I found that draping it over an ironing board and then quilting towards me off the edge of the ironing board with no hoop worked really well. The board could be adjusted to a comfortable height for wherever I was sitting, and the quilt could be slid over it to get at different bits. The weight of the quilt kept it in place so I could tug gently on it and maintain the tension. I used my left hand to support it - did have to remember to stop and wiggle my fingers every now and then so they didn't get stiff!
I tried a hoop (just a medium sized embroidery one I had handy to test the concept, but the same idea), and it made it really hard to control the stitches, I couldn't push the needle in and out in one go and I couldn't feel where it should go out again from the back.