RESUMO
QUESTIONS: In people who have had a stroke, how comparable are the effects of home-based exercises with those of equivalent centre-based exercises for improving walking speed, balance, mobility and participation? Is the comparability of the effects of these two types of exercise maintained beyond the intervention period? DESIGN: Systematic review of randomised controlled trials. SEARCH STRATEGY: Searches were conducted on MEDLINE, AMED, EMBASE, Cochrane, PsycINFO and PEDro databases, without date or language restrictions. PARTICIPANTS: Participants in the reviewed studies were ambulatory adults at any time after stroke. INTERVENTIONS: The experimental intervention consisted of home-based exercises, which was compared with equivalent doses of centre-based exercises. OUTCOME MEASURES: Walking speed, balance, mobility and participation. DATA ANALYSIS: The quality of included trials was assessed using the PEDro scores. Outcome data were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Nine trials involving 609 participants were included. Random-effects meta-analyses provided high-quality evidence that home-based and centre-based exercises provide similar effects on walking speed (MD -0.03 m/s, 95% CI -0.07 to 0.02) and balance (MD 0 points, 95% CI -1 to 2). Results regarding mobility (SMD -0.4, 95% CI -1.3 to 0.4) and participation (MD -5 points, 95% CI -19 to 10) were imprecise. For most outcomes, the effects of home-based exercises and centre-based exercises remained similar beyond the intervention period. CONCLUSION: Effects of home-based prescribed exercises on walking speed, balance, mobility and participation are likely to be similar to improvements obtained by equivalent doses of centre-based exercises after stroke. REVIEW REGISTRATION: PROSPERO (CRD42021254642).
