200 - Behaviour change approaches within digital health technology-based interventions to facilitate early upper limb rehabilitation post stroke: a scoping review

Abstract

Purpose: Digital health technologies (DHTs) have the potential to support individuals to make changes to their behaviour in the early months following a stroke that will enable engagement with the intensive upper limb rehabilitation that is crucial to their recovery. In the absence of review literature in this area this scoping review aimed to identify and explore the use of behaviour change approaches in DHT-based interventions for upper limb rehabilitation in the first six months after stroke.

Methods: A scoping review was completed in line with current guidelines. A multi-database search was undertaken, using terms relating to behaviour change, DHT, physical rehabilitation, stroke and upper limb. Sources were screened independently by two reviewers against pre-defined eligibility criteria. These included participants who had experienced a stroke in the last six months and the use of a DHT for an upper limb rehabilitation intervention which incorporated a behaviour change approach. Sources were appraised for overall quality. Data was charted from the sources and included the study design and detail about the intervention with a focus on the DHT and behaviour change approaches. The behaviour change technique taxonomy version 1 (BCTTv1) was used to identify and code specific behaviour change techniques. Findings were synthesised using descriptive statistics and presented as text, tables and figures.

Results: Eight of the 809 sources screened (1%) were included in the review. All the sources were experimental studies (8/8, 100%) and three quarters (6/8, 75%) were feasibility studies. Studies had features indicating quality, but common weaknesses were noted. The most frequently identified DHTs were activity monitors (4/8, 50%) and virtual reality (VR) (4/8, 50%). No studies (0/8, 0%) reported a theory, model, or framework for behaviour change. All interventions used the BCTTv1 cluster of feedback and monitoring (8/8, 100%). The most frequent clusters used in activity monitors were feedback and monitoring (4/11, 36%), goals and planning (3/11, 27%) and associations (3/11, 27%), whereas for VR they were feedback and monitoring (4/14, 29%) and reward and threat (4/14, 29%).

Conclusion(s): This scoping review identifies that evidence surrounding the use of behaviour change approaches in DHT-based interventions for upper limb rehabilitation in the first six months after stroke is limited despite the importance of early and intensive rehabilitation and the potential for DHTs to influence behaviour change. Within all the identified sources BCTs associated with feedback and monitoring were identified however none reported underpinning theory. Further research is needed to identify and understand how DHTs can best influence behaviour change in order to optimise early upper limb rehabilitation following a stroke.

Impact: This review raises awareness of the limited evidence about DHT-based interventions in early upper limb stroke rehabilitation which incorporate approaches to change behaviour. This is an important consideration for clinicians at a time when they are being encouraged to move towards DHT-based interventions at pace and are looking for innovative ways to increase the intensity of upper limb rehabilitation without increasing the burden on limited staffing resources.