Effects of a Health-Education Mobile App on Stroke-Related Knowledge and Health-Related Quality of Life in Patients with Stroke: A Randomized Controlled Trial (Preprint)
BACKGROUND Education regarding risk factors for stroke can prevent stroke recurrence and improve health-related quality of life (HRQOL) in patients with stroke. However, health-education mobile apps addressing risk factors for recurrent stroke are required. OBJECTIVE To develop a health-education mobile app related to stroke and examine its effectiveness on stroke-related knowledge and HRQOL in patients with stroke. METHODS In this single-blind randomized controlled trial, we recruited 76 stroke patients without cognitive impairment from stroke wards of 4 teaching hospitals and randomly assigned them to either complete the health-education app intervention (intervention group; n = 38) or undergo usual care by using a stroke-related health-education manual (control group; n = 38). The app was administered for a maximum of 30 days. The improvement in patients’ stroke knowledge (primary outcome) and HRQOL (secondary outcome) was assessed using the stroke-knowledge questionnaire and European Quality of Life–Five Dimensions (EQ-5D) questionnaire, respectively. RESULTS Total 63 patients were assessed in posttest (intervention group, n = 30; control group, n=33). In posttest, compared with the intervention group, the control group had nonsignificantly lower scores on the stroke-knowledge questionnaire (28.00 ± 5.46 vs 29.04 ± 5.27; Cohen’s d = 0.194; P = .43) and EQ-5D index (0.46 ± 0.41 vs 0.62 ± 0.29; Cohen’s d = 0.451; P = .07), but nonsignificantly higher scores on the EQ-5D visual analog scale (VAS; 65.00 ± 18.37 vs 62.30 ± 18.77; Cohen’s d = −0.145; P = .57). In the intervention group, posttest scores on the stroke-knowledge questionnaire were significantly higher than pretest scores (29.07 ± 5.27 vs 26.23 ± 6.65, P = .002); however, no significant differences were noted in the EQ-5D index (0.62 ± 0.29 vs 0.55 ± 0.29, P = .11) or VAS scores (62.30 ± 18.77 vs 59.67 ± 20.17, P = .45). In the subgroup analysis of the intervention group, patients aged ≤55 years demonstrated a higher percent improvement in stroke knowledge than did those aged >55 years (89% vs 58%; P = .08). CONCLUSIONS A short intervention period, weak patient involvement strategy, lack of reminders and animations may be the reasons hampered improvement between intervention and control groups. Although the improvements in stroke knowledge and HRQOL were nonsignificant in our between-group comparison, our subgroups analysis indicated that the use of our app led to greater stroke-knowledge improvement in younger patients with stroke (aged ≤55 years). Therefore, we suggest clinical professionals should incorporate our app into stroke care to improve the stroke knowledge and HRQOL of their patients with stroke. CLINICALTRIAL NCT02591511