Pedagogy and Enriched Environment for Rehabilitation in the HOME after stroke (PEER HOMEcare): study protocol for a single-group feasibility study

Home-based rehabilitation after stroke is increasingly important, as pressure on hospital services rise and recovery occurs mostly at home. Enriching the home 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 benefits for functional recovery, translation to human home-based rehabilitation remains limited. This study investigates the feasibility of the Pedagogy and Enriched Environment for Rehabilitation in the HOME after stroke (PEER HOMEcare) intervention. This theory-driven, person-centred intervention, introduces 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 activity patterns, informing objective insights into motor behaviour, and progressive modifications to the home. Primary outcomes of feasibility and acceptability are 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. A dedicated website (www.peerhomecare.com) provides informational resources for all participants and project therapists. This study will provide important knowledge about PEER HOMEcare and provide information for a future trial evaluating its clinical effectiveness in home-based stroke rehabilitation. Trial registration in www.ClinicalTrials.gov on 06-04-2026, NCT07517120.