Self-Reported Acceptance of a Wearable Activity Monitor in Persons With Stroke: Usability Study

Wearable activity monitors offer clinicians and researchers accessible, scalable, and cost-effective tools for continuous remote monitoring of functional status. These technologies can complement traditional clinical outcome measures by providing detailed, minute-by-minute, remotely collected data on a wide array of biometrics, including physical activity and heart rate. There is significant potential for the use of these devices in rehabilitation after stroke if individuals will wear and use the devices; however, the acceptance of these devices by persons with stroke is not well understood.

This study investigated the self-reported acceptance of a commercially available, wrist-worn wearable activity monitor (the Fitbit Inspire 2; Fitbit Inc) for remote monitoring of physical activity and heart rate in persons with stroke. We also assessed relationships between reported acceptance and adherence to wearing the device.

Sixty-five participants with stroke wore a Fitbit Inspire 2 for 3 months, at which point we assessed acceptance using the Technology Acceptance Questionnaire (TAQ), which includes 7 dimensions: perceived usefulness, perceived ease of use, equipment characteristics, privacy concerns, perceived risks, facilitating conditions, and subjective norm. We then performed Spearman correlations to assess relationships between acceptance and adherence to device wear, calculated as both the percentage of daily wear time and the percentage of valid days the device was worn during the 3 weeks preceding TAQ administration.

Most participants reported generally agreeable responses, with high overall total TAQ scores across all 7 dimensions, indicating strong acceptance of the device; "Agree" was the median response to 29 of the 31 TAQ statements. Participants generally found the device beneficial for their health, efficient for monitoring, easy to use and to don and doff, and unintrusive to daily life. However, participant responses on the TAQ did not show significant positive correlations with measures of actual device wear time (all P>.05).

This study demonstrates generally high self-reported acceptance of the Fitbit Inspire 2 among persons with stroke. Participants reported general agreement across all 7 TAQ dimensions, with minimal concerns interpreted as being directly relatable to poststroke motor impairment (eg, donning and doffing the device, using it independently). However, the high self-reported acceptance scores did not correlate positively with measures of real-world device wear. Accordingly, it should not be assumed that persons with stroke will adhere to wearing these devices simply because they report high acceptability.