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

Neibling, Bridee A., Jackson, Sarah M., Hayward, Kathryn S., and Barker, Ruth N. (2021) Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review. Journal of NeuroEngineering and Rehabilitation, 18. 43.

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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.

Item ID: 70005
Item Type: Article (Research - C1)
ISSN: 1743-0003
Keywords: Home, Perseverance, Practice, Stroke, Technology, Upper limb
Copyright Information: © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit he Creative Commons Public Domain Dedication waiver (http://creativecomm applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC APP1088449
Date Deposited: 02 Feb 2022 21:50
FoR Codes: 42 HEALTH SCIENCES > 4201 Allied health and rehabilitation science > 420109 Rehabilitation @ 100%
SEO Codes: 20 HEALTH > 2003 Provision of health and support services > 200301 Allied health therapies (excl. mental health services) @ 100%
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