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

Clin Rehabil. 2022 Dec;36(12):1565-1577. doi: 10.1177/02692155221121015. Epub 2022 Aug 25.


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.

Keywords: Stroke; activities of daily living; exercise therapy; meta-analysis; rehabilitation.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Exercise Therapy
  • Humans
  • Rehabilitation Centers
  • Stroke Rehabilitation*
  • Stroke*
  • Upper Extremity