Introduction
In stroke rehabilitation, repetitive, task-specific training is one of the key principles.1,2 For stroke patients with upper limb dysfunction, constraint-induced movement therapy and its modifications are one of the most promising techniques taking this principle into account.1–4 To induce the use of the affected arm in everyday life,5 constraint-induced movement therapy comprises an intensive motor training, the use of adherence-enhancing behavioural methods and the immobilization of the non-affected hand.5,6 A four-week home-based training in conjunction with the support of a non-professional coach (e.g. family member) and reduced professional assistance to meet ambulatory care conditions (home-based constraint-induced movement therapy (homeCIMT)) is one way to deliver constraint-induced movement therapy to patients in long-term care.7 The HOMECIMT trial showed homeCIMT to be superior to conventional therapies with regard to the self-perceived use of the stroke-affected arm in daily activities.8
HomeCIMT and other forms of constraint-induced movement therapy have been shown to be particularly effective in improving upper limb function post stroke.1,3 However, these interventions will only work if patients adhere to them. Constraint-induced movement therapy requires numerous hours of repetitive exercises, which are likely to present a challenge for patients.9,10 Regarding homeCIMT, the involvement of a non-professional coach might be an additional challenging aspect for both, patients and non-professional coaches. Thus, it is vital to better understand the users’ experiences with different forms of constraint-induced movement therapies in order to adapt the way how we deliver these interventions and maximize adherence to them. However, there are only few investigations with the users’ perspectives on constraint-induced movement therapies. We are only aware of three minor qualitative studies investigating the experiences of two or three patients with modified constraint-induced movement therapies.11–13 A qualitative research approach, in particular, provides information about the users’ experiences with the practical application of a therapy.14,15
In addition to the cluster randomized controlled HOMECIMT trial, we conducted a comprehensive qualitative study to explore the users’ perspectives on homeCIMT following the driving question: What are the experiences of chronic stroke patients and non-professional coaches with homeCIMT?[…]