Staying Active: Promoting Activity Engagement for Post-Stroke Pain Management with Insights from Ecological Momentary Assessment.

Abstract

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.