Objective: To establish short-term feasibility and usability of wrist-worn wearable sensors to capture arm/hand activity of stroke survivors and to explore factors related to use of the paretic arm/hand. Methods: 30 chronic stroke survivors were monitored with wrist-worn wearable sensors during 12h/day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use and self-efficacy. Usability of the wearable sensors was assessed using the adapted System Usability Scale and an exit interview. Associations between motor performance and capacity (arm/hand impairments and activity limitations) were assessed using Spearman's correlations. Results: Minimal technical issues or lack of adherence to the wearing schedule occurred, with 87.6% of days procuring valid data from both sensors. Average sensors wear time was 12.6 (standard deviation: 0.2) h/day. Three participants experienced discomfort with one of the wristbands and three other participants had unrelated adverse events. There were positive self-reported usability scores (mean: 85.4/100) and high user satisfaction. Significant correlations were observed for measures of motor capacity and self-efficacy with paretic arm use in the home and the community (Spearman's correlation rhos: 0.44-0.71). Conclusions: This work demonstrates the feasibility of using low-cost wearable sensor technology to capture paretic arm activity outside the laboratory. It also provides insight into factors related to everyday arm use, such as motor capacity and self-efficacy. Impact: The integration of wearable technologies into clinical practice offers new possibilities to complement in-person clinical assessments and better understand how each person is moving outside of therapy and throughout the recovery and reintegration phase. Insights gained from monitoring stroke survivors in the home and community will inform future efforts to effect durable gains in paretic arm/hand use in the lived environment.

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: CW is a member of the data safety and monitoring board for Enspire DBS Therapy, Inc and receives an honorarium for her services, is a member of the external advisory board for MicroTransponder, Inc. and receives payment for her consulting. She is Editor of the 6th edition of Motor Control and Learning, published by Human Kinetics, Inc and receives royalty payments. She is an Editor for the 2nd Edition of Stroke Recovery and Rehabilitation, published by DemosMedical Publishers and receives royalty payments; JR is a full-time employee of Flint Rehabilitation Devices, LLC; DZ is a full-time employee and co-owner of Flint Rehabilitation Devices, LLC; no other relationships or activities that could appear to have influenced the submitted work.

This study was funded by the Southern California Clinical and Translational Science Institute (SC CTSI) Voucher program and the NIH R41 Small Business Technology Transfer funds (# HD104296) to JR and CW. MD is supported by the Fonds de la Recherche en Sante du Quebec and the Division of Biokinesiology and Physical Therapy, University of Southern California. The support for the REDCap platform was provided by the National Center for Advancing Translational Science (NCATS) of the NIH (#UL1TR001855 and #UL1TR000130).

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Ethics committee IRB of the University of Southern California gave ethical approval for this work.

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All data produced in the present study are available upon reasonable request to the authors.