Effective home programme intervention for adults: a systematic review

Abstract

Objective: To summarize evidence on effective home programme intervention for adults and describe characteristics of successful home programmes. Data sources: A search was conducted of MEDLINE, CINAHL, PsycINFO, EMBASE, DARE, The Physiotherapy Evidence Database, Cochrane Database of Systematic Reviews, OTSeeker and Google Scholar and references in manuscripts retrieved. Review methods: Two independent reviewers determined whether retrieved study abstracts met inclusion criteria: human subjects; adults; home programme intervention; systematic reviews, randomized controlled trials or controlled trials. Included papers were appraised for study design, participants, type and intensity of intervention, and outcomes. Methodological quality of trials was rated using the PEDro scale (1–10 highest). Results: Thirty-two papers were retrieved (6 systematic reviews, 26 trials). The 23 randomized controlled trials and 3 controlled trials were appraised. All the retrieved papers were level 1a, 1b or 2b evidence. Major findings were: (a) home programme intervention was more effective than no intervention at all; (b) home programme intervention was equally effective to expert-provided therapy, except when therapeutic modalities were used; and (c) different instruction formats produced similar outcomes. Home programmes with favourable outcomes were more likely to: involve the patients in establishing the programme; intervene on the person, task and environment; and provide feedback about progress. Dose did not appear to be related to outcome. Conclusion: There is grade 1A evidence supporting the effectiveness of home programmes for adults. Home programmes are as effective as expert-provided therapy.