Staying Active: Promoting Activity Engagement for Poststroke Pain Management With Insights From Ecological Momentary...

To investigate the effect of activity engagement on current and future pain in individuals after stroke.

Prospective observational study using a smartphone-based ecological momentary assessment (EMA) as a real-time measurement for monitoring poststroke pain (PSP) and activity engagement in natural contexts.

Home and community.

Persons with mild-to-moderate stroke (N=202) completed the study protocol, with the EMA completion rate of ≥30%. Participants (mean age=59.7y; SD=11.7) were primarily men (55%), White (55%), married (52%), unemployed (57%), and had an ischemic stroke (90%).

Not applicable.

Participants completed EMA surveys 5 times per day for 2 weeks, reporting their pain and activity engagement. EMA-measured pain was characterized by its level of severity. EMA-measured activity engagement was characterized by daily functioning metrics, including location, company, and activity. We employed multilevel models to investigate concurrent and time-lagged relationships between pain and activity engagement.

In concurrent models, engagement in physical activities (β=0.088), time spent with care providers (β=0.249), and hospitalizations (β=0.667) or outpatient clinic visits (β=0.137) were associated with increased pain. In contrast, spending time with coworkers (β=-0.092), friends (β=-0.046), and spouses (β=-0.068) was associated with decreased pain. In time-lagged models, participating in physical activities (β=-0.052) and activities of daily living (ADL; β=-0.038) were associated with reduced subsequent pain, whereas spending time with care providers (β=0.102) and in hospitals (β=0.520) were associated with increased subsequent pain.

EMA provides new insights into understanding the impact of activity engagement on PSP in daily contexts. Strategies promoting social interaction may reduce current pain, and physical activity and ADL participation may reduce subsequent pain.