Supplementary file 1_Barriers and facilitators to telerehabilitation adherence in young and middle-aged stroke survivors: a qualitative COM-B analysis.docx

Objective<p>To explore the barriers and facilitators to telerehabilitation adherence among young and middle-aged stroke survivors using the Capability, Opportunity, Motivation–Behavior (COM-B) model.</p>Methods<p>A qualitative descriptive study was conducted with 15 stroke survivors aged 18–60 years 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.</p>Results<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.