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. 2025 Apr 23;15(1):14190.
doi: 10.1038/s41598-025-95726-z.

Enhancing long-term adherence in elderly stroke rehabilitation through a digital health approach based on multimodal feedback and personalized intervention

Xintong Wen #  1   2 , Yuxuan Li #  3   4 , Qi Zhang  5 , Zhiwei Yao  2 , Xijie Gao  2 , Zhibo Sun #  6 , Xing Fang  2 , Wei Huang  7   8
Affiliations

Enhancing long-term adherence in elderly stroke rehabilitation through a digital health approach based on multimodal feedback and personalized intervention

Xintong Wen et al. Sci Rep. .

Abstract

Multimodal digital health technologies aim to improve long-term adherence in stroke patients through personalized feedback and psychological monitoring. However, the interactive effects of physiological and psychological factors on rehabilitation adherence remain unclear. This study evaluates personalized feedback, physiological and psychological factors, and their independent and synergistic effects to optimize rehabilitation adherence in elderly stroke patients. This study was designed as a longitudinal study, with data collected from 180 participants across two central hospitals between March and September 2024. A linear mixed effects model (LMM) was used to analyze the impact of physiological monitoring, psychological monitoring, and personalized feedback mechanisms on long-term patient adherence. Data were gathered through structured questionnaires, resulting in a final sample size of 540 data points. The time effect has a significant positive effect on rehabilitation compliance. The rehabilitation plan completion rate (A1) increases by 1.25 (t = 34.25) and 2.28 units (t = 62.56) in the mid-term follow-up (T2) and long-term follow-up (T3) respectively; the self-reported compliance score (A2) increases by 1.12 (t = 31.39) and 2.3 points (t = 64.27) at T2 and T3 respectively; the completion of specific activities (A3) increases by 1.37 (t = 50.34) and 2.34 units (t = 86.26); the number of interruptions (A4) decreases by 0.89 (t = -17.31) and 2.11 times (t = -41.17) respectively. In personalized feedback, high-quality feedback (D2) significantly promotes compliance (β = 0.0318, t = 2.08), while excessively frequent feedback (D1) showes a negative impact (β=-0.0914, t=-1.93 ). In terms of psychological factors, positive emotion (C3) has a significant positive effect on compliance (β = 0.1572, t = 2.695), while depressed emotion (C1) significantly reduces interruption behavior (β=-0.0885). The interaction effect between physiological factors and psychological factors is not significant, indicating that their influence is relatively independent. This study demonstrates that personalized feedback, psychological support, and time effects are essential for enhancing rehabilitation adherence in elderly stroke patients. High-quality, relevant feedback significantly improves adherence, while ineffective feedback may have adverse effects. Positive emotions within psychological factors promote adherence, whereas depressive emotions hinder recovery, underscoring the importance of psychological support. Although physiological and psychological factors lack significant interactive effects, their independent influences merit attention and optimization in rehabilitation interventions.

Keywords: Adherence; Elderly patients; Linear mixed effects model; Personalized feedback intervention; Rehabilitation; Stroke.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was reviewed and approved by the Ethics Committee of Wuhan Union Hospital (Approval Number: WHUHTMC-K-2024306). The committee confirmed that the project aligns with the principles of the Declaration of Helsinki and medical ethics requirements, and it granted approval for the study within the specified period. Written informed consent was obtained from all participants after explaining the study’s purpose, procedures, and their rights, including the right to withdraw at any time. Data collection and analysis adhered to strict anonymization protocols to ensure participant privacy, with secure data storage in compliance with relevant regulations. Consent for publication: Consent for publication was obtained from all individual participants included in the study. Participants were informed that their anonymized data would be used for research and publication purposes, and they provided consent for their data to be shared in an academic setting without revealing their identities. Consent to participate: Informed consent was obtained from all individual participants included in the study. All participants were provided with comprehensive information regarding the study’s purpose, procedures, potential risks, and their rights, including the right to withdraw at any time without penalty. Consent forms were signed prior to participation, ensuring that each participant voluntarily agreed to take part in the study.

Figures

Fig. 1
Fig. 1
Conceptual framework for enhancing long-term adherence in stroke rehabilitation using multi-modal feedback.
Fig. 2
Fig. 2
Changes in long-term adherence subvariables with SBP and C1.
Fig. 3
Fig. 3
Residuals vs. Fitted Values for model validation.
Fig. 4
Fig. 4
Q-Q Plot of residuals for each model in the robust mixed effects analysis.
See this image and copyright information in PMC

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References

    1. Hilkens, N. A., Casolla, B., Leung, T. W., De Leeuw, F. E. & Stroke Lancet ;403(10446):2820–2836. doi:10.1016/S0140-6736(24)00642-1 (2024). - PubMed
    1. Stinear, C. M., Lang, C. E., Zeiler, S. & Byblow, W. D. Advances and challenges in stroke rehabilitation. Lancet Neurol.19 (4), 348–360. 10.1016/S1474-4422(19)30415-6 (2020). - PubMed
    1. Johnson, C. O. et al. Global, regional, and National burden of stroke, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol.18 (5), 439–458. 10.1016/S1474-4422(19)30034-1 (2019). - PMC - PubMed
    1. Murray, C. J. & Lopez, A. D. Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet349 (9064), 1498–1504. 10.1016/S0140-6736(96)07492-2 (1997). - PubMed
    1. Teasell, R. et al. Canadian stroke best practice recommendations: rehabilitation, recovery, and community participation following stroke. Part one: rehabilitation and recovery following stroke; 6th edition update 2019. Int. J. Stroke. 15 (7), 763–788. 10.1177/1747493019897843 (2020). - PubMed