Advancing Home-Based Brain Attack Rehabilitation with Electrotherapeutic-Pneumatic Stimulated Forearm Device Configurations

Home-based cardiac rehabilitation versus hospital-based rehabilitation: A cost effectiveness analysis

Treatment efficacy of a hybrid home-based rehabilitation intervention for patients with stroke: A randomized crossover trial

Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder among older adults, characterised by dizziness and imbalance caused by the displacement of otoconia into the semicircular canals. Although canalith repositioning manoeuvres are considered the standard treatment, their high recurrence rate and the need for frequent clinic visits highlight the demand for supplementary therapeutic approaches. This review examines the effectiveness of home-based vestibular rehabilitation and the associated challenges in managing patients with BPPV. A comprehensive search of databases including PubMed, Scopus, Science Direct, Web of Science, PEDro, Mendeley, and Google Scholar identified 251 records using keywords such as “BPPV” and “home-based exercise rehabilitation.” Following the screening of 228 records and full-text review of 172 articles, 17 studies met the inclusion criteria. The total sample included 541 patients with BPPV, with intervention group sizes ranging from 10 to 154 and control group sizes from 10 to 151. Intervention durations varied between 1 and 24 weeks. The findings indicate that home-based rehabilitation can reduce dizziness, improve balance and gait, lower fall risk, and enhance quality of life. Digital tools such as telephone consultations and online platforms were frequently used to support adherence and monitor exercise performance. However, the effectiveness varied across studies, with some reporting substantial benefits and others showing limited improvements. This review highlights the potential of digital technologies in enhancing home-based vestibular rehabilitation, while also emphasising the need for further research to optimise protocols and assess long-term outcomes.

BackgroundUpper extremity rehabilitation in persons with stroke should be dose-dependent and task-oriented. Virtual reality (VR) has the potential to be used safely and effectively in home-based rehabilitation. This study aimed to investigate the effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke.MethodsThis was a single-blind, randomized, controlled trial conducted at two centers. The subjects were 14 outpatients with chronic stroke more than 6 months after the onset of the stroke. The participants were randomly divided into two groups. The intervention group (n = 7) performed a home rehabilitation program for the paretic hand (30 min/day, five days/week) using a VR device (RAPAEL Smart Glove™; NEOFECT Co., Yung-in, Korea) for four weeks. The control group (n = 7) participated in a conventional home rehabilitation program at the same frequency. All participants received outpatient occupational therapy once a week during the study period. The outcome measures included the Fugl-Meyer Assessment of upper extremity motor function (FMA-UE), Motor Activity Log-14 (MAL), Jebsen-Taylor Hand Function Test (JTT), and Box and Block Test (BBT) scores.ResultsAll 14 participants completed the study. Compared to the control group, the intervention group showed more significant improvements in FMA-UE (p = 0.027), MAL (p = 0.014), JTT (p = 0.002), and BBT (p = 0.014). No adverse events were observed during or after the intervention.ConclusionCompared to a conventional home program, combining a task-oriented virtual reality home program and outpatient occupational therapy might lead to greater improvements in upper extremity function and the frequency of use of the paretic hand.Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry in Japan (Unique Identifier: UMIN000038469) on November 1, 2019; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043836.

BackgroundRehabilitation post-knee arthroplasty is integral to regaining knee function and ensuring patients’ overall well-being. The debate over the relative effectiveness and safety of outpatient versus home-based rehabilitation persists.MethodsA thorough literature review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across four databases. Two researchers independently identified eligible studies centering on knee arthroplasty patients undergoing either outpatient or home-based rehabilitation. Study quality was assessed using the Cochrane Collaboration’s risk of bias tool, while continuous outcomes were subject to meta-analyses using Stata 17 software.ResultsOur analysis identified no significant differences in primary outcomes, including Range of Motion, Western Ontario and McMaster Universities Arthritis Index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, and the Knee Society Score, between home-based and outpatient rehabilitation across different follow-up points. Adverse reactions, readmission rates, the need for manipulation under anesthesia, reoperation rate, and post-surgery complications were also similar between both groups. Home-based rehabilitation demonstrated cost-effectiveness, resulting in substantial annual savings. Furthermore, quality of life and patient satisfaction were found to be comparable in both rehabilitation methods.ConclusionsHome-based rehabilitation post-knee arthroplasty appears as an effective, safe, and cost-efficient alternative to outpatient rehabilitation. Despite these findings, further multicenter, long-term randomized controlled trials are required to validate these findings and provide robust evidence to inform early rehabilitation choices post-knee arthroplasty.

Home-based rehabilitation is a promising approach to improve access to pulmonary rehabilitation. To assess whether self-monitored, home-based rehabilitation is as effective as outpatient, hospital-based rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Randomized, multicenter, noninferiority trial. 10 academic and community medical centers in Canada. 252 patients with moderate to severe COPD. After a 4-week education program, patients took part in home-based rehabilitation or outpatient, hospital-based rehabilitation for 8 weeks. They were followed for 40 weeks to complete the 1-year study. The primary outcome was the change in Chronic Respiratory Questionnaire dyspnea subscale score at 1 year. The primary analysis took a modified intention-to-treat approach by using all patients who provided data at the specified follow-up time, regardless of their level of adherence. The analysis used regression modeling that adjusted for the effects of center, sex, and baseline level. All differences were computed as home intervention minus outpatient intervention. Both interventions produced similar improvements in the Chronic Respiratory Questionnaire dyspnea subscale at 1 year: improvement in dyspnea of 0.62 (95% CI, 0.43 to 0.80) units in the home intervention (n = 107) and 0.46 (CI, 0.28 to 0.64) units in the outpatient intervention (n = 109). The difference between the 2 treatments at 1 year was small and clinically unimportant. The 95% CI of the difference did not exceed the prespecified noninferiority margin of 0.5: difference in dyspnea score of 0.16 (CI, -0.08 to 0.40). Most adverse events were related to COPD exacerbations. No serious adverse event was considered to be related to the study intervention. The contribution of the educational program to the improvement in health status and exercise tolerance cannot be ascertained. Home rehabilitation is a useful, equivalent alternative to outpatient rehabilitation in patients with COPD.

This study aims to evaluate whether an 8-week, nurse-led, home-based pulmonary rehabilitation programme improves walking capacity, anxiety and sleep quality in adults with chronic obstructive pulmonary disease. This was a single-centre, open-label, parallel-group randomized controlled trial with assessments at baseline and week 8. Ninety adults with stable COPD (GOLD II-III) were enrolled and randomized 1:1 (fixed-block size = 2; SNOSE concealment); 84 completed week-8 assessments and were analysed (home-based rehabilitation, n = 43; standard care, n = 41). Participants' mean age was 67.71 years; 73.8% were male; mean baseline FEV1 was 55% predicted. The 8-week intervention comprised home-based breathing and full-body resistance exercises (3-5×/week, 25-30 min), initiated with a tele-monitored session to ensure correct technique and supported by weekly nurse-led calls, alongside structured nurse-delivered education. Prespecified primary outcomes were 6-min walk distance, anxiety (STAI) and sleep quality (PSQI); secondary outcomes were cardiopulmonary signs, dyspnoea and spirometric indices. At week 8, the intervention improved walking capacity versus control (p < 0.001). Anxiety decreased on STAI-I/II (p < 0.001), and overall sleep quality improved on PSQI (p = 0.001), with benefits on Subjective Sleep Quality and Daytime Dysfunction (both p < 0.001); effects on Sleep Disturbances and Sleep Medication were smaller. Dyspnoea (Borg) also improved (p < 0.001). Secondary outcomes were consistent, and no intervention-related adverse events occurred. Nurse-led, home-based pulmonary rehabilitation is a feasible and safe approach that improves functional capacity as well as psychological and sleep outcomes in adults with chronic obstructive pulmonary disease. ClinicalTrials.gov identifier: NCT06862713.

INTRODUCTION:Stroke causes physiologic functional changes such as vascular resistance and arterial remodeling. This study aimed to explore the effects of 3-month regular home-based exercise rehabilitation on brachial flow-mediated dilation (FMD), daily physical activity, and upper and lower extremity sensorimotor of the acute ischemic stroke patients.MATERIALS AND METHODS:This randomized control trial was done from August 2017 to September 2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational hospital. Patients were randomly assigned to the home-based rehabilitation program (intervention group) or usual care (control group). Fugl-Meyer upper and lower extremity sensorimotor score and Barthel score were evaluated in both the groups before and 3 months after baseline assessment. Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health. The intervention group received home-based rehabilitation exercise program for 3 months. The control group did not receive home-based rehabilitation program and incentive telephone call. All data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.RESULTS:Forty ischemic stroke patients (twenty in the intervention group and twenty in the control group) were examined. Results showed that Barthel score and Fugl-Meyer upper and lower extremity score and FMD in the intervention group were significantly higher than the control group after 3-month home-based exercise rehabilitation (P < 0/001).CONCLUSION:Twelve-week regular home-based exercise training was well tolerated by the intervention group. After this period, improvements were reported in brachial FMD as well as daily physical activity and upper and lower extremity functional capacity.

The effectiveness of a nurse-led home-based cardiac rehabilitation based on instant information intervention in the prognosis of patients with TAVR: A randomized controlled trial protocol.

Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms — Cornwall Heart Attack Rehabilitation Management Study (CHARMS)

The benefits of cardiac rehabilitation programmes have been well documented including reductions in mortality, improved physical performance, and improved quality of life. However, a large number of special needs patients often fail to access these programmes. Of particular concern are elderly patients with chronic illness and disability. To evaluate the effectiveness of a home-based cardiac rehabilitation programme in improving health outcomes and rehabilitation access for special-needs patients. Using a one-group pre and post-test quasi-experimental design 40 elderly patients recently discharged from hospital following a cardiac event completed the Short Form Health Survey, the Angina Quiz, and the Exercise Assessment Questionnaire prior to undertaking home-based rehabilitation. The rehabilitation programme consisted of four community nursing contacts over a 9-week period primarily aimed at individual patient education and carer support. Descriptive statistics provided analysis for demographic data. Repeated measures multivariate analysis of variance (manova) were computed to examine changes in health-state and practices. Significant positive changes were found for measures of quality of life, knowledge of angina, and exercise tolerance. Additionally, the higher levels of participation and completion by older women was encouraging. Development of carer competence through an improved knowledge base and nursing support was also evident. While theoretically defensible positive outcomes were found these results need to be replicated in a larger study. Similarly, the limitations imposed by a single group pretest, post-test design suggest that claims of generalizability need to be limited to the specific variables measured in this study. The study demonstrated medium term positive health outcomes. These positive findings suggest that home-based rehabilitation using larger samples of older patients with comorbidities, and using randomized comparative group designs, may be a fruitful area in future research.

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. 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. 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%). 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. Home-based rehabilitation can be an effective alternative method for improving ADL independence in patients with stroke by providing a familiar and convenient environment.

Objective: Tremor is a clinically depicted commonly encountered neurological disorder which results after a stroke or brain injury like Parkinson's disease which causes rhythmic and reflex oscillatory movement of a body, particularly upper arm, which is difficult to diagnose and manage. Tremor is influenced by Physiological and Psychological factors which can affect any age group specifically in middle age and older persons. The modern treatment facilities and features available are very expensive and unreachable for rural people. Hence there arises a necessity to develop a portable device to overcome such situations. Methods: This paper introduces a portable and wearable device using accelerometer sensor assisted with pneumatic mechanism for tremor suppression in the upper arm. This portable device may help to suppress tremor and improve muscle control and coordination in the upper arm. Once the device is connected with the patients arm, the pneumatic circuit supplies required air through the hand cuff to keep the arm on control with reference to the signal obtained from the accelerometer sensor. The results: The performances of the device are measured in three different stages say before inflation, during partial inflation and full inflation. The results depicts 30% of improvement in tremor suppression at three different levels of tremor occurrence which is measured in terms of voltage between 1.6 and 2V at high, medium and low levels at different time intervals with frequency &lt;10Hz. Conclusion: This device is a cost effective and portable closed loop system which is exclusively designed to reduce the tremor without affecting the upper limb voluntary movements.

To compare the effects of home-based rehabilitation and occlusal splints or centre-based rehabilitation in patients with temporomandibular joint disorders (TMD). A systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov electronic databases were consulted from inception to August 2023, searching for randomized controlled trials (RCTs) that compared home-based rehabilitation for TMD with splints or centre-based rehabilitation. The risk of bias was assessed using the Cochrane risk of bias tool. 23 RCTs (1402 participants, three comparator interventions) were identified. Very low-certainty evidence suggested there are no clinically difference between home-based rehabilitation and splints in pain intensity (mean difference (MD) 7.75, 95% confidence interval (CI): 2.17 to 13.32), maximal mouth opening (MMO) (MD 1.83, 95% CI: −0.27 to 3.93) at short and long-term follow-up, in sleep quality (MD: 1.67, 95% CI: −2.04 to 3.56) and quality of life (psychological: MD 0.94, 95% CI: −4.43 to 6.31; general: MD −1.18, 95% CI: −5.72 to 5.37) at short-term follow-up. Low-certainty evidence suggested that home-based rehabilitation plus manual therapy is more effective for TMD treatment compared to home-based rehabilitation at short-term follow-up (pain intensity: MD: 14.93, 95% CI: 7.72 to 21.93; MMO: MD −2.93, 95% CI: −5.3 to −0.54; sleep quality: MD 1.4, 95% CI: 0.09 to 2.71). Compared with home-based rehabilitation, Transcutaneous Electrical Nerve Stimulation (TENS) and Low-Level Laser Therapy (LLLT) was superior in pain relief at short-term follow-up. Low and very low-certainty evidence suggests home-based rehabilitation could be considered a low-cost, beneficial therapy alternative for TMD patients to relieve symptoms.