{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:32Z","timestamp":1790571392517,"version":"4.1.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the barriers and facilitators to telerehabilitation adherence among young and middle-aged stroke survivors using the Capability, Opportunity, Motivation\u2013Behavior (COM-B) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive study was conducted with 15 stroke survivors aged 18\u201360\u202fyears recruited from a tertiary hospital in China. Data were collected via one-on-one semi-structured interviews and analyzed using directed content analysis, with iterative mapping of codes to COM-B sub-domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fourteen themes were identified across the six COM-B dimensions, comprising eight barriers and six facilitators. Capability barriers included post-stroke physical exhaustion and low digital confidence, while facilitators were perceived functional recovery and movement self-correction. Opportunity barriers encompassed physical space limitations, unstable internet connectivity, and social isolation; facilitators were family support and therapist supervision. Motivational barriers included efficacy skepticism, digital fatigue, and re-injury anxiety; facilitators were return-to-work aspiration and routine integration. Adherence was shaped by dynamic interactions among these factors rather than isolated determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Telerehabilitation adherence in young and middle-aged stroke survivors is influenced by a complex interplay of physical, cognitive, environmental, social, and motivational factors. Multi-component interventions that simultaneously target capability, opportunity, and motivation\u2014such as fatigue management, digital skills training, home environment optimisation, family involvement, vocational goal-setting, serious games, and peer support\u2014are warranted to enhance engagement and improve long-term outcomes. The COM-B model provides a useful framework for designing such tailored strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1885751","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:29:48Z","timestamp":1790569788000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to telerehabilitation adherence in young and middle-aged stroke survivors: a qualitative COM-B analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Yiling","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meilan","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufang","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University","place":["Xiamen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/17474930211065917","article-title":"World stroke organization (WSO): global stroke fact sheet 2022","volume":"17","author":"Feigin","year":"2022","journal-title":"Int J 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