Compliance With In-Home Self-Managed Rehabilitation Post-Stroke is Largely Independent of Scheduling Approach.

Objective: To investigate how participants self-schedule their engagement with domestic rehabilitation gaming platform, and how their scheduling behavior in turn influence overall compliance.

Design: Cohort of individuals randomized to receive in-home rehabilitation gaming during a multi-site randomized controlled trial.

Setting: In-home self-managed rehabilitation.

Participants: Eighty community-dwelling participants who were >6 months post-stroke and had mild to moderate upper extremity impairment (N=80).

Interventions: Participants were prescribed 15 hours of independent in-home self-scheduled game play for upper extremity mobility over 3 weeks.

Main Outcome Measures: Total number of hours of active game play was objectively measured by the rehabilitation gaming system. Cluster analysis identified scheduling patterns from the following scheduling characteristics: total number of sessions, average session length, and consistency of play schedule.

Results: Four distinct scheduling profiles were revealed, 3 of which were associated with complete or near-complete compliance, while a fourth (inconsistent schedule of short, infrequent sessions) was associated with very poor compliance. Poor compliance could be predicted within the first 7 days of the program with 78% accuracy based on the same play pattern metrics used to identify player profiles.

Conclusions: Our findings support client autonomy in selecting the home practice schedule that works best for them, as compliance can successfully be achieved through a variety of different scheduling patterns. The objective measurements of compliance provided through rehabilitation gaming can assist therapists to identify individuals early on who exhibit scheduling behavior that is predictive of poor compliance.