Strategies to Enhance Adherence to Home Exercise Programmes Among Stroke Survivors: A Scoping Review

Background Although sustained home-based exercise is crucial for post-stroke functional recovery, patient adherence remains notoriously low, necessitating effective strategies to improve it, particularly in long-term rehabilitation. Objective(s) This review aims to map and synthesise evidence on interventions, frameworks, and strategies that improve adherence to home exercise programmes among adult stroke survivors. Methods Scoping review following PRISMA guidelines, with a literature search across Web of Science, Scopus, PubMed, EBSCOhost, the Cochrane Library, and PEDro databases, was conducted. Studies examining strategies to enhance adherence to self-managed stroke rehabilitation were included. The included articles were subjected to data extraction and qualitative synthesis. Results A total of 1702 articles were identified; 38 articles (1156 stroke patients) were finally included following screening and analysis. Included studies highlighted two primary interventional approaches: digital health technologies and multicomponent behavioural strategies. Technology-integrated approaches include telerehabilitation, virtual reality games, robotic-assisted devices, and smartphone applications with objective monitoring, which exhibited high usability, provided real-time feedback, and improved patient motivation. However, providing technology or enhanced prescription materials alone resulted in mixed adherence outcomes compared to standard paper-based method programs. The strongest improvements in compliance and functional mobility were seen when tools were combined with structured behavioral coaching (such as goal-setting and telephone monitoring) and active involvement of care partners, as in the H-GRASP, CARE-CITE-Gait, and ADHERE trials. Conclusions Sustaining HEP adherence post-stroke requires a multifaceted approach. Integrating remote digital monitoring with theory-driven behavioural coaching and structured caregiver support optimizes long-term patient engagement and stroke recovery in the home setting. Keywords Stroke, Adherence, Home-Based Exercise, Technology, Behaviour