Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme

Introduction The Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the United Kingdom that provides 90 hours of therapy over three weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and carers. Design Descriptive qualitative. Setting Clinical outpatient neurorehabilitation service. Participants Clinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and carers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded, transcribed verbatim and analysed by four researchers using a thematic approach to identify main themes. Results Four focus groups were completed: three including stroke survivors (n = 16) and carers (n =2), and one including clinicians (n = 11). The main stroke survivor themes related to psychosocial aspects of the programme (“you feel valued as an individual”), as well as the behavioural training provided (“gruelling, yet rewarding”). The main clinician themes also included psychosocial aspects of the programme (“patient driven ethos – no barriers, no rules”), and knowledge, skills and resources of clinicians (“it is more than intensity, it is complex”). Conclusions As an intervention, the QSUL Programme is both comprehensive and complex. The impact of participation in the programme spans psychosocial and behavioural domains from the perspectives of both the stroke survivor and clinician. Strengths and limitations ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by funds from the Occupational Therapy Research Fund, National Hospital for Neurology and Neurosurgery. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Available on request by a qualified researcher.