Home-based exercises are as effective as equivalent doses of centre-based exercises for improving walking speed and balance after stroke: asystematicreview.

Abstract

In people who have had a stroke, how comparable are the effects of home-based exercises with those of equivalent centre-based exercises for improving walking speed, balance, mobility and participation? Is the comparability of the effects of these two types of exercise maintained beyond the intervention period? Systematic review of randomised controlled trials. Searches were conducted on MEDLINE, AMED, EMBASE, Cochrane, PsycINFO and PEDro databases, without date or language restrictions. Participants in the reviewed studies were ambulatory adults at any time after stroke. The experimental intervention consisted of home-based exercises, which was compared with equivalent doses of centre-based exercises. Walking speed, balance, mobility and participation. The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Nine trials involving 609 participants were included. Random-effects meta-analyses provided high-quality evidence that home-based and centre-based exercises provide similar effects on walking speed (MD -0.03 m/s, 95% CI -0.07 to 0.02) and balance (MD 0 points, 95% CI -1 to 2). Results regarding mobility (SMD -0.4, 95% CI -1.3 to 0.4) and participation (MD -5 points, 95% CI -19 to 10) were imprecise. For most outcomes, the effects of home-based exercises and centre-based exercises remained similar beyond the intervention period. Effects of home-based prescribed exercises on walking speed, balance, mobility and participation are likely to be similar to improvements obtained by equivalent doses of centre-based exercises after stroke. PROSPERO (CRD42021254642).