Fall risk perception toolkit based on "digital human" for community-dwelling older patients with stroke: development and validation

Abstract

Background: This study aims to develop a fall risk perception toolkit based on "digital human" (FRP-digital human), test its usability among community-dwelling older patients with stroke, and verify its implementation effect.

Methods: The toolkit underwent three phases: development, usability test, and effectiveness verification. A mixed method usability test was conducted with 20 participants who met the criteria. The toolkit was validated in a 12-week two-arm pilot study involving 80 community-dwelling older patients with stroke. Two groups of participants were randomly assigned to either the intervention or the control group to receive the same content of health education. Intervention group received health education based on "digital human", while control group received traditional online PDF text health education. The usability test contained Post-Study System Usability Questionnaire (PSSUQ), Customer Effort Score (CES), Net Promoter Score (NPS), and user interviews. Rate of Participant (RP), Rate of Adherence (RA), fall risk perception, object fall risk and quality of life were selected as outcome indicators. The corresponding measurement tools were calculation of RP and RA, Fall Risk Perception Scale for community-dwelling older adults (FRPS), Timed Up and Go test (TUG), and the Short Version of the Stroke Specific Quality of Life scale (SV-SS-QoL).

Results: Four functional modules of FRP-digital human were determined. 20 participants completed the usability test. The CES was 3.1, NPS was 4.5 and the overall satisfaction of PSSUQ was 72.14%. Six themes were obtained from user interviews. A total of 80 participants completed the pilot study. The RP was 100% in both intervention group and control group, and significant differences was observed in RA between two groups (P < 0.05). There were statistically significant differences in FRPS and the SV-SS-QoL between two groups (P < 0.001). No statistically significant was observed in TUG between two groups (P = 0.996).

Conclusion: FRP-digital human can be accepted by community-dwelling older patients with stroke and help improve their fall risk perception and quality of life. Moreover, the design of the WeChat mini program increased its generalizability to promote more successful health care delivery.

Trial registration: This study has been registered at the Chinese Clinical Trial Registry: ChiCTR2300068365 (2023-02-16).

Keywords: Digital human; Digital intervention; Fall risk perception; Home-based rehabilitation; Older adults; Personalized healthcare; Stroke.

Fig. 1

Vision 2 of FRP-digital human Notes: The top left is the homepage, and the rest figures illustrated the toolkit’s interface when using four different modules

Fig. 2

The CONSORT flow chart DECLARATIONS Ethics approval and consent to participate This study was approved by the Medical Ethics Committee of Jiangnan University (JNU202212011RB24), and informed consent was obtained from all subjects involved in the study Consent for publication Not applicable Availability of data and materials The datasets generated and analyzed during the current study are not publicly available due to we need to continue to conduct trials with large samples but are available from the corresponding author on reasonable request