Self-administered, home-based, upper limb practice in stroke patients: A systematic review
Yih Wong, Louise Ada, Rongrong Wang, Grethe Månum, Birgitta Langhammer
Research Department, Sunnaas Rehabilitation Hospital, Bjoernemyr, Norway. E-mail: firstname.lastname@example.org
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.
Therapist-supervised, home-based practice early after stroke is known to reduce poor outcome in people with stroke. However, due to limited resources in the community, self-administered, home-based, upper limb practice is often prescribed after stroke. Whether such practice (without therapist supervision) is effective in reducing upper limb activity limitation is unknown. It is also not known whether home-based practice is more effective with or without the use of technology and assistive devices. We reviewed 15 studies involving 788 participants. The findings indicate that, in chronic and severely disabled stroke survivors, self-administered, home-based practice is no more effective than no intervention in improving upper limb activity. Also, home-based practice involving technology and assistive devices is no more effective than home-based practice without such devices. The existing evidence is insufficient to draw a more robust conclusion. Further research is needed to determine the effect of self-administered, home-based practice in these patients.
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