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Home-based is as effective as centre-based rehabilitation for improving upper limb motor recovery and activity limitations after stroke: a systematic review with meta-analysis [with consumer summary]
Nascimento LR, Gaviorno LF, de Souza Brunelli M, Goncalves JV, Areas F
Clinical Rehabilitation 2022 Dec;36(12):1565-1577
systematic review

OBJECTIVE: This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke. DATA SOURCES: AMED, Medline, Embase CINAHL, Cochrane, PsycINFO, and PEDro databases. REVIEW METHODS: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3-43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI -0.9 to 3.8), dexterity (MD -0.01 pegs/s; 95% CI -0.04 to 0.05), upper limb activity performance (SMD -0.04; 95% CI -0.25 to 0.18), and quality of movement (0.1 points; 95% CI -0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation. CONCLUSION: Effects of home based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke.

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