Abstract
OBJECTIVES: Stroke survivors face a significant burden of disability, necessitating regular activity to improve their functional abilities, well-being, and quality of life. We conducted this systematic review and meta-analysis to assess the feasibility and effectiveness of professionally supervised, home-based rehabilitation in stroke survivors. DATA SOURCES: A comprehensive search of PubMed, Scopus, and Web of Science was carried out from inception until December 2023. STUDY SELECTION: We included randomized controlled trials assessing the effectiveness of home-based rehabilitation under professional supervision (intervention) for stroke patients compared with hospital-based, unsupervised home exercise, or no therapy (control). DATA EXTRACTION: We extracted and analyzed the mean difference (MD) between groups in improvements using various rehabilitation assessment scales: Fugl-Meyer Assessment (FMA), Barthel Index (BI), Modified Barthel Index, Berg Balance Scale, 6-minute walk test, and Modified Ashworth Scale. DATA SYNTHESIS: Seventeen articles were eligible for meta-analysis. The intervention group showed significantly higher BI scores in both early (MD, 2.71; 95% CI, 0.14-5.28; P=.04) and late stages (MD, 4.53; 95% CI, 1.67-7.4; P=.002) compared with controls. The Modified Barthel Index was also significantly higher in the home-based group (MD, 5.12; 95% CI, 1.63-8.62; P=.004). For FMA, significant differences were observed only after 3 months (MD, 3.99; 95% CI, 2.87-5.11; P<.0001) favoring the intervention group. Similarly, the 6-minute walk test results favored the intervention group (MD, 27.5; 95% CI, 14.72-40.29; P<.0001). No significant differences were observed in the Berg Balance Scale and Modified Ashworth Scale between groups. Subgroup analysis confirmed the superior effectiveness of home-based rehabilitation compared with both center-based rehabilitation and unsupervised home exercise in improving BI and FMA scores. CONCLUSIONS: This systematic review and meta-analysis of randomized controlled trials suggests that home-based rehabilitation under professional supervision among stroke survivors facilitates more rapid and substantial improvements relative to hospital-based rehabilitation and unsupervised home exercise.