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Background
Globally, stroke is one of the most disabling adult chronic diseases, the second-leading cause of death, and the third-leading cause of mortality and disability combined [1]. According to the Global Burden of Disease (GBD) Study 2019, new and prevalent cases of stroke were 12.2 and 101 million, respectively, which in turn leads to 143 million Disability-Adjusted Life Years (DALYs) and 6.55 million deaths [2]. Stroke-related disability is associated with remarkable functional impairments [3]. Stroke survivors (SSVs) therefore require long-term rehabilitation by different health professionals that usually involve clinic visits and home-based treatment programs to supplement and maintain clinic-based treatments [3]. Continuous rehabilitation places the burden of care on the informal caregivers with the attendant long-term multidisciplinary process that involves many rehabilitation professionals and clinic attendances [4].
Reducing the degree of dependency in activities of daily living (ADL) to as near the pre-stroke level as possible is often a central aim of rehabilitation programs and other related interventions for people with stroke [2]. Often, community-based rehabilitation services in many low-income communities are poorly developed and inadequate, resulting in untimely discharge of patients, and limiting the attainment of optimal functional independence [5]. Physiotherapy plays an important role in the process of rehabilitation of SSVs. As a part of the multidisciplinary team, a physiotherapist is responsible for the prescription, promotion, and education of patients about the importance and value of exercises related to optimal physical function, wellness, and quality of life [6]. Post-discharge, physiotherapy as the mainstay of stroke rehabilitation, is continued on outpatient therapy sessions. However, there are challenges of cost, distance, time, and selecting the best means to sustain the immediate and long-term post-intervention outcomes [7].
Home exercise programs (HEPs) are the biggest components of success in physical therapy that have been used over the years to supplement clinic-based therapy sessions [8]. HEPs generally include directions for exercises that the patient should continue to perform independently at home outside the clinic days. Frankly speaking, HEPs are up to 50% of the reason for achieving better outcomes [9]; considering the average physical therapy visit ranges from 45 to 60 min per session [10], which may not be enough time to make the drastic change the SSV needs [11]. The extent of optimal independence hinges on the...