Keeping Active with Texting after Stroke (KATS): A single-arm feasibility and acceptability study of a behavioural intervention to promote community-based physical activity after stroke rehabilitation

Objectives To test the feasibility and acceptability of a text-message-delivered behavioural intervention to promote and maintain physical activity and recovery after stroke rehabilitation. 

Design A single-arm acceptability and feasibility study. 

Setting Community rehabilitation services in two Health Board areas in Scotland. 

Participants People with stroke who could participate in physical activities and use a mobile phone were recruited during rehabilitation and community rehabilitation. 

Intervention Keeping Active with Texting after Stroke (KATS) is an automated text message-delivered intervention informed by behaviour change theory. It delivers a structured sequence of 103 messages over 14 weeks to support the uptake and maintenance of physical activities following stroke rehabilitation. 

Outcomes Data on recruitment, retention and satisfaction were collected. Semistructured interviews explored intervention acceptability. Preintervention and postintervention measures provided preliminary information on step count, functional independence, mental well-being, self-efficacy and quality of life. 

Results 18 men and 13 women were recruited; three withdrew before intervention commencement. All 28 participants who received at least one text message completed the study, indicating 100% retention. Median satisfaction score was 23/25 (range 12-25). All but one participant read and responded to texts, indicating good engagement. Effect sizes (Cohen's d; per cent change) were demonstrated in step count (0.2; 13%), extended activities of daily living (0.24; 8.3%) and mental well-being (0.35; 7%). Participants perceived KATS as acceptable, valuing messages and motivational prompts, but personalised tailoring was desired by some. 

Conclusions Recruitment, retention and outcome measure completion were feasible, and KATS was perceived as acceptable. Findings suggest some modifications of messages and goal-setting processes are required to accommodate participants with diverse physical activity capabilities before a definitive trial. Promising indicators of effects were detected, although interpretation must be cautious because the study was not powered to determine efficacy, and there was no control group. Based on these findings, KATS will be further optimised before evaluating effectiveness in a randomised controlled trial.