AUTHOR=DiCarlo Julie A. , Erler Kimberly S. , Petrilli Marina , Emerson Kristi , Gochyyev Perman , Schwamm Lee H. , Lin David J. 

TITLE=SMS-text messaging for collecting outcome measures after acute stroke

JOURNAL=Frontiers in Digital Health

VOLUME=5

YEAR=2023

URL=https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2023.1043806

DOI=10.3389/fdgth.2023.1043806

ISSN=2673-253X

ABSTRACT=<sec><title>Introduction</title><p>Traditional methods for obtaining outcomes for patients after acute stroke are resource-intensive. This study aimed to examine the feasibility, reliability, cost, and acceptability of collecting outcomes after acute stroke with a short message service (SMS)-text messaging program.</p></sec><sec><title>Methods</title><p>Patients were enrolled in an SMS-text messaging program at acute stroke hospitalization discharge. Participants were prompted to complete assessments including the modified Rankin scale (mRS) and Patient-Reported Outcomes Measurement (PROM) Information System Global-10 at 30, 60, and 90 days postdischarge <italic>via</italic> SMS-text. Agreement and cost of SMS-text data collection were compared to those obtained from traditional follow-up methods (<italic>via</italic> phone or in the clinic). Participant satisfaction was surveyed upon program conclusion.</p></sec><sec><title>Results</title><p>Of the 350 patients who agreed to receive SMS texts, 40.5% responded to one or more assessments. Assessment responders were more likely to have English listed as their preferred language (<italic>p</italic> = 0.009), have a shorter length of hospital stay (<italic>p</italic> = 0.01), lower NIH stroke scale upon admission (<italic>p</italic> &lt; 0.001), and be discharged home (<italic>p</italic> &lt; 0.001) as compared to nonresponders. Weighted Cohen’s kappa revealed that the agreement between SMS texting and traditional methods was almost perfect for dichotomized (good vs. poor) (<italic>κ </italic>= 0.8) and ordinal levels of the mRS score (<italic>κ </italic>= 0.8). Polychoric correlations revealed a significant association for PROM scores (<inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM1"><mml:mi>ρ</mml:mi></mml:math></inline-formula> = 0.4, <italic>p</italic> &lt; 0.01 and <inline-formula><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="IM2"><mml:mi>ρ</mml:mi></mml:math></inline-formula> = 0.4, <italic>p</italic> &lt; 0.01). A cost equation showed that gathering outcomes <italic>via</italic> SMS texting would be less costly than phone follow-up for cohorts with more than 181 patients. Nearly all participants (91%) found the program acceptable and not burdensome (94%), and most (53%) felt it was helpful. Poststroke outcome data collection <italic>via</italic> SMS texting is feasible, reliable, low-cost, and acceptable. Reliability was higher for functional outcomes as compared to PROMs.</p></sec><sec><title>Conclusions</title><p>While further validation is required, our findings suggest that SMS texting is a feasible method for gathering outcomes after stroke at scale to evaluate the efficacy of acute stroke treatments.</p></sec>