Self-advocacy is associated with positive health outcomes, which is a central issue in chronic disease management. This study attempted to define self-advocacy operationally and conduct a mixed-methods analysis of self-advocacy among stroke patients in China.

Schwartz-Barcott and Kim’s method was used to clarify the concept of self-advocacy.

Two hospitals in Zhengzhou and Luoyang City, Henan Province, China.

A total of 12 stroke patients were recruited and interviewed face to face from October 2023 to December 2023.

A three-phase method (theoretical phase, fieldwork phase and final analysis phase) was employed to conduct the mixed concept analysis. In the theoretical phase, a literature search was conducted using PubMed, Web of Science, EBSCO, Embase, PsycINFO, CNKI, Wanfang database, VIP database and CBMdisc. 38 articles in databases were evaluated without time limits up to August 2023. In the fieldwork phase, semistructured interviews were used to interview the 12 participants who were chosen using purposive sampling. In the final analysis phase, the results from both the initial and second phases were integrated.

The review of literature in the theoretical phase determined the attributes of the concept, including ‘self-cognition’, ‘self-decision making’, ‘effective communication’, ‘social connection’. In the field study phase, attributes such as ‘self-awareness’, ‘self-care knowledge and abilities’ and ‘seeking support’ were added. In the final analysis phase, self-advocacy was finally defined as five attributes: ‘self-awareness’, ‘self-care level’, ‘self-decision-making’, ‘effective communication’ and ‘seeking support’.

Self-advocacy was defined as the capacity of stroke patients to comprehend and articulate their personal needs and care preferences, make proactive and meaningful decisions, engage in effective communication with healthcare providers and derive strength by seeking support from others.

Stroke is one of the leading causes of disability and mortality worldwide, particularly in China, where it imposes significant economic and psychological burdens on patients and their families. Traditional in-hospital rehabilitation is often limited by resource constraints, leading to interruptions in weekend therapy, which can delay recovery. Remote rehabilitation platforms offer a potential solution by providing continuous, therapist-guided rehabilitation training during weekends. This study aims to evaluate the effectiveness of a remote rehabilitation training platform in improving motor function, self-efficacy and social participation in stroke patients while also assessing its impact on caregiver burden. The findings will provide evidence for the integration of remote rehabilitation into stroke care protocols, offering a scalable solution to enhance recovery and reduce societal costs.

A total of 168 stroke patients will be recruited from three hospitals in Shanghai and randomly assigned to either an intervention group or a control group. A remote rehabilitation platform will be used to perform guided exercises on weekends for the intervention group, whereas the control group will receive standard in-hospital rehabilitation. Primary outcomes will be assessed using the 10 metre walk test, and secondary outcomes will include the Barthel Index, Fugl–Meyer motor function assessment and Zarit Caregiver Burden Scale.

This study was approved by the Ethics Committee of the Institutional Review Board of Shanghai University of Traditional Chinese Medicine (Ethics Approval Number: 2024-2-14-01). All participants will provide written informed consent prior to enrolment. Trial results will be disseminated through peer-reviewed publications, presentations at international stroke and rehabilitation conferences, and engagement with patient advocacy groups. Findings will also be shared with healthcare policymakers to promote the integration of remote rehabilitation into clinical practice. Individual participant data will remain confidential and be stored securely in accordance with data protection regulations.

This trial was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR2500101741). The date of registration was 29 April 2025.