| Summary: | <p><strong>Purpose</strong></p>
<p>Stroke survivors receive considerable rehabilitation efforts as inpatients, but one-on-one therapy decreases after discharge. The gap between the amount of required therapy and the lack of its availability in this phase of care may be partly overcome by self-practice. However, patient's adherence to prescribed programs is often low. While single studies have examined factors affecting adherence in this specific case, they have not been reviewed and synthesised previously.</p>
<p><strong>Methods</strong></p>
<p>A thematic synthesis of qualitative studies explored factors affecting stroke survivors’ adherence to prescribed, recovery-oriented self-practice. Five databases were systematically searched for references: Medline, Psycinfo, CINAHL, Embase, and ASSIA. Quality assessment was undertaken using the CASP tool.</p>
<p><strong>Results</strong></p>
<p>From 1308 references, 68 potential papers were read in full, and 12 were included in the review. An overarching theme was identified as: “Tailoring and personalization rather than standardization.” It was informed by the following three analytical themes: “The meaning of ‘self’ in self-practice,” “Identifying self-practice as a team effort,” and “Self-practice that is grounded in one’s reality.”</p>
<p><strong>Conclusion</strong></p>
<p>To have a positive effect on adherence to self-practice, clinicians are advised to spend time learning about each individual’s life circumstances, so they can tailor proposed exercise programs to patients’ personal situations, preferences, and needs.</p>
<p><strong>IMPLICATIONS FOR REHABILITATION</strong></p>
<ul>
<li>The topic of patient’s adherence to self-practice of prescribed exercise is a common concern, often voiced by frustrated rehabilitation health professionals. Bridging the gap between the patient’s needs for post-discharge intensive therapy and the inability of healthcare systems to provide it could be filled partly by self-practice.</li>
<li>
<p>Adherence to self-practice has become even more essential since the COVID 19 pandemic and the decrease in face-to-face delivery of rehabilitation due to social distancing requirements.</p>
</li>
<li>
<p>Adherence to exercise is a broad topic. Reasons for poor adherence differ between patient populations and the exercises they are prescribed. This study focuses on post-discharge stroke survivors’ adherence to recovery targeted exercise that could be described as repetitive and less physically demanding movements and functions.</p>
</li>
<li>
<p>Reviewed studies were qualitative and usually included a relatively small number of participants within a specific context. Using thematic synthesis, we combined these small pieces of the puzzle into a larger picture, to produce recommendations that could be drawn on by clinicians to improve self-practice adherence.</p>
</li>
</ul>
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