Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

Abstract

Background Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance. Registration: PROSPERO CRD42017072799—https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72799

Neurorehabilitation From a Distance: Can Intelligent Technology Support Decentralized Access to Quality Therapy?

“…Thirdly, the implementation of artificial intelligence embedded in neurorehabilitation technologies needs to be clinically motivated and transparent to patients, caregivers and healthcare practitioners in order to increase the trust in technology-assisted rehabilitation in a home-centered model. All these aspects are essential to ensure that neurological patients accept rehabilitation technologies and actively selfengage in therapy (Neibling et al, 2021).…”

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

“…In order to accept different new technologies as part of their recovery process, patients need to trust their therapist and be open to novelty. The presence of fear that the devices are too fragile and that they may get damaged during exercises can decrease acceptability for patients unfamiliar with technology [9]. The teletherapy system should fulfill some basic requirements such as assuring user safety, being user-friendly, not needing frequent technical maintenance, and requiring minimal home reorganization and investment [13].…”

“…Researchers also noted the patients' preference for the application interface. The most suitable interface is a calm interface without bright, fast-moving images [9]. The existence of user support in any form was also stated as being a priority [45], including in the transition period from conventional therapy to the new therapy [9].…”

“…Loss of upper limb functionality severely impacts patients' quality of life [6,8]. The average time hospitalized post-stroke patients spend training their upper limbs is insufficient for total function recovery [7,9]. As a result of short hospitalizations and limited human resources available for face-to-face rehabilitation therapy, the majority of stroke survivors are discharged with functional deficits and are in need of continuous recovery treatment [6,10].…”

“…For example, improvements of arm function have been obtained after sessions summing 3 h or more per week [10]. Traditional exercises provided for patients upon discharge in order to be practiced at home have low adherence because of motivation loss, lack of pleasure while exercising and tasks that are either too hard or too easy [9]. Stroke rehabilitation represents a complex field that brings together physiotherapy, occupational therapy, speech and language therapy and neuropsychology [10].…”