Design and evaluate a mobile app for post-stroke shoulder rehabilitation adherence

Thesis Abstract

Post-stroke shoulder rehabilitation remains a critical component of functional recovery, yet adherence to prescribed physiotherapy exercises continues to be suboptimal, often impeding optimal outcomes for patients. This study addresses the challenge of improving adherence to shoulder rehabilitation protocols among post-stroke patients through the development and evaluation of a dedicated mobile application. The primary aim is to design a user-centered mobile app that facilitates engagement, motivation, and compliance with shoulder exercise regimens, and to empirically assess its effectiveness in promoting adherence. The specific objectives include (1) to identify barriers and facilitators to rehabilitation adherence among post-stroke patients; (2) to design a mobile app grounded in the Health Belief Model and Self-Determination Theory to address identified barriers; (3) to evaluate the usability and acceptability of the app among users; and (4) to assess the app’s efficacy in enhancing adherence rates, functional shoulder outcomes, and patient satisfaction over a three-month period. Employing a mixed-methods research design, the study first conducts qualitative interviews with 30 post-stroke patients and 10 physiotherapists to explore contextual factors influencing adherence, using thematic analysis to extract salient themes. Subsequently, a prototype development process incorporates user-centered design principles, and the app is iteratively refined based on feedback. For the quantitative phase, a randomized controlled trial (RCT) with a sample of 120 post-stroke patients from outpatient rehabilitation clinics is conducted. Participants are randomly assigned to either the intervention group, which uses the mobile app alongside standard physiotherapy, or to a control group receiving standard care alone. Data collection instruments include validated adherence questionnaires, the Shoulder Pain and Disability Index (SPADI), the System Usability Scale (SUS), and structured satisfaction surveys, administered at baseline, three months, and follow-up. Quantitative data are analyzed using descriptive statistics, independent t-tests, and repeated measures ANOVA to detect differences in adherence and functional outcomes between groups over time. Regression analysis explores predictors of adherence, incorporating variables such as demographic factors, motivation levels, and app usage frequency. Thematic analysis of qualitative feedback complements quantitative findings, providing insights into user perceptions, barriers overcome, and areas for further improvement. Expected findings include a statistically significant increase in adherence rates and shoulder function scores in the app-using group compared to controls, alongside high usability and satisfaction ratings. The mobile app is anticipated to serve as a feasible and effective tool for enhancing rehabilitation compliance, thereby contributing to improved functional recovery post-stroke. This research advances knowledge by integrating behavioral theories into health technology design and providing empirical evidence of mHealth interventions’ effectiveness in stroke rehabilitation. The study demonstrates the importance of user-centered design and evidence-based frameworks in developing digital health solutions. The primary conclusion underscores that tailored mobile applications can serve as viable adjuncts to traditional physiotherapy, significantly improving adherence and functional outcomes among post-stroke patients. Based on these findings, it is recommended that rehabilitation programs integrate smartphone-based interventions into standard care, and further research should explore long-term effects, scalability, and customization for diverse stroke populations. This study establishes a foundation for future developments in mobile health strategies aimed at optimizing post-stroke recovery trajectories.