App-led Exercise Program as Part of Device-Based Therapy Improves Access to Structured Exercise Programs in Stroke Patients Discharged to Home

Background and/or Objectives: Only 30% of stroke patients receive physical/occupational therapy and/or structured exercise programs (SEP) early after discharge from the hospital.

Design: Data from the EMAGINE trial (NCT05044507) was analyzed to investigate if a novel, app-led exercise program, concurrently delivered with neuromodulatory therapy, led to improved access to SEP following discharge. In addition to participating in standard physical and occupational therapy, participants were asked to conduct 45 treatment sessions, one-hour daily, 5x/week, beginning in the acute care hospital (ACH) or inpatient rehabilitation facility (IRF) and continuing upon discharge with caregiver support. A treatment session included active/sham non-invasive electromagnetic therapy in conjunction with an app-led, therapist-prescribed SEP.

Setting : Hospital, Inpatient Rehabilitation, and home.

Participants : Inclusion criteria included ischemic stroke with upper extremity impairment, a modified Rankin Scale 3-4 between 4-21 days post-stroke, and discharged to home. 73 patients met study criteria, mean age 59.0 [±12.6], 34% female, 49% White, mRS 3.96 [±0.20], FMA-UE 25.7 [±10.5],

Interventions: This is a secondary analysis of clinical trial data.

Main Outcome Measures: Timing of treatment and number of treatment sessions received.

Results: The 1st SEP session occurred at 14.6 [±4.4] days post-stroke. The first home app-led session occurred 2.5 [±3.3] days after discharge, vs 9.8 [±7.2] days from discharge to the first traditional PT/OT session. Within 30 days of discharge, participants completed 18.0 [±4.2] app-led sessions, vs 8.7 [±8.6] traditional PT/OT sessions. Nearly 20% of participants received no traditional PT/OT within 30 days of discharge, while 96% participated in >2 app-led sessions/week (vs 38% in traditional sessions/week), with an average of 4.2 [±0.97] sessions/week (vs 2.03 [±2.00] of traditional sessions/week).

Conclusions: Use of an app-led therapeutic exercise program facilitated a 107% increase in SEP participation, with a 74% reduction in treatment onset delay. This suggests that this type of SEP may provide more intensive and earlier access to therapy after return home post-stroke than standard care.