Background: The significant and growing impact of stroke disability has prompted researchers and clinicians to re-think the core components of rehabilitation. While the concept of “task challenge” is often described as influencing individual’s experiences and outcomes of stroke rehabilitation, it is poorly understood. Challenge holds various meanings, including overlap with descriptions of task difficulty, physiological intensity, cognitive load and perceived effort, which can lead to suboptimal implementation of challenge in clinical practice.

Purpose: To explore how challenge is conceptualised in stroke rehabilitation from the perspectives of people with stroke, physiotherapists, occupational therapists and speech-language therapists.

Methods: Principle-based concept analysis was used to explore challenge within the stroke rehabilitation literature. A systematic search and screening process was used to select literature with high informational value. Included papers were analysed to elicit understandings of the range of purposes, meanings and uses of challenge, within and across rehabilitation perspectives.

Results: A total of 42 papers were included. Challenge appeared to be a multidimensional and dynamic concept which was understood through three facets: nominal, functional and perceived challenge. Nominal challenge was understood as the task difficulty based solely on characteristics of the task. Functional challenge was defined as an interaction between the task difficulty and the person’s ability. Perceived challenge emerged as the person’s subjective experience of challenge. In practice, functional and perceived challenge were predominantly used to create optimal challenge.

Conclusions: Challenge is an important concept which, when carefully optimised to the person’s ability and perception, may positively influence their engagement with and outcomes from stroke rehabilitation.

Implications: Challenge involves a multifaceted, multidimensional and dynamic interaction between the task, the person’s ability and their subjective experience. Therapists should consider both functional and perceived approaches to the operationalisation of optimal challenge with the person.

Background:
Informal carers play a significant role in stroke recovery, but care provision can be challenging, including emotional distress, anxiety, and social isolation. With the abruptness of stroke presentation and the psychological stress of suddenly supporting a person with stroke, interventions that enhance carers’ ability to cope with and build resilience are required.

Purpose:
To report the feasibility and benefits of a strengths-based resilience intervention (SBRI) for carers of stroke survivors.

Methods:
Based on systematic review and qualitative findings along with experts’ advice, a recognised strengths-based resilience intervention was modified and evaluated using a randomised controlled trial comparing SBRI with usual care. SBRI was group delivered once a week for 8 weeks by a researcher with a psychology background and a trained Stroke Foundation advisor. SBRI focused on resilience skills, growth, flexible thinking, and identifying and cultivating character strengths. Qualitative interviews explored benefits, acceptability and sought improvement suggestions. Data were analysed with the General Inductive Approach. Quantitative measures (Connor–Davidson Resilience Scale (CD-RISC) and Psychological General Well-Being Index (PGWBI) scores were compared between groups using Cohen’s d.

Results:
Of 27 participants (NZ European=23, Māori=2, Asian=2, male carer =1, age mean(SD) 61(7), range 52-77 years), 13 were randomised to the SBRI group. SBRI was feasible to deliver, acceptable and potentially beneficial, but more suitable to carers two years post-stroke. A significant between group difference were found for CD-RISC (p = 0.01, d = 1.01) post-intervention.

Conclusions:
SBRI was found potentially beneficial and acceptable, and worthy of further investigation. Additional input is required for new carers. Future trials must broaden recruitment diversity.

Implications:
Interventions focusing on carers’ resilience should be integrated into stroke rehabilitation to ensure sustainability of care provided to stroke survivors, thus enhancing stroke recovery. Physiotherapists can be trained to deliver SBRI to develop their role of supporting carers.