Annually more than 270,000 people suffer from acute strokes in Germany, out of which roughly 200,000 experience it for the first time. For the majority of the affected patients further consequences follow after the incident including physical handicaps and emotional distress leading to the stroke evolving into a chronic illness. Successional therapy is then mostly carried out through consulting settled general practitioners and neurologists, undergoing ergo-, logo- or physiotherapy and visiting rehabilitation institutions instantaneously after the stroke occurrence. Apart from rehabilitative procedures, which aim to most effectively target remission of the stroke symptoms, secondary prophylaxis measures play a major role. In this connection an example would be the intake of individually selected medications through which the risk of experiencing a consecutive stroke shall be minimized.
To support patients in the difficult times following a stroke, the interdisciplinary Competence Center Biomedical Data Science at the Institute for Applied Informatics (InfAI), an affiliated institute of the Leipzig University, together with the University Clinical Center Leipzig, specifically the Clinical Center and Polyclinic for Neurology, are developing an innovative digital concept for the improvement of stroke aftercare – the PostStroke-Manager. This concept comprises an IT infrastructure that integrates several apps for patients, physicians and stroke pilots (Schlaganfalllotsen) as well as mobile sensors, so-called wearables. The PostStroke-Manager puts the patients in the center of the mostly multifaceted treatment structures and helps them to ideally handle their new living situation in various manners.
In particular, the system comprises a Patient-App enabling direct contact to stroke pilots and the further treating general practitioner (GP) as well as proposals for rehabilitative measures. In this way it is possible to optimally adjust the available therapies and rehabilitation programmes to the patient’s needs. Furthermore, the PostStroke-Manager can help with secondary prophylaxis matters by i.e. reminding the patient to take their medications and – provided that the patient enabled the function – recording important parameters like heart rate, systolic and diastolic blood pressure via Bluetooth blood pressure monitors. In case of persistent or declining hemiparesis, movements of the right and left arm may also be recorded by mobile sensor wristbands. By contrasting these movements, activity differences between the left and right side of the body can be determined and monitored. In addition, the PostStroke-Manager allows to track preventive measures, like increased physical activity or reduced nicotine and alcohol consumption. The system automatically integrates and analyzes the acquired multimodal data for every patient individually. Newly developed algorithms enable then the determination of personalized patterns and detect deviations from these patterns. To improve therapy planning, the GP is provided with all this information.
The PostStroke-Manager is activated during acute treatment at the hospital, which usually takes place at a ward specialized in stroke, the Stroke Unit. The basis is herby depicted by the findings ascertained during the acute phase and still evolving constraints. Hereby the following most significant therapeutic and rehabilitative procedures shall already be planned for the patient without causing any time delays. Thereinafter the health status improving medicamentous and non-medicamentous measures can be regularly updated by the overseeing GP and fitted to the individual patient’s needs. Emerging questions about benefits and the demand of medications and adjuvants can directly be answered by a stroke pilot through the Patient-App. This way the patient-centered care incorporating the most optimal rehabilitation and secondary prophylaxis measures can be arranged and practiced without involving any time delays. In addition, the PostStroke-Manager offers the patient a feedback system about their own health-related behaviour and already commenced therapy progress, which should contribute to boosting the patient’s self-efficacy and health competence.
The patient shall be accompanied by purposely trained stroke pilots within the project throughout the first year after their acute stroke incident. Within this time frame the patient will learn to use the PostStroke-Manager such that subsequently the individualized aftercare through digital offers can be further warranted.
Although the digitalization advances rapidly in medicine, the PostStroke-Manager represents the first project which focusses on the patient-centered care situation of stroke patients and uses eHealth- and mHealth-Technologies for this purpose.
The project is funded by public funds of the Free State of Saxony within the scope of the guide line “eHealthSax” for a time frame of 3.5 years. There is a close cooperation with the Independent Division for General Medicine (Selbstständige Abteilung für Allgemeinmedizin) of the Medical Department of the Leipzig University and the German Foundation for Stroke-Help (Stiftung Deutsche Schlaganfallhilfe). Furthermore, the project is supported by the German Pension Insurance Central Germany (Deutsche Rentenversicherung Mitteldeutschland).