Photo of a hand holding a smartphone

Smartphone-Based Program Effective in Helping People Stick to Healthy Behaviors to Improve Stroke Recovery


A smartphone-based, coach-supported educational program called iSMART (Self-Management Augmented Rehabilitation Technologies) is a low-cost, effective way to help people manage their chronic symptoms, emotions, and engagement in daily activities after a stroke, according to a new paper published in JMIR Rehabilitation and Assistive Technologies.

 People who have experienced a stroke are at a higher risk of developing depression and having a lower quality of life. While inpatient rehabilitation for stroke patients averages about 18 days, once back at home, it is common for people to experience fatigue, depressed mood, withdrawal from some activities, and cognitive dysfunction, which can impact stroke recovery. Being able to manage these symptoms is an important aspect of stroke rehabilitation. Researchers have looked towards smartphone-based programs focusing on education to help patients manage life after stroke and build self-efficacy.

“Rehabilitation care focuses on lessening impairment and disability after stroke, which rarely includes training to promote long-term management of post-stroke problems after transitioning to community living,” says Alex Wong, PhD, Assistant Director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and corresponding author of the study. “Smartphone-based platforms offer new ways to remotely enable people with such training through instructions, goal setting, activity monitoring, and real-world feedback. iSMART is one of these programs and aims to fill this gap,” 

iSMART, developed by Wong and colleagues, is a coach-guided, technology-supported self-management intervention designed to support people managing chronic conditions and maintaining active participation in daily life after stroke. A coach provides educational materials through the iSMART smartphone app, and texting allows the coach to encourage and motivate participants to engage in healthy behaviors to promote stroke recovery and wellness. 

To evaluate the efficacy of iSMART, Wong and colleagues randomized twenty-four participants with mild to moderate stroke to either participate in iSMART or receive general educational materials on stroke rehabilitation. The trial lasted 12 weeks, with iSMART participants working with the coach weekly and receiving daily goal-specific text messages to improve their adherence to managing daily life challenges. 

The iSMART group significantly improved self-efficacy in managing emotions, symptoms, daily activities, treatments, and medications, while participants in the control group had negligible to small improvements. Participants in the iSMART had significantly higher rates of using strategies to manage activities at home, work, and in the community than the control group. 

“We also found that participants responded to 80% of text messages sent by the iSMART platform, which may reflect that our participants really got a lot out of it and enjoyed it.,” says Wong. “Our participants also rated iSMART as feasible and appropriate, according to their ratings of standard implementation measures.”

Coauthors on the paper include Zhaoying Li, MS of the University of North Carolina School of Medicine; Yating Lei, MS of New York University; Quoc Bui, MD and Ginger Nicol, MD of Washington University School of Medicine, St. Louis; Olivia DePaul, OTD of Memorial Hospital Belleville, IL; David Mohr, PhD of Northwestern University Feinberg School of Medicine; Sunghoon Lee, PhD of the University of Massachusetts Amherst; Mandy W. M. Fong, PhD of Michigan Avenue Neuropsychologists; Christopher Metts, MD of the Medical University of South Carolina; and Stephanie Tomazin, MPH, of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab.

This study was supported by grants from the American Occupational Therapy Foundation (AOTFIRG20Wong) and the National Center for Medical Rehabilitation Research (K01HD095388). The research reported in this publication was also supported by the National Institute of Mental Health (R34 MH118395) and the Washington University Mobile Health Research Core, part of the Institute of Clinical and Translational Sciences, funded by the National Center for Advancing Translational Sciences (UL1TR002345).