Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Feb 13, 2026
Open Peer Review Period: Feb 19, 2026 - Apr 16, 2026
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The impact of a virtual mindfulness program adapted for stroke survivors: A mixed methods study
ABSTRACT
Background:
Mindfulness has potential to improve lives after stroke but survivors experience barriers (e.g. transportation) to attend face-to-face programs. Only two virtual mindfulness programs have been explored for stroke survivors, but they included the diagnosis of traumatic brain injury and only persons with high levels of chronic fatigue, not representative of the general population of persons with stroke.
Objective:
The aims of this study were to: 1) investigate the effect of a virtual mindfulness program for stroke survivors on the primary outcomes of acceptance, stress and self-compassion and secondary outcomes including fatigue, depression, anxiety, and sleep; 2) explore the stroke survivor experience to better understand the effectiveness of the mindfulness program.
Methods:
This was a mixed methods study involving eight stroke survivors with a mean age of 55.3 years (range 41-66) and mean time post stroke of 48.6 months (range 7 to 94). Primary outcomes measured before (PRE), after the program (POST), and two months later (POST2) included the Illness Cognition Questionnaire (ICQ), the Acceptance of Illness Questionnaire (AIQ), the Perceived Stress Scale (PSS), and the Self-compassion Scale (SCS). Secondary outcomes included Frieberg Mindfulness Inventory (FMI), Mental Fatigue Scale (MFS), Patient-Reported Outcomes Measurement Information System (PROMIS®)-Short Form (depression, anxiety, fatigue, sleep disturbance). A paired t-test was conducted to compare PRE, POST and POST2 outcomes. Qualitative data was collected via a semi structured interview with each participant after the program.
Results:
Significant improvements were observed from PRE to POST for PSS (P=.03) and the SCS (P=.003), with continued improvements demonstrated at POST2. Although acceptance showed an improved trend from PRE to POST to POST2, only the ICQ helplessness scale was close to being significant (P=.05). Several secondary outcomes improved significantly from PRE to POST2 including FMI (P=0.003) and the PROMIS subscales of fatigue (P=.04) and sleep (P=.03). The qualitative findings supported the quantitative results and provided a deeper understanding of the impact on participants.
Conclusions:
These results demonstrate how a virtual mindfulness program adapted for stroke may benefit survivors including decreasing stress and increasing self-compassion. Although changes in acceptance were not significant, a trend of improvement from PRE to POST to POST2 was observed and worthy of further investigation. Significant improvements were also observed for secondary outcomes of fatigue and sleep. Virtual mindfulness programs offer a feasible and promising approach to help survivors move forward with life after stroke. Due to small sample size, results should be interpreted appropriately and further research is recommended. Clinical Trial: No registration
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