Refining mHealth exercise support for stroke survivors: A user-centred design approach

Objective Stroke survivors often face barriers to structured physical activity due to physical or cognitive limitations. A recent feasibility trial of the mobile health (mHealth) version of the i-REBOUND programme (Internet-delivered Rehabilitation for Exercise after stroke) showed that it was safe, well-accepted, and accessible, but findings also highlighted aspects of the exercise support needing improvement. This study aimed to refine the mHealth version of i-REBOUND using a structured user-centred design (UCD) approach, and addressing limitations identified in prior feasibility testing. Methods This study applied a collaborative design that followed a three-phase UCD process: (1) review and preparation, using feasibility study data to identify key areas for refinement; (2) define and devise, conducting digital workshops and interviews with stroke survivors ( n = 15) and physiotherapists ( n = 3) to explore experiences and needs; and (3) develop and test, iteratively prototyping and user-testing modified exercise content based on phase 2 findings. Results Key refinements included (1) expanding the exercise components to include a variety of exercises, including seated and hemiplegia specific options; (2) developing new instructional content with embedded explanations of exercise purpose and difficulty modifications; and (3) creating prescribed physiotherapist-led exercise components in the same format as the supervised classes, enabling a more time- and personnel-efficient yet personalised delivery of the programme. Conclusion The refinements, such as seated and hemiplegia-specific exercise options and on-demand physiotherapist-led sessions, highlight how tailored mHealth solutions can better meet the needs of diverse stroke survivors and support sustained engagement. The collaborative process also highlighted the value of early and continuous user involvement.