title: Home-based therapy programmes for upper limb functional recovery following stroke.
abstract: BACKGROUND
  With an increased focus on home-based stroke services and the undertaking of programmes, targeted at upper limb recovery within clinical practice, a systematic review of home-based therapy programmes for individuals with upper limb impairment following stroke was required.
  
  
  OBJECTIVE
  To determine the effects of home-based therapy programmes for upper limb recovery in patients with upper limb impairment following stroke.
  
  
  METHODS
  We searched the Cochrane Stroke Group's Specialised Trials Register (May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to May 2011), EMBASE (1980 to May 2011), AMED (1985 to May 2011) and six additional databases. We also searched reference lists and trials registers.
  
  
  METHODS
  Randomised controlled trials (RCTs) in adults after stroke, where the intervention was a home-based therapy programme targeted at the upper limb, compared with placebo, or no intervention or usual care. PRIMARY OUTCOMES were performance in activities of daily living (ADL) and functional movement of the upper limb. SECONDARY OUTCOMES were performance in extended ADL and motor impairment of the arm.
  
  
  METHODS
  Two review authors independently screened abstracts, extracted data and appraised trials. We undertook assessment of risk of bias in terms of method of randomisation and allocation concealment (selection bias), blinding of outcome assessment (detection bias), whether all the randomised patients were accounted for in the analysis (attrition bias) and the presence of selective outcome reporting.
  
  
  RESULTS
  We included four studies with 166 participants. No studies compared the effects of home-based upper limb therapy programmes with placebo or no intervention. Three studies compared the effects of home-based upper limb therapy programmes with usual care.
  
  
  METHODS
  we found no statistically significant result for performance of ADL (mean difference (MD) 2.85; 95% confidence interval (CI) -1.43 to 7.14) or functional movement of the upper limb (MD 2.25; 95% CI -0.24 to 4.73)).
  
  
  RESULTS
  no statistically significant results for extended ADL (MD 0.83; 95% CI -0.51 to 2.17)) or upper limb motor impairment (MD 1.46; 95% CI -0.58 to 3.51). One study compared the effects of a home-based upper limb programme with the same upper limb programme based in hospital, measuring upper limb motor impairment only; we found no statistically significant difference between groups (MD 0.60; 95% CI -8.94 to 10.14).
  
  
  CONCLUSIONS
  There is insufficient good quality evidence to make recommendations about the relative effect of home-based therapy programmes compared with placebo, no intervention or usual care.
authors.affiliation: Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK. fmacvicar@yahoo.com.
authors.forename: Fiona
authors.initials: F
authors.lastname: Coupar
authors.forename: Alex
authors.initials: A
authors.lastname: Pollock
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Legg
authors.forename: Catherine
authors.initials: C
authors.lastname: Sackley
authors.forename: Paulette
authors.initials: P
authors.lastname: van Vliet
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D006699:Home Care Services; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D034941:Upper Extremity