活動的な状態を維持する：生態学的瞬間評価からの洞察を用いた脳卒中後の疼痛管理のための活動エンゲージメントの促進

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 post-stroke pain and activity engagement in natural contexts.

Home and Community PARTICIPANTS: Persons with mild-to-moderate stroke (N = 202) completed the study protocol, with the EMA completion rate of at least 30%. Participants (mean age = 59.7 years; 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 five times per day for two 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 the location, company, and activity in which they engaged. 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 post-stroke pain in daily contexts. Strategies promoting social interaction may reduce current pain, and physical activity and ADL participation may reduce subsequent pain.