Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review.

No study directly measured perseverance; adherence, dropout, satisfaction, motivation, and upper limb outcomes were used as stand-ins. The included studies were not designed to explore perseverance, so factors were inferred from reports and surrogate measures. Quantitative support was limited, and meta-analysis was not possible because adherence reporting and study data were heterogeneous. Only four studies had more than 30 stroke survivors, and many were small case series or single-case studies. Eighty-eight percent of studies included chronic stroke survivors, so the findings are mainly from chronic practice. Upper limb disability could not be classified because studies used different measures, so it is unclear how findings apply across impairment levels. Quality was mixed: qualitative studies were high quality, but quantitative and mixed-methods studies were moderate to low, and poor quality studies were not excluded. Twenty-six different technologies and very different doses were studied, so no single device or dose can be recommended.

The review was funded by the Nursing and Allied Health Scholarship and Support Scheme, a James Cook University Research Training Program Scholarship, and a National Health and Medical Research Council of Australia Fellowship.

Do not conclude that any specific home technology improves upper limb recovery. The review synthesised reports from many different devices, doses, therapist contacts, and family supports, and perseverance was inferred from adherence and dropout rather than measured directly.