Effectiveness of home-based Rehabilitation on Activities of Daily Living in Patients With Stroke: Systematic Review and Meta-Analysis

Abstract

Objective This systematic review compared the effectiveness of home-based rehabilitation with that of hospital-based rehabilitation and usual care on activities of daily living (ADL) independence in patients with stroke.Methods Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library databases were searched for studies published between January 2000 and January 2024. This review was registered in the International Prospective Register of Systematic Reviews. Randomized controlled trials on home-based rehabilitation of patients with stroke were included. The included studies investigated ADL independence, upper limb function, mobility, balance, aerobic endurance, and quality of life. Two independent researchers extracted data using an extraction form and assessed the risk of bias and quality of evidence.Results Forty-six studies were included in the qualitative synthesis, and 34 studies were included in the quantitative synthesis using Review Manager software 5.4. ADL independence was not significantly different between patients receiving home-based rehabilitation and hospital-based rehabilitation (standardized mean difference (SMD) = 0.17 [95% CI = 0.00 to 0.34], I2 = 29%). However, a significant difference was observed between home-based rehabilitation and usual care (SMD = 1.24 [95% CI = 0.69 to 1.79], I2 = 91%).Conclusion Home-based rehabilitation is comparable to hospital-based rehabilitation and more effective than usual care and should be considered for patients with stroke after discharge to facilitate effective recovery. However, the high overall risk of bias requires cautious interpretation.Impact Home-based rehabilitation can be an effective alternative method for improving ADL independence in patients with stroke by providing a familiar and convenient environment.