Engagement strategies to support sub-acute, post-stroke upper limb interventions: A co-design study

Objective To co-design clinician-delivered strategies to support stroke survivor engagement during sub-acute, face-to-face upper limb rehabilitation sessions. Design Four-stage integrated knowledge translation co-design study. Participants Three groups of purposively selected knowledge-users (stroke survivor, clinician and science). Setting Science knowledge-user group included international authors and industry leaders with stroke recovery and/or engagement expertise. Other knowledge-users were Australian clinicians and stroke survivors recruited through research networks. Intervention/methods No intervention was delivered. Study scope was defined through team meetings (Stage 1); knowledge-user perspectives on engagement were collected through workshops and interviews (Stage 2); data were synthesised through descriptive content analysis (Stage 3); engagement strategies were refined through knowledge-user workshops and interviews (Stage 4). Results Study scope was restricted to in-person rehabilitation sessions in the subacute recovery phase (Stage 1). Thirty knowledge-users participated (stroke survivor n = 9, clinician n = 11 and science n = 10) in workshops and interviews (Stage 2). Thirteen engagement themes were identified and synthesised into 10 engagement strategies (Stage 3). Eighteen knowledge-users (stroke survivor n = 5, clinician n = 8 and science n = 5) refined strategy wording, framing and confirmed personalisation as the governing principle across strategies that may be applied through two clinician-adjustable parameters: timing (proactive or reactive) and emphasis (subtle to explicit) (Stage 4). Conclusion Using co-design, we produced a suite of clinician strategies that may support stroke survivor engagement during post-stroke upper limb rehabilitation sessions. Personalisation through timing and emphasis was positioned as the governing principle guiding each engagement strategy. Feasibility for use in clinical practice remains to be tested.