Pedagogy and Enriched Environment for Rehabilitation in the HOME After Stroke (PEER-HOMEcare): Study Protocol for a Single-Group Feasibility Study.

Abstract

Home-based rehabilitation after stroke is increasingly important, as pressure on hospital services rise and recovery occurs mostly at home. Enriching the home (Environmental Enrichment, EE) represents a potential strategy to support rehabilitation by providing continuous task- and context-specific stimulation that promotes functional recovery through frequent and exploratory use of the affected arm. Exploratory behaviour - self-initiated, varied and adaptive movements - is an important driver of motor learning and neuroplasticity. While strong evidence from animal research demonstrates the benefits of EE for functional recovery, translation to human home-based rehabilitation remains limited. This study will investigate the feasibility of the Pedagogy and Enriched Environment for Rehabilitation in the HOME after stroke (PEER-HOMEcare) intervention. PEER-HOMEcare translates EE by introducing meaningful, targeted and progressive home modifications to promote exploratory use of the affected arm during daily activities. In this prospective, single group, experimental study, 45 stroke survivors (≥ 18 years), within 6 months post-stroke across Norway, Sweden and Latvia will participate. Wearable sensors will be used to capture exploratory behaviour and activity patterns, giving objective insights to inform progressive modifications to the home. Primary outcomes of feasibility and acceptability will be assessed through questionnaires, logs and interviews. Intervention fidelity, participant adherence and adverse events will be evaluated. Secondary outcomes include changes in arm function, self-perceived activities of daily living and psychosocial outcomes. This study will provide important knowledge about the feasibility of an innovative EE approach for home-based rehabilitation, informing a future trial evaluating its clinical effectiveness. Trial registration in https://www.ClinicalTrials.gov on 06-04-2026, NCT07517120.