Sequential multiple assignment randomised trial to develop an adaptive mobile health intervention to increase physical activity in people poststroke in the community setting in Ireland: TAPAS trial protocol.

INTRODUCTION: Stroke is the second-leading cause of death and disability globally. Participation in physical activity (PA) is a cornerstone of secondary prevention in stroke care. Given the heterogeneous nature of stroke, PA interventions that are adaptive to individual performance are recommended. Mobile health (mHealth) has been identified as a potential approach to supporting PA poststroke. To this end, we aim to use a Sequential Multiple Assignment Randomised Trial (SMART) design to develop an adaptive, user-informed mHealth intervention to improve PA poststroke. METHODS AND ANALYSIS: The components included in the 12-week intervention are based on empirical evidence and behavioural change theory and will include treatments to increase participation in Structured Exercise and Lifestyle or a combination of both. 117 participants will be randomly assigned to one of the two treatment components. At 6 weeks postinitial randomisation, participants will be classified as responders or non-responders based on participants' change in step count. Non-responders to the initial treatment will be randomly assigned to a different treatment allocation. The primary outcome will be PA (steps/day), feasibility and secondary clinical and cost outcomes will also be included. A SMART design will be used to evaluate the optimum adaptive PA intervention among community-dwelling, ambulatory people poststroke. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Health Service Executive Mid-Western Ethics Committee (REC Ref: 026/2022). The findings will be submitted for publication and presented at relevant national and international academic conferences TRIALS REGISTRATION NUMBER: NCT05606770.

Identifying factors affecting the placement of mentally ill patients.

BACKGROUND: There is now general agreement that a comprehensive psychiatric service can operate with the minimum use of in-patient facilities. Consequently, the emphasis in most European countries is on reducing the number of inpatient beds and expanding the range of community care facilities, including day hospital services, available to mentally ill patients. Decision-making with respect to placement is now even more important given the changes currently taking place on the supply side. METHOD: The study examines the factors that influence placement decision-making between inpatient care and day hospital care in one Health Board in Ireland. Placement was examined over a 9 month period for all patients presenting for treatment in one particular area with a population of 39000 people. Patients were not randomized between the two settings due to ethical concerns about the randomization process. The issue of placement is analysed using a logit estimation procedure. RESULTS: The results suggest that two variables have a significant affect on placement for the population under review: whether the patient is accompanied at the time of admission and the domicile of the patient. CONCLUSIONS: Greater flexibility with respect to the opening hours of day hospital facilities, linked to improved transport facilities, together with further analysis on the process of admission to hospital, particularly the dynamics of the interaction between providers, patients, and accompanying persons, may improve placement decision-making for mentally ill patients.