Perspectives of stroke survivors and informal caregivers on home-based mental practice for upper limb recovery after stroke: a qualitative co-design study

In this qualitative study, we explored the views of stroke survivors and informal caregivers regarding three types of mental practice for upper limb recovery: (1) action observation (AO); (2) motor imagery (MI); and (3) combined action observation and motor imagery (AO + MI). Semi-structured interviews and focus groups were conducted between December 2021 and October 2022 with 23 participants (13 caregivers and 10 stroke survivors).Thematic analysis generated three higher-order themes: <i>(1) Mental practice: understanding and recent experience</i>. Although comprehension of AO, MI, and AO + MI varied, participants could provide clear, jargon-free explanations of these methods. <i>(2) Feasibility of home-based training</i>. Caregivers often felt overburdened, confused, and unsupported in home-based care but considered mental practice education useful for rehabilitation. <i>(3) User perspectives on a digital prototype</i> (Webapp). Participants viewed the WebApp interface as overly text-heavy and recommended a more visually engaging design. This study provides new insights into stroke survivors' and caregivers' understanding and perceptions of mental practice and highlights the potential of co-designed digital resources to enhance engagement and support home-based rehabilitation. These findings will inform the iterative refinement of mental practice materials for future feasibility and acceptability testing in chronic stroke survivors.