Stroke survivors’ experiences with home-based telerehabilitation using an assistive device to improve upper limb function: a qualitative study

Figures & data

Figure 1. HoMEcare aRm rehabiLItatioN (MERLIN) device.

photograph of a man sitting at a table in the kitchen with his arm extended in the training device. Across the man, a computer is mounted on the edge of the table. On the screen, a game is visible with coloured shapes that need to be placed in the right box with the matching colour and shape.

Figure 2. Flow chart of the data analysis process.

eight rectangle boxes are shown which show the process of the method used for the analysis and who performed the analysis. 1: Transcribing interviews ad verbatim (AHS); 2: Open coding three interviews (AHS, SGR); 3: Forming code tree based on the interview guide (inductive) and the interviews (deductive) (AHS, SGR, JMH, CKvdS); 4: Coding remaining interviews with frequent consensus meetings (AHS, SGR); 5: Summarising quotes (AHS, SGR); 6: Consensus meeting on summaries (AHS, SGR, GAB, JMH, CKvdS); 7: Summarising the framework (AHS, SGR); 8: Consensus meeting on final summaries (AHS, SGR, GAB, JMH, CKvdS).

Table 1. Participant characteristics (n = 11).

	Mean ± standard deviation
Age (years)	66.0 ± 8.4
Time after stroke (months)	22.5 ± 9.7
	Mean (range)
Training time (hours)	16,4 (5.5–32.8)
	N	%
Sex (male/female)	8/3	73/27
Type of stroke (haemorrhagic/ischemic)	1/10	9/91
Dominant side (left/right)	0/11	0/100
Affected side (left/right)	7/4	64/36
Living situation (with partner/alone)	10/1	91/9
Interview (with partner/alone)	2/9	18/82

Table 2. Important topics and recommendations regarding rehabilitation assistive devices.

Important topics for assistive training devices	Illustrative quotes	Recommendations for future devices
Device ergonomics	“A massive device. And I also can’t imagine everyone had the physical space for it.” (P1)	Compact device
	“I had problems with the set-up of the device. It was a constant search to get the right posture." (P3)	Assure ergonomic position while using the device
	“In the end, the hand was feeling numb. […] Because the hand could not fit in properly, you push it in.” (P5)	Assure the adjustability of the device components
Cognitive games	“And it also helped yes, with the Memory game. Then you had to think and in the beginning that is very hard and that improved.” (P5)	Add diverse categories of games including cognitively challenging games
Increasing difficulty	“Performing double functions, grasping and lifting, I found that very difficult in the beginning. And at the end that was very simple.” (P3)	Exercises should remain challenging upon progression
Loose screws, wear of the device, blocking wheels	“Because of the Teflon and the paint, it attaches very badly so what happens, it shatters in little pieces. Which end up on the wheels and the paint sticks to them.” (P9)	Robustness of the device for intensive use
Rewards	“I thought it was fun. And there was also some excitement. Because you had to get as many points as possible.” (P5)	Gamification with a rewarding feedback system
Variation in games	“There should be per evening, or per time you do it, there should be at least six different [games].” (P1)	Variety in games and in-game objects

Table 3. Important topics and recommendations regarding home-based (tele)rehabilitation.

Important topics for home-based (tele)rehabilitation	Illustrative quotes	Recommendations  for future home-based (tele)rehabilitation
Guidance at the start	“And maybe it would be an idea to provide more guidance at the beginning [of the training].” (P11)	Intensive guidance in the start-up phase.
Telerehabilitation communication	“That thing [the tablet] hung [at eye level in a standard] and you had to type up in the air and that is difficult.” (P3)	User-friendly communication system for one-handed persons
Therapy compliance	“[…] and actually the last period I did it [the training] mostly in the evening. […] Then I am tired and it [that the training tires him] doesn’t matter anymore. […] I liked it better. […] It is a search when to use it.” (P3)	Incorporate the training into an individualised daily training schedule (at convenient times)
Therapy duration	“Yes, I would have liked to train longer, definitely longer.” (P9)	Therapy duration more than six weeks
Therapy intensity	“My arm was in an unnatural position. […] That you also build up in intensity, start with three, four, five, six games or so. That you expand that.” (P1) “I noticed that when you were, say twenty minutes, into the training, you would be *sighing sound* done after that. Tired.” (P2)	Gradually increase the length of the training sessions. Training sessions preferably less than 30 min, possibly divide the training into two sessions a day.

Data availability statement

Data will be made available upon request via DataverseNL. To protect the privacy of the participants, it is not possible to fully anonymize the transcript of the interviews and therefore we publish the data with restricted access. The coding tree will be published with open access. DataverseNL: https://doi.org/10.34894/MBABRA.