There is currently no consensus on a definition of participation that describes experiences and challenges of people with stroke. This meta-synthesis aimed to identify, appraise and synthesise qualitative research on stroke survivors' views of their experiences of social participation. Ten electronic databases were searched for relevant qualitative studies in English from January 2001 and ending September 2011. Searching was extended to grey literature, hand searching journals, checking references and contacting authors of included studies. Two independent reviewers extracted data and assessed methodological study quality. A meta-ethnographic approach described by Noblit and Hare was used to synthesise findings. Eleven articles met the inclusion criteria. Five main themes were identified: (1) change and disruption; (2) perceived magnitude of individual barriers; (3) pursuing personal choices; (4) building individual confidence and (5) evaluating personal meaning. The ability of the person to accept their stroke-related problems and adapt their behaviour and attitude by using active decision-making and self-management skills are central factors to social participation post stroke. This synthesis contributes an important addition to the conceptual understanding of social participation relevant to people with stroke within the UK. Implications for Rehabilitation Social participation post stroke appears to be a dynamic, complex and continuous individual process, and a personalised longer term approach to rehabilitation would be beneficial. Rehabilitation should be focussed on what is most meaningful to the person following their stroke. Professionals can do this by using questions which explore what stroke survivors want to do; what they perceive to be the significant barriers, and what skills and supportive networks are needed. Our findings emphasise the importance of rehabilitation practitioners supporting stroke survivors' to engage with meaningful self-selected social activities and the importance of stroke survivors having the freedom and autonomy to set their own goals within rehabilitation. The person's ability to adapt their behaviour and attitude by being positive, hopeful, determined, resilient and courageous is an essential part of pursuing their self-selected valued activities. Acknowledging and encouraging the importance of these behaviours and attitudes should be promoted in rehabilitation.

Aim: To understand how people with stroke and carers adapt over time, and how health professionals support transition to home. Method: A multi-perspective, prospective, qualitative, longitudinal study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. Twenty-four participants (eight triads, including people with stroke, carers and health professionals) were included. Thematic and narrative analysis facilitated identification of cross-cutting themes according to individual trajectories post-stroke. Findings: A major theme: “regaining control of life” suggested a shift in perspective after six months at home. Four sub-themes help to understand the triads’ perspectives over time: i) importance of team involvement; ii) differences in perceived roles within the triad; iii) differences in expectations and collaboration within the triad and iv) planning a different future. People who were involved in supporting adaptation and rehabilitation processes were reported differently between triads and over time, showing the complexity of interrelations. A reduction in professional involvement was matched by changes in participants’ goals and expectations. Conclusion: Findings suggest the importance of a dyadic perspective and a gradual increase in people with stroke and carers’ active engagement. Professionals’ approach throughout rehabilitation should be modified according to people with stroke and carers’ changing needs and expectations.

The use of arts, literature and reflective writing has becoming increasingly popular in health professionals education. However, research examining its contribution as an educational strategy to promote narrative reasoning capabilities is limited, particularly from the students' perspective. This study aimed to explore the final year physiotherapy students' perspectives about the contribution of arts, literature and reflective writing in facilitating narrative reasoning capabilities. Three focus group meetings using a semi-structured interview schedule were carried out to collect data. Focus group sessions were audiotaped and transcribed verbatim. Interpretative phenomenological analysis was used to conduct the study and analyze the transcripts. Three themes emerged: (1) developmental understanding of the patients' experiences; (2) developmental understanding about the self; and (3) embedding reflection in clinical practice. Students emphasized an increasing capability to be sensitive and vicariously experience the patient's experience. Through reflective writing, students reported they became more capable of thinking critically about their practice and learning needs for continuous professional development. Finally, students highlighted the contribution of these strategies in making reflection part of their practice. Final year physiotherapy students reported enhanced skills of narrative reasoning. The findings support the inclusion of these strategies within the undergraduate physiotherapy curricula.

Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies. Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice. Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles. Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed. Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms. The MoveONParkinson project aims to enhance exercise engagement among people with Parkinson’s Disease (PwPD) in the Portuguese context through the ONParkinson digital platform, which provides mobile and web interfaces. While the broader MoveONParkinson project has been previously described from a health-focused perspective, this study specifically focuses on the development and integration of an AI-driven conversational agent (CA) for the Portuguese language, called PANDORA, within the mobile interface of the solution to assist and motivate PwPD in their exercise routines. PANDORA (Parkinson Assistant in Natural Dialogue and Oriented by Rules and Assessments), designed based on Self-Determination Theory (SDT), addresses the psychological needs of autonomy, competence, and relatedness. A preliminary study involving 20 PwPD, 10 caregivers, and 5 healthcare professionals informed the design requirements for PANDORA. The development process involved four main phases: (1) Design of the Chatbot’s Motivation Model, (2) Design and implementation of the conversational agent, (3) Technical Performance Evaluation, and (4) User Experience Evaluation. Technical Performance Evaluation, conducted with three physiotherapists, assessed domain coverage, coherence response capacity, and dialog management capacity, achieving 100% accuracy in domain coverage and coherence response capacity and 89% in dialog management capacity. The User Experience Study involved eight PwPD users recruited from Portuguese healthcare units performing predefined tasks, with user satisfaction scores ranging from 4.2 to 4.9 on a five-point Likert scale. The findings indicate that integrating a conversational agent with motivational cues tends to increase patient engagement. However, further studies are required to determine PANDORA’s impact on exercise engagement in PwPD.

Background: The high incidence and prevalence of upper limb impairment post stroke highlights the need for advancements in rehabilitation. Brain-computer interfaces (BCIs) represent a promising technology by directly training the central nervous system. The integration of motor imagery (MI) and motor observation through virtual reality (VR) using BCIs provides valuable opportunities for rehabilitation. However, the diversity in intervention designs demonstrates the lack of guiding recommendations integrating neurorehabilitation principles for BCIs. Objective: This study aims to develop recommendations for BCI interventions using task specificity and ecological validity through simulated VR tasks for upper limb stroke survivors by gathering tacit knowledge from neurorehabilitation experts, patients’ experiences, and engineers’ expertise to ensure a comprehensive approach. Methods: A multiperspective qualitative study was conducted through collaborative design workshops involving stroke survivors (n=17), neurorehabilitation experts (n=13), and biomedical engineers (n=3), totaling 33 participants. This innovative approach aimed to actively engage stakeholders in developing multifaceted solutions for complex health interventions. Results: Six themes emerged from the thematic analysis: (1) importance of patient-centered approach, (2) clinical evaluation and patient selection, (3) recommendations for task design, (4) guidelines for structuring BCI intervention, (5) key factors influencing motivation, and (6) technology features. From these themes, the following recommendations (R) are established: (R1) MI-based VR-BCI interventions must be conducted through a patient-centered approach, based on individualized preferences, needs, and goals of the user, by an interdisciplinary team; (R2) selection criteria must include upper limb impairment, cognitive and communication assessment, and clinical traits, such as MI capacity, neglect, and depression must be assessed since they might influence intervention outcomes; (R3) tasks to perform should preferably be based on daily living activities, including unilateral and bilateral tasks, and a variety of tasks must be available for selection to ensure meaningfulness for the user and suitability to clinical traits; (R4) intervention must be structured by different progressing levels starting with simple, gross movements and adding complexity through additional movement features, cognitive demand, or MI difficulty; (R5) optimal levels of motivation must be sustained through task variability, gamification elements, and task demand adequacy; and (R6) multisensorial potential of MI-based VR-BCI must be effectively harnessed through the adequate adjustment of visual, haptic, and proprioceptive feedback modalities to the patient. Conclusions: Current results contribute to establishing clear guidelines on patient selection, task design, intervention structuring, motivation factors, and tailoring of sensory feedback. This framework presents a foundation for optimal implementation of VR-BCI–based interventions that associate MI and motor observation, optimizing cortical activity during the intervention, patients’ engagement, and clinical outcomes. Future research should explore the application of these guidelines for validation and investigate BCIs’ efficacy according to different combinations of patients’ profiles, task characteristics, and technology features.