Strengths, limitations, and way forward of home-based rehabilitation practices after stroke: a scoping review

Home-based motor rehabilitation after stroke has a great potential to promote task-specific and context-specific training in a familiar, functionally rich context, supporting more personalised, engaging, and adaptable rehabilitation experiences. This review aims to map existing practices in home-based motor rehabilitation after stroke and critically examine whether this potential is fully utilized and identify strengths and limitations. It further explores how healthcare professionals can optimise their planning and delivery of interventions. A scoping review was conducted following the PRISMA guidelines. Comprehensive searches were conducted in 5 databases: PubMed, CINAHL, MEDLINE, APA PsycINFO and Web of Science. Two reviewers independently screened the studies for eligibility and extracted characteristics of each study into a data charting table. Sixty-six studies met the inclusion criteria. The results highlighted a consistent implementation of task-specific exercises but limited implementation of context-specific stimuli, inadequate training dosage, and limited contextual adaptation to the home environment. Further, instructional methods tended to be overly prescriptive, co-design strategies applied inconsistently, and caregiver engagement often underutilised. Existing practices do not fully utilize the potential of home-based rehabilitation. We argue clinical work should prioritise early-phase interventions with adequate intensity and develop pedagogical frameworks to guide home modifications and instructional methods. The framework should support progressive and engaging practice, and fully adopt co-designed, person-centred approaches that meaningfully involve family caregivers.