The Adaptive Physical Activity Study in Stroke (TAPAS): A Feasibility Sequential Multiple Assignment Randomized Trial

Area of Science:

• Neurology
• Rehabilitation Medicine
• Digital Health

Background:

• Physical inactivity post-stroke elevates the risk of recurrent stroke.
• Adaptive physical activity (PA) interventions are crucial for recovery.
• Sequential Multiple Assignment Randomized Trials (SMARTs) offer a flexible design for adaptive interventions.

Purpose of the Study:

• To assess the feasibility of a mobile health (mHealth) adaptive PA intervention for individuals post-stroke.
• To evaluate recruitment, retention, and adherence rates of the mHealth intervention.
• To explore preliminary effects on physical activity, fatigue, and quality of life.

Main Methods:

• A SMART design was employed, randomizing participants to online exercise (EX) or lifestyle PA (LPA).
• Non-responders were re-randomized to switch or augment their intervention based on 6-week step count data.
• General linear models and weighted/replicated regressions analyzed intervention trends.

Main Results:

• Recruitment, retention, and adherence rates were high (85%, 84%, 82% respectively).
• Positive trends were observed for nonresponse strategies, intervention switching, step count, fatigue, and quality of life.
• Starting with EX and switching to LPA showed potential benefits for fatigue, quality of life, and daily living.

Conclusions:

• This SMART demonstrated the feasibility of adaptive mHealth PA interventions post-stroke.
• The findings support the design of definitive SMART trials for optimizing PA interventions.
• Adaptive mHealth strategies show promise for improving outcomes in stroke survivors.