the New Standard Measure for Post-Stroke Functioning (Preprint)

BACKGROUND Functional disability is common after stroke. To inform new treatments, better measures are needed to advance our understanding of post-stroke functioning. Ecological momentary assessment (EMA) provides a putatively valid measure of everyday functioning by assessing patients during their lived experiences. OBJECTIVE This study aims to validate the smartphone-based EMA to characterize post-stroke everyday functioning and symptoms. METHODS Participants (N=212) with mild to moderate stroke were assessed five times daily for 14 days with EMA surveys to appraise mental, somatic, and cognitive symptoms, and what, with whom, and where participants were doing activities. Participants also completed standardized assessments during lab visits. RESULTS Most participants (median age = 60 years) were ischemic stroke (90%) and neurologically mild (median NIHSS = 2). Total 14,140 EMA surveys were analyzed. Participants were home 78% of the time and primarily participated in passive, unproductive activities, especially watching television and resting. EMA was sensitive to indicators of post-stroke disability; unemployed participants reported fewer vocational activities (W =12183.5, P < .001) but more activities of daily living (ADL) (W =6995, P < .001) and passive activities (W =7499.5, P =.003) than employed counterparts. Users of mobility devices and participants with cognitive problems spent significantly less time on vocational activities (W =2717, P< .0001 for mobility devices; W =7278, P= .03 for cognitive problems) and more on ADL (W =4807.5, P= .010 for mobility devices; W =9516.5, P< .001 for cognitive problems) than non-users and those without cognitive problems. Our data supported the validity of EMA methods in stroke, with small-to-moderate correlations of EMA with in-lab measures of daily functioning and very large correlations between EMA and in-lab measures of symptoms, especially those measuring the same constructs. CONCLUSIONS Our findings reveal that EMA tracked post-stroke functioning precisely. EMA may be beneficial in examining post-stroke functional recovery, monitoring patients for home-based interventions, and for longitudinal research. CLINICALTRIAL NA