Frontiers in Rehabilitation Sciences · Published 2026-06-29 · DOI 10.3389/fresc.2026.1743882
Ryu Kobayashi, Norikazu Kobayashi
BackgroundSome patients demonstrate exceptional post-stroke recovery beyond prognostic expectations; this phenomenon is referred to as positive deviance. Understanding how such recovery is perceived in clinical practice may provide insights for improving rehabilitation.AimThis study aimed to explore how occupational therapists perceive and interpret psychological and behavioral processes observed among stroke survivors whose activities of daily living (ADL) improvement exceeded prognostic predictions.MethodsA qualitative descriptive design was employed. Semi-structured interviews were conducted with eight occupational therapists working in a rehabilitation ward. The analysis focused on psychological and behavioral processes in patients with post-stroke ADL improvement beyond prognostic expectations, as perceived by the therapists. Data were analyzed inductively using reflexive thematic analysis.ResultsSix themes were identified as common patterns of psychological and behavioral processes among the patients: 1) maintaining own identity based on occupation; 2) positive and flexible problem-solving orientation; 3) mental fortitude to face challenges; 4) self-management toward goal attainment; 5) development of self-efficacy through accumulated successful experiences; and 6) proactive use of social support.ConclusionsThe psychological and behavioral processes associated with positive deviance, as perceived by occupational therapists, provide a clinically grounded perspective on stroke recovery and may inform the development of rehabilitation strategies to enhance recovery outcomes.
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Kobayashi, R., Kobayashi, N. (2026). Psychological and behavioral processes in stroke survivors with recovery exceeding prognostic expectations: a qualitative study of positive deviance. Frontiers in Rehabilitation Sciences. https://doi.org/10.3389/fresc.2026.1743882