Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

Viktoria Fruhwirth; Lisa Berger; Thomas Gattringer; Simon Fandler-Höfler; Markus Kneihsl; Andreas Schwerdtfeger; Elisabeth Margarete Weiss; Christian Enzinger; Daniela Pinter

doi:10.3389/fneur.2021.791545

Evaluation of a Newly Developed Smartphone App for Risk Factor Management in Young Patients With Ischemic Stroke: A Pilot Study

Front Neurol. 2022 Jan 5:12:791545. doi: 10.3389/fneur.2021.791545. eCollection 2021.

Authors

Viktoria Fruhwirth^{1

2}, Lisa Berger^{2

3}, Thomas Gattringer^{1

4}, Simon Fandler-Höfler¹, Markus Kneihsl¹, Andreas Schwerdtfeger⁵, Elisabeth Margarete Weiss⁶, Christian Enzinger^{1

2

4}, Daniela Pinter^{1

2}

Affiliations

¹ Department of Neurology, Medical University of Graz, Graz, Austria.
² Research Unit for Neuronal Plasticity and Repair, Department of Neurology, Medical University of Graz, Graz, Austria.
³ Department of Neuropsychology - Neuroimaging, Institute of Psychology, University of Graz, Graz, Austria.
⁴ Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
⁵ Department of Health Psychology, Institute of Psychology, University of Graz, Graz, Austria.
⁶ Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria.

Abstract

Background: Efficient treatment of modifiable vascular risk factors decreases reoccurrence of ischemic stroke, which is of uttermost importance in younger patients. In this longitudinal pilot study, we thus assessed the effect of a newly developed smartphone app for risk factor management in such a cohort. Methods: The app conveys key facts about stroke, provides motivational support for a healthy lifestyle, and a reminder function for medication intake and blood pressure measurement. Between January 2019 and February 2020, we consecutively invited patients with ischemic stroke aged between 18 and 55 years to participate. Patients in the intervention group used the app between hospital discharge and 3-month follow-up. The control group received standard clinical care. Modifiable risk factors (physical activity, nutrition, alcohol consumption, smoking behavior, obesity, and hypertension) were assessed during the initial hospital stay and at a dedicated stroke outpatient department three months post-stroke. Results: The study cohort comprised 21 patients in the app intervention group (62% male; age = 41 ± 11 years; education = 12 ± 3 years) and 21 sex-, age- and education-matched control patients with a comparable stroke risk factor profile. Baseline stroke severity was comparable between groups (intervention: median NIHSS = 3; control: median NIHSS = 4; p = 0.604). Three months post-stroke, patients in the intervention group reported to be physically almost twice as active (13 ± 9 h/week) compared to controls (7 ± 5 h/week; p = 0.022). More intense app usage was strongly associated with higher physical activity (r = 0.60, p = 0.005) and lower consumption of unhealthy food (r = -0.51, p = 0.023). Smoking behavior (p = 0.001) and hypertension (p = 0.003) improved in all patients. Patients in the intervention group described better self-reported health-related quality of life three months post-stroke (p = 0.003). Conclusions: Specifically designed app interventions can be an easily to implement and cost-efficient approach to promote a healthier lifestyle in younger patients with a stroke.

Keywords: app; risk factor management; secondary prevention; smartphone; stroke.