Participants randomly allocated to the intervention group will receive FBB in addition to usual care. FBB is an 8-week home-based programme aimed at improving stroke survivors’ balance, gait and memory. FBB was developed by the multidisciplinary healthcare team of the project in partnership with a ballet dance instructor and four stroke survivors (three women and one man, age 39–65 years, stroke duration 2–6 years). We chose ballet in lieu of other dance styles because it places emphasis on priori mastery of low-impact workouts to maintain proper body alignment, build core and lower extremity strengths and flexibility, before moving on to more complicated ballet movements. These workouts are particularly helpful for stroke survivors in correcting their balance and gait problems. Furthermore, classical ballet training emphasises motor learning for smooth performance of movements.16 When put in practice for rehabilitation training, we also emphasised to survivors on rehearsal of body movements mentally before putting the movements into actions. It mirrors mental imagery to promote motor relearning and to enhance brain plasticity and cognitive functions.16 17 Musical beats are also integrated in ballet training, requiring coordination of both cognitive and physical activities to move the body according to the planned sequence and time. With repeated and longer duration of practice, performing ballet-inspired movements also improves cardiorespiratory fitness. The movements can be practiced alone, with partners or in groups to facilitate social engagement.

Bandura’s constructs of self-efficacy and outcome expectation18 underpin the design and implementation of FBB. Strategies will be adopted to enhance participants’ self-efficacy and outcome expectations of performing ballet-inspired workouts.13 14

Eight carefully selected ballet-inspired workouts are integrated16 17: basic body positions, trunk movement, pointed toes, turn in and out, tendus (sliding and extending foot), plies (bending knees), eleves (lifting up on balls of feet) and coupes (shifting body weight). The workouts are aimed at enhancing participants’ awareness of body parts and ability in maintaining proper body alignment and postural control. Participants will perform the workouts starting from a sitting position and progress to a standing position with or without physical support as their postural control improves. They will perform mental imagery of each workout after viewing demonstrations, and memorising the movements before performing. Each workout is designed to resemble a daily activity commonly performed by women or men.

We will integrate the workouts into a 60-minute structured session adapted from a typical ballet class.4 To maintain an appropriate level of challenge, the difficulty of the workouts will increase progressively subject to participants’ willingness and improved condition.

FBB will be delivered by trained lay and peer stroke volunteers with the support of volunteer healthcare professionals. The lay volunteers will provide home visits and virtual sessions to participants. The healthcare professionals will provide expert advice to volunteers during implementation. All volunteers will receive 4 days of structured training conducted by the principal investigator with over 10 years of ballet experience. Lay and peer stroke volunteers will be asked to complete an exit test to demonstrate the ability to deliver the FBB independently. Training completion will be determined by a satisfactory performance in the test and completion of one supervised on-site session and one virtual session.

A self-directed resource package will be developed in form of a website and guidebook for participants’ convenience of access. It will contain videos to demonstrate the workouts, animated videos to illustrate the information and a suggested weekly goal-and-action plan for 8 weeks.

FBB will consist of two weekly 90-minute at-home support sessions delivered by two lay volunteers (one of them will be a stroke survivor) in weeks 1–2, and six weekly 15-minute virtual interactions (by phone or internet media) by either lay volunteer in the remaining weeks. Participants will be asked to perform the 60-minute session two times per week during these 8 weeks. The home-based sessions will introduce participants to FBB, the resources package and safety precautions. The lay volunteers will conduct virtual sessions and discuss strategies to address challenges in performing workouts, reinforcing outcome expectations, appraising incremental progress and reinforcing participation as planned for the following weeks. They will update the healthcare professionals about the participant’s progress, and consult them for advice if needed. All adverse events will be documented and reported to the clinical research ethics committee.

Strategies will be adopted to ensure safety of the participants during FBB. Participants are reminded to perform FBB each time starting from a sitting position and progressing to a standing position as their postural control improves. Family members or carers are encouraged to join FBB with participants and/or provide standby support to participants while they are doing FBB. The preparation of environment include preparing for a chair without wheels for support, adequate space and light and a phone nearby for making contacts when necessary. The breaks are mandatory to avoid overexertion.

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