{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:38:13Z","timestamp":1792798693333,"version":"4.5.0"},"reference-count":24,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2020,10,4]],"date-time":"2020-10-04T00:00:00Z","timestamp":1601769600000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Occupational Therapy Research Fund, National Hospital for Neurology and Neurosurgery.","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"https:\/\/ror.org\/048b34d51","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,8,21]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the UK that provides 90-hours of therapy over 3-weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Descriptive qualitative. Data analysis was performed using a conventional thematic content approach to identify main themes by four researchers to avoid any potential bias or personal motivations, promoting confirmability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Clinical outpatient neurorehabilitation service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Clinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and caregivers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded and transcribed verbatim by a professional transcription agency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four focus groups were completed: three including stroke survivors (n=16) and caregivers (n=2), and one including clinicians (n=11). The main stroke survivor themes related to\n                      <jats:italic>psychosocial<\/jats:italic>\n                      aspects of the programme (\u2018you feel valued as an individual\u2019), as well as the\n                      <jats:italic>behavioural training<\/jats:italic>\n                      provided (\u2018gruelling, yet rewarding\u2019). The main clinician themes also included\n                      <jats:italic>psychosocial<\/jats:italic>\n                      aspects of the programme (\u2018patient driven ethos\u2014no barriers, no rules\u2019) and\n                      <jats:italic>knowledge, skills and resources<\/jats:italic>\n                      of clinicians (\u2018it is more than intensity, it is complex\u2019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As an intervention, stroke survivors and clinicians consider the QSUL Programme to be both comprehensive and complex. The nature of the interventions in the programme spans psychosocial and behavioural domains. We suggest the future clinical trials of upper limb rehabilitation consider testing the efficacy of these multiple interacting components.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-036481","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T17:26:20Z","timestamp":1601918780000},"page":"e036481","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Pushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation Programme"],"prefix":"10.1136","volume":"10","author":[{"given":"Kate","family":"Kelly","sequence":"first","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Brander","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Strawson","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Ward","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, London, UK"},{"name":"Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5240-3264","authenticated-orcid":false,"given":"Kathryn","family":"Hayward","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Florey Institute of Neuroscience and Mental Health, and NHMRC CRE in Stroke Rehabilitation and Brain Recovery, The University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,10,5]]},"reference":[{"key":"2025121220220166000_10.10.e036481.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.6.1279"},{"key":"2025121220220166000_10.10.e036481.2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-9993(94)90161-9"},{"key":"2025121220220166000_10.10.e036481.3","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-12-162"},{"key":"2025121220220166000_10.10.e036481.4","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24734"},{"key":"2025121220220166000_10.10.e036481.5","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0276"},{"key":"2025121220220166000_10.10.e036481.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0911341"},{"key":"2025121220220166000_10.10.e036481.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2014.10.022"},{"key":"2025121220220166000_10.10.e036481.8","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1177\/1545968319846120","article-title":"Long-dose intensive therapy is necessary for strong, clinically significant, upper limb functional gains and retained gains in Severe\/Moderate chronic stroke","volume":"33","author":"Daly","year":"2019","journal-title":"Neurorehabil Neural Repair"},{"key":"2025121220220166000_10.10.e036481.9","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.004695"},{"key":"2025121220220166000_10.10.e036481.10","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jphys.2016.08.006","article-title":"Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review","volume":"62","author":"Schneider","year":"2016","journal-title":"J Physiother"},{"key":"2025121220220166000_10.10.e036481.11","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-319954"},{"key":"2025121220220166000_10.10.e036481.12","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2025121220220166000_10.10.e036481.13","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"2025121220220166000_10.10.e036481.14","unstructured":"Green J , Thorogood N . 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