In this study the user requirements of the Neurorehabilitation Ecosystem for Sustained Treatment (NEST), a system containing: an exercise app, smartwatch and virtual coach designed for stroke survivors, will be investigated. Focus groups or interviews will be held in three countries, Italy, Spain and the Netherlands. During these focus groups open-ended questions will be asked about the different components of NEST.

After stroke, patients often experience a reduced arm-function. This function can partly be regained during a long and intensive rehabilitation. However, due to the ageing population and the increasing stroke cases, there is not enough time and money for this long and intensive rehabilitation in a rehabilitation center. Home-based rehabilitation could offer a solution to this problem. Currently, a new home-based rehabilitation system is being developed, named the Neurorehabilitation Ecosystem for Sustained Treatment (NEST). This system consists of three different components: an app, in which games can be played; a smartwatch which monitor the arm function of the patient and a virtual coach which will motivate the patient. However, this system is still being developed and it is unknown whether it meets the user requirements.

Therefore, the goal of this study is to identify factors for NEST to maximize usability, acceptance and usefulness by stroke patients, therapists and caregivers in the home situation. We conducted a qualitative focus group study, with 5 patients, 5 caregivers and 5 therapists in each of the three centers in Italy, Spain and the Netherlands. In each of the three centers, 3 focus groups or interviews will take place; one with patients, one with caregivers and one with therapists. First an introduction will be given in which the participants will see a video of NEST. Then questions about the systems will be asked. In total this will take 2 hours with a 30-minute break for patients. The main objective of this study is to get a list with factors that NEST needs to fulfill in order for it to be used by patients, caregivers and therapists. This will come out of an inductive thematic analysis from the focus groups.

Stroke survivors:

Inclusion criteria:

• People who had a stroke and were discharged from the rehabilitation center within one year from now.
• Range of different hand functioning measured with the Fugl-Meyer Assessment (only the upper extremity part will be used)
• 18 years or older

Exclusion criteria:

• Low cognitive functioning, with a mini mental state examination score below 21
• Extremely limited smartphone user
• Patients suffering from aphasia

Caregivers:

Inclusion criteria:

• An informal caregiver of a stroke patient (mostly a family member or friend)
• Stroke patient was discharged within one year from now
• 18 years or older

Exclusion criteria:

- Extremely limited smartphone user

Healthcare professionals:

Inclusion criteria:

• Working as a therapist in one of the centres
• Working with stroke patients on a daily basis

Exclusion criteria:

- Extremely limited smartphone user

All healthcare professionals worked at the participating centres. All stroke survivors received or were still receiving treatment at the participating centres. Most caregivers were related to the participating stroke survivors or recruited via social media.

Due to the nature of the data (interviews and focus groups) it is not possible to provide complete anonymized data.