Abstract
Background: Post-stroke recovery is highly dependent on rehabilitation intensity. However, stroke survivors often experience limited rehabilitation following hospital discharge, hindering recovery. Mental practice, combining action observation and motor imagery (AO+MI) offers a promising, low-cost, and accessible adjunct to conventional rehabilitation. While AO+MI has shown potential in improving upper limb function, optimal implementation strategies remain underdeveloped. This PhD aimed to co-design and develop a home-based AO+MI intervention for individuals with chronic stroke.Methods: A mixed-methods approach, guided by the UK Medical Research Council (MRC) framework, informed the development of a theory- and evidence-based AO+MI intervention. The five-stage process included: (1) a systematic review and metaanalysis evaluating the effects of AO+MI on upper limb recovery; (2) design of a prototype web-based application to deliver AO+MI, informed by theoretical frameworks and user feedback; (3) a qualitative study exploring stroke survivors’ and caregivers’ understanding and experiences of mental practice and the prototype; (4)
refinement of the prototype through co-design workshops; and (5) protocol development for a feasibility RCT.
Results: The meta-analysis of seven RCTs (n=189) found moderate effects of AO+MI on FMA-UE scores (SMD=0.58, 95% CI: 0.13–1.04), and combined FMA-UE and ARAT scores (SMD=0.70, 95% CI: 0.32–1.09). No significant moderators affected results. The qualitative study (n=23) identified three themes: (1) mental practice understanding and experience, (2) challenges in home-based training, and (3) user
perspectives on the digital prototype. co-design workshops feedback on the second web app version was positive, with suggestions to expand exercise content.
Conclusion: This research supports AO+MI as an effective intervention for upper limb recovery post-stroke and offers a user-informed digital tool for home use. The codesign approach ensured relevance and feasibility, while qualitative insights
highlighted the need for clear terminology and user involvement to enhance engagement and effectiveness. This research contributes to a deeper understanding
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of the challenges and opportunities for incorporating mental practice into daily
rehabilitation routines. Should the intervention prove feasible and acceptable in future studies, it holds significant potential to improve post-stroke rehabilitation outcomes.
| Date of Award | 11 Feb 2026 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | John Franklin (Supervisor), Jonathan Robinson (Supervisor) & Daniel Eaves (Supervisor) |