Background: Interventions that drive post-stroke upper-limb motor recovery are not fully conceptualised. Those invested in improving such interventions include researchers conducting preclinical research and clinical research, clinicians working in clinical practice, and people with lived experience. These perspectives have not previously been captured and synthesised to identify the essential elements of post-stroke upper-limb motor interventions and their neuroscientific rationale.
Aims: To investigate neuroscience concepts that are important to drive upper-limb post-stroke motor recovery from the perspective of people with expertise in preclinical research, clinical research, clinical practice, and lived experience.
Methods: Semi-structured interviews were conducted with four international participant groups targeted through purposive sampling. Preclinical research and clinical research participants were selected from top published authors using group-specific keywords in SCOPUS. Clinical practice participants had >7 years of experience treating post-stroke upper-limb impairment. Lived experience participants had lived with post-stroke upper-limb impairment for >6 months. Interviews were transcribed verbatim and content analysis was performed to develop themes. Thematic saturation, defined as three consecutive interviews yielding no new themes, signalled the end of recruitment to a participant group.
Results: Thirty-seven participants from eight countries (preclinical research n=9, clinical research n=9, clinical practice n=9, lived experience n=10) were interviewed. Three themes were identified. Theme 1, ‘Relevant, answerable questions in stroke recovery research’, included two subthemes: ‘Dismantle research silos’ and ‘Assimilation and operationalisation of the research pipeline’. Theme 2, ‘Recovery in practice and in principle’, included three subthemes: ‘Restitution’, ‘Optimisation’, and ‘Stroke heterogeneity’. Theme 3, ‘Interventions to drive optimal stroke recovery’, included three subthemes: ‘Complex interventions’, ‘Personalised interventions’, and ‘Neuroscience foundations’.
Conclusion: Collectively, participants identified that interventions need to be complex and reflect the heterogeneity of stroke. The challenge that remains is to develop personalised interventions that balance what to do in principle (neuroscience of recovery) with what is possible in practice.