Stroke survivor, caregiver and therapist experiences of home-based stroke rehabilitation: a thematic synthesis of qualitative studies

Background: Following the initial period of hospitalisation, stroke rehabilitation is increasingly occurring within the home. As such, the home setting becomes a critical environment in the context of rehabilitation service provision. Objectives: This study aimed to explore what factors influence the experiences of stroke survivors, caregivers and therapists participating in home-based rehabilitation. Methods: A systematic approach to thematic synthesis of qualitative studies began with search term development, followed by database search (CINAHL, Emcare, Medline, Scopus) from inception to 1 November 2022 using keywords and synonyms of ‘stroke survivor’, ‘therapist’, ‘caregiver’, ‘home rehabilitation’ and ‘experience’. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Data were analysed inductively for themes using a three-step thematic synthesis approach. Results: A total of 26 studies were included in this thematic synthesis. Across the data, three overarching analytical themes were constructed, including (i) The significance of place, (ii) The impact of relationships, and (iii) The meaning of therapy. Conclusions: The home setting offers benefits and challenges to delivery and participation in physical rehabilitation after stroke, shaped by various psychosocial and environmental factors that influence outcomes. Altered roles and relationships developed within the home setting influence participatory experience, whilst the setting can offer a familiar and relevant context to promote engagement in meaningful and purposeful therapy. Prior to hospital discharge, therapists who integrate personalised contexts into therapeutic environments can better prepare stroke survivors and caregivers for therapeutic participation within the home. Furthermore, future studies conducted before, during and after therapy focussing on stroke survivor, caregiver and therapist experiences of home-based rehabilitation can provide greater insight into the barriers and facilitators of home-based rehabilitation acceptance, adherence and implementation.