Self-administered, home-based, upper limb practice in stroke patients: A systematic review

Abstract

Objective: To investigate the effectiveness of self-administered, home-based, upper limb practice in improving upper limb activity after stroke. To compare structured home-based practice vs non-structured home-based practice.

Methods: Databases were searched for randomized or quasi-randomized controlled trials using a pre-defined search strategy. Data were extracted from 15 studies involving 788 participants. The quality of included studies was assessed using the PEDro scale. The studies included an experimental group that received self-administered, home-based practice for upper limb activity limitations of any level of severity and any time after stroke, and a control group that received no intervention, or received non-structured home-based practice. Only measures of upper limb activity were investigated.

Results: Self-administered, home-based practice did not improve activity compared with no intervention (standardized mean difference 0.00, 95% confidence interval; -0.47 to 0.48). There was no difference between structured and non-structured home-based practice in terms of upper limb activity (SMD -0.05, 95% CI -0.22 to 0.13).

Conclusion: Existing self-administered, home-based practice is not more effective than no intervention in improving upper limb activity in chronic, severely disabled stroke survivors. Structured home-based practice is no more effective than non-structured home-based practice.