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Telerehabilitation systems have the potential to enable therapists to monitor and assist stroke patients in achieving high-intensity upper extremity exercise in the home environment. We adopted an iterative user-centred approach, including multiple data sources and meetings with end-users and stakeholders to define the user requirements for home-based upper extremity rehabilitation using wearable motion sensors for subacute stroke patients. We performed a requirement analysis consisting of the following steps: 1) context & groundwork; 2) eliciting requirements; 3) modelling & analysis; 4) agreeing requirements. During these steps, a pragmatic literature search, interviews and focus groups with stroke patients, physiotherapists and occupational therapists were performed. The results were systematically analysed and prioritised into "must-haves", "should-haves", and "could-haves". We formulated 33 functional requirements: eighteen must-have requirements related to blended care (2), exercise principles (7), exercise delivery (3), exercise evaluation (4), and usability (2); ten should-haves; and five could-haves. Six movement components, including twelve exercises and five combination exercises, are required. For each exercise, appropriate exercise measures were defined. This study provides an overview of functional requirements, required exercises, and required exercise measures for home-based upper extremity rehabilitation using wearable motion sensors for stroke patients, which can be used to develop home-based upper extremity rehabilitation interventions. Moreover, the comprehensive and systematic requirement analysis used in this study can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context. This study provides an extensive overview of user requirements for home-based upper extremity rehabilitation using wearable motion sensors in stroke patients. These requirements can be used as a basis for developing home-based UE telerehabilitation interventions. Including these requirements may facilitate the clinical implementation of such telerehabilitation systems. The comprehensive and systematic approach used in this sudy can be applied by other researchers and developers when extracting requirements for designing a system or intervention in a medical context. [ABSTRACT FROM AUTHOR]

AbstracteHealth solutions at home are gaining interest and relevance in healthcare; however, they face challenges in sustaining motivation for therapy due to difficulties in creating meaningful connections between technology and people receiving care. In this article, we explore how embodied agents in eHealth interventions could be designed to establish a motivating relationship with people in the context of home-based stroke rehabilitation. We studied this potential by referring to the need for social relatedness in Self-Determination-Theory (SDT) and how this translates to the design of embodied agents’ characters, the collaborations they afford and the partnerships they establish over time. In co-creative ideation sessions with stroke survivors, this potential was explored, resulting in an interactive prototype of ‘Edo the Coach’, i.e. an embodied agent for home-based upper extremity stroke rehabilitation that was evaluated by stroke survivors in their home contexts. Based on the insights gained, we reflect on the potential of using SDT for designing embodied agents that foster motivational relationships between patient and agent as an answer to the growing demand for eHealth-supported self-care within an increasingly digitized healthcare context. [ABSTRACT FROM AUTHOR]

Purpose: eHealth-based exercise therapies were developed to increase stroke patients' adherence to home-based motor rehabilitation. However, these eHealth tools face a rapid decrease in use after a couple of weeks. This study investigates stroke patients' motivation for home-based upper extremity rehabilitation with eHealth tools and their relation with Basic Psychological Needs., Materials and Methods: This is a qualitative study using thematic analysis. We conducted semi-structured interviews with stroke patients with upper extremity motor impairments, who were discharged home from a rehabilitation centre, after they interacted with a novel eHealth coach demonstrator in their homes for five consecutive days., Results: We included ten stroke patients. Thematic analysis resulted in eight themes for home-based rehabilitation motivation: Curiosity, Rationale, Choice, Optimal challenge, Reference, Encouragement, Social Support and Trustworthiness. Those themes are embedded into three Basic Psychological Needs: "Autonomy", "Competence", and "Relatedness"., Conclusion: Eight motivational themes related to the three Basic Psychological Needs describe stroke patients' motivation for home-based upper extremity rehabilitation. We recommend considering those themes when developing a home-based eHealth intervention for stroke patients to increase the alignment of eHealth tools to the patient's needs and reduce motivational decreases in home-based rehabilitation.