title: Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study.
abstract: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users' physical activity is visualized by fish swimming.
  
  
  
  To evaluate the potential effectiveness of STARFISH in stroke survivors.
  
  
  
  Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index.
  
  
  
  The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group-time interactions for other outcome measures.
  
  
  
  Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.
authors.affiliation: a School of Medicine , University of Glasgow , Glasgow , UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Paul
authors.affiliation: b Institute of Health and Wellbeing , University of Glasgow , Glasgow , UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
authors.affiliation: c School of Computing Science , University of Glasgow , Glasgow , UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Brewster
authors.affiliation: d Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.affiliation: d Institute of Cardiovascular and Medical Sciences , University of Glasgow , Glasgow , UK.
authors.forename: Jason M R
authors.initials: JM
authors.lastname: Gill
authors.affiliation: e NHS Greater Glasgow & Clyde , Glasgow , UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Alexander
authors.affiliation: f School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK.
authors.forename: Danny
authors.initials: D
authors.lastname: Rafferty
authors.affiliation: g AKM Statistics , Glasgow , UK.
authors.forename: Angus K
authors.initials: AK
authors.lastname: McFadyen
authors.affiliation: c School of Computing Science , University of Glasgow , Glasgow , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ramsay
authors.affiliation: a School of Medicine , University of Glasgow , Glasgow , UK.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Dybus
mesh_terms: D000368:Aged; D005260:Female; D015438:Health Behavior / Q000502:physiology; D006801:Humans; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D063731:Mobile Applications; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000295:instrumentation / Q000379:methods*; D017741:Survivors
keywords: chronic disease; clinical trial; intervention; rehabilitation; stroke; telemedicine