Translation and Cultural Adaptation of the Home Graded Repetitive Arm Supplementary Program (Home-GRASP) for Stroke Survivors in Spain

Background/Objectives: Home-based rehabilitation programs can increase upper-limb practice after stroke and support recovery beyond formal therapy sessions. However, no Spanish version of the Home Graded Repetitive Arm Supplementary Program (Home-GRASP) participant exercise manual was available. This study aimed to translate and cross-culturally adapt the manual for use in Spain and evaluate its clarity, comprehensibility, and ease of use. Methods: The original Home-GRASP participant exercise manual was independently translated into Spanish by two translators, reviewed by an expert committee, culturally adapted, and pilot tested with 13 adults with subacute or chronic stroke-related upper-limb hemiparesis receiving outpatient rehabilitation in Spain. Clarity and comprehensibility were assessed through direct observation of exercise performance and a participant questionnaire. Results: The expert committee considered that forward translations preserved the underlying concepts and therapeutic intent of the original manual and required only minor linguistic modifications. Expert review resulted in adaptations to photographs, exercise instructions, and layout. During pilot testing, all 35 exercises were evaluated, resulting in 49 exercise performances. Seven execution errors were identified across four exercises and were mainly related to ambiguities in movement descriptions or visual instructions. Following revision of the affected exercises, no further errors were observed. All participants reported that the manual was easy to use, 92.3% found it easy to understand, and 76.9% reported being able to perform the exercises independently. Conclusions: The Spanish version of the Home-GRASP participant exercise manual was successfully translated and cross-culturally adapted for use in Spain. The adapted manual showed preliminary evidence of satisfactory clarity, comprehensibility, and ease of use, supporting its use as a culturally appropriate resource for home-based upper-limb rehabilitation after stroke.