Effect of a digital resilience-based course-game sequential intervention on social participation in stroke survivors with limb dysfunction: a randomised controlled trial protocol.

Social participation impairments are highly prevalent after stroke and are strongly associated with diminished quality of life.

• Existing interventions have demonstrated limited effectiveness in addressing social participation after stroke.
• Current interventions focus predominantly on physical functional training while neglecting critical psychological and behavioural processes.
• Traditional face-to-face delivery models suffer from poor accessibility, particularly in contexts with unevenly distributed rehabilitation resources.

The trial is designed as a single-centre, assessor-blinded, two-arm randomised controlled trial recruiting 152 stroke survivors with limb dysfunction.

• Participants will be recruited from three rehabilitation wards of a single tertiary rehabilitation hospital (Shanghai First Rehabilitation Hospital).
• Participants will be randomly allocated in a 1:1 ratio to either the intervention group or the control group.
• All analyses will follow the intention-to-treat principle.
• The study has been approved by the Ethics Committee of Shanghai First Rehabilitation Hospital (YK-2025-03-011) and registered as ChiCTR2500110444.

The intervention group will receive a digital resilience-based course-game sequential intervention over a 7-week period.

• The intervention is designed to first impart knowledge and skills through the course, followed by their application and reinforcement in a game context to facilitate behaviour transfer.
• The control group will receive a structured, attention-matched control condition comprising digitally delivered general health education materials.
• The sequential design aims to bridge the gap between physical recovery and community reintegration through psychological and behavioural processes.

The primary outcome is social participation assessed using the Frequency subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) immediately post-intervention.

• Secondary outcomes include resilience, exercise adherence, physical function, social network, and life-space mobility.
• All outcomes will be measured at three time points: baseline, immediately post-intervention, and at 3-month post-intervention.
• The USER-P Frequency subscale serves as the primary measure of social participation.

If found effective, the research team aims to implement the intervention as usual care within the participating services and beyond.

• Trial findings will be disseminated via peer-reviewed publications and conference presentations.
• The digital delivery format is intended to address accessibility challenges in contexts with unevenly distributed rehabilitation resources.
• The intervention targets the transition from physical recovery to community reintegration, which existing interventions have inadequately addressed.