What This Means
This research explored why younger and middle-aged stroke survivors (ages 18-60) do or do not stick with telerehabilitation—remote physical therapy conducted at home using technology. Researchers in China interviewed 15 stroke survivors in depth and used a structured psychological framework called the COM-B model (Capability, Opportunity, Motivation-Behavior) to organize what they heard. They found 14 distinct themes explaining adherence, including 8 barriers and 6 facilitators spanning physical ability, the home environment, and personal motivation.
The study found that barriers ranged widely: some survivors struggled with physical exhaustion or lacked confidence using digital tools, others faced cramped living spaces, unreliable internet, or feelings of isolation, while still others doubted whether remote therapy actually worked, experienced burnout from screen use, or feared injuring themselves without direct supervision. On the positive side, noticing physical improvement, having family members involved, being supervised by a therapist remotely, wanting to return to work, and successfully building exercise into a daily routine all helped people stay engaged. Importantly, these factors did not work in isolation—they interacted with each other in complex ways.
This research suggests that simply offering telerehabilitation technology is not enough to keep stroke survivors engaged; programs need to address multiple challenges at once. For working-age stroke survivors in particular, tapping into vocational goals (like returning to a job) may be a powerful motivator. Practical supports like teaching digital skills, helping optimize home exercise spaces, involving family members, and offering peer networks could all play important roles in making remote stroke rehabilitation more effective.