BACKGROUND: Home-based, self-managed stroke rehabilitation is needed to supplement limited clinical resources. This study compared a home-based online self-managed program, Stroke Rehabilitation Online Guide (STRONG), versus paper exercise program (PEP) for improving upper extremity function after stroke. METHODS: In this randomized trial, 43 participants with stroke were stratified by motor ability and self-efficacy, then assigned to either STRONG (n = 22) or PEP (n = 21). A 6-week intervention phase (> 1 hour, 5 days weekly) was followed by 6 weeks of optional training. STRONG included self-selected upper extremity task practice with optional web-based video games and guided exercises. PEP included written upper extremity exercises. Primary outcomes were Fugl-Meyer Upper Extremity Assessment and Wolf Motor Function Test-Timed. Secondary outcomes included Motor Activity Log amount of use and movement quality, Wolf Motor Function Test-Function, Stroke Motivation Scale, and Self-Efficacy Scale. RESULTS: STRONG did not demonstrate superiority in Fugl-Meyer Upper Extremity Assessment or Wolf Motor Function Test-Timed. Within-group Fugl-Meyer Upper Extremity Assessment improvements were similar (STRONG: 1.8 points versus PEP: 2.1 points at post training; 3.3 versus 1.9 at follow-up). However, STRONG participants reported better quality and increased arm and hand use in daily activities (Motor Activity Log-quality of movement and Motor Activity Log-amount of use) at post training and follow-up. Additionally, STRONG participants showed higher self-efficacy post training, though not maintained at follow-up. CONCLUSION: Both programs produced modest motor improvements. Although STRONG did not outperform PEP in primary outcomes, participants reported improved daily arm and hand use and movement quality and higher program continuation. Home-based, self-managed rehabilitation focused on daily tasks and optional exercises appears beneficial in individuals with stroke. Larger studies are needed to confirm these results. REGISTRATION: URL: https://www. clinicaltrials.gov; Unique identifier: NCT03484182.

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