A self-directed upper limb program during early post-stroke rehabilitation: A qualitative study of the perspective of nurses, therapists and stroke survivors

INTRODUCTION: This study aimed to explore the perspective of nurses, therapists and stroke survivors on the performance of upper limb self-exercise and use outside therapy during early inpatient stroke rehabilitation. METHODS: A descriptive qualitative approach was used in focus groups with nurses (n = 21) and therapists (n = 8), as well as in-depth semi-structured interviews with stroke survivors (n = 8) who were undergoing subacute inpatient stroke rehabilitation. Inductive thematic analysis of data was performed according to participant group. RESULTS: Nurses and therapists perceived that stroke survivors played a central role in determining the success of a self-directed upper limb program. Nurses perceived that stroke survivors needed a lot of prompting to be motivated to perform self-directed upper limb therapy outside therapy. Therapists perceived that not all stroke survivors would be able to perform self-directed upper limb therapy and deemed it important to consider stroke survivor factors before commencing a program. Although some stroke survivors expressed initial reservations with performing self-practice, many indicated that they would participate in the self-directed upper limb program because they wanted to recover faster. CONCLUSION: A difference between the perspective of nurses/therapists and stroke survivors towards self-directed upper limb performance outside therapy was found. Deeper stroke survivor engagement and a shift in rehabilitation culture to encourage stroke survivor autonomy are important considerations for a self-directed upper limb program. Teamwork amongst healthcare professionals and families is essential to support stroke survivors to participate in a self-directed upper limb program during early inpatient stroke rehabilitation.