Effectiveness and implementation of home-based motor relearning for social participation after stroke: a hybrid type 2 stepped-wedge trial.

BACKGROUND

Social participation is often limited in stroke survivors. The motor relearning approach (MRA) improves short-term motor outcomes in clinical settings, but most recovery occurs at home with limited professional support. Implementation strategies are needed to enhance home-based MRA delivery.

OBJECTIVE

To evaluate the effectiveness and implementation of a home-based MRA program for stroke survivors.

METHODS

This stepped-wedge cluster randomized hybrid type 2 trial was conducted across 5 hospitals in southern China. Participants received a 3-month home-based MRA guided by the Capability, Opportunity, Motivation-Behavior (COM-B) model, integrating digital tools and nurse-led support. Outcomes included social participation (primary), and functional independence, exercise adherence, social support, and depression (secondary), assessed at baseline, 3, 6, and 9 months. Implementation outcomes, including adoption, acceptability, feasibility, fidelity, and sustainability, were assessed qualitatively. Quantitative data were analyzed in R using linear mixed-effects models.

RESULTS

A total of 283 stroke survivors were included (MRA n = 163; control n = 120). For social participation, the MRA × time (T) interaction was significant (β = -1.16, 95% CI -1.81 to -0.50, P < 0.01), the between-group difference became significant at T3 (9 months). Exercise adherence also improved in the MRA group (interaction β = 0.68, P < 0.01). Depressive symptoms declined over time (interaction β = -0.25, P < 0.01), with lower scores in the MRA group at T3. Functional independence showed a significant interaction (β = 0.86, P = 0.01) not confirmed by point-wise comparisons. No effect was observed on social support. Implementation outcomes indicated high adoption, acceptability, feasibility, fidelity, and sustainability.

CONCLUSION

Home-based MRA may be associated with greater long-term social participation improvements in stroke survivors, along with improvements in exercise adherence and depressive symptoms. Home-based MRA may support continuity of care after stroke.

DATA REGISTRATION: The trial was prospectively registered with the Chinese Clinical Trial Registry (ChiCTR2300071597).