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

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 experimental group received self-administered home-based practice for people with upper limb activity limitations of any level of severity and any time after stroke. The control group received no intervention, or 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; SMD 0.00, 95% confidence interval; 95% CI -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.