Background: Restoring hand function is a primary focus of neurorehabilitation after stroke and spinal cord injury. However, monitoring hand use outside the clinic remains challenging. We developed a clinical decision support system (CDSS) using egocentric video to provide therapists with information about their patients' hand use at home and evaluated its clinical utility. Methods: Five patient-therapist dyads were recruited. Patient-participants recorded activities of daily living using head-mounted cameras. Dashboards presenting processed video data were generated for each patient. Therapists reviewed the dashboard created for their patient and participated in semi-structured interviews and structured questionnaires. A mixed-methods approach with thematic analysis was used to evaluate the CDSS's clinical usefulness. Results: Four themes emerged: (1) Data Interpretation Preferences, (2) Bridging the Clinic-Home Divide, (3) Tailoring Therapy Through Home Observations, and (4) Practical Realities of Implementation. Therapists strongly preferred video footage over graphical data, valuing its rich insights into their patients' real-world activities. The CDSS was perceived as useful for understanding patient performance at home and potentially influencing therapy planning. Conclusions: This study demonstrates the potential of using egocentric video to inform clinical decision-making in neurorehabilitation. Therapists found the system useful, particularly for assessing performance in naturalistic settings, but voiced concerns about workflow integration. Despite challenges, therapists across technical familiarity levels expressed trust in the system and willingness to use it regularly, indicating it could enhance their ability to tailor therapy plans to patients' real-world activities.