Home-based exercise programs for disabilities of walking activity caused by neurological disorders: Systematic Review with Meta-Analysis

Abstract

INTRODUCTION: As increase life expectancy, the searches for conducts to improve functional independence in chronically altered conditions as is common in the neurological dysfunction. OBJECTIVES: To evaluate the effect of therapeutic home based exercise programs (HBE) on impairment of walking activity due to stroke, Parkinson's disease (PD), multiple sclerosis and HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). METHODS: data sources PubMed, Scielo, Pedro, Cochrane Library; available in English, Portuguese, Spanish, German or French languages; no time restrictions; selection made by two independent researchers, in three stages; included Clinical Trials with interventions of HBE Programs for adults with gait or balance disabilities arising from the above neurological conditions; gait speed or distance, strength, balance, mobility, functionality and functional independence were the variables; methodological quality with PEDro scale; PICOS strategy guided the extraction date. Weighted mean differences (WMD), 95% confidence intervals (CI), and the heterogeneity assessed by the I² test with RevMan 5.3 program. Results in balance (WMD 2.8; CI 1.5; 4.1) and in cardiorespiratory capacity (WMD 29.3m; IC 8.3; 50.2) for people with stroke are effectiveness. For people with Multiple Scleroses there is improvement in physiological profile (WMD -1.3; CI -0.5; 2.0) and mobility (WMD -3.3; CI -5.1; -1,4). CONCLUSIONS: The HBE is effective on walking activity, improve performance and functional mobility in neurological impairments. Is suggested HBE on public health to includ elements for management of disabilities on the programs and the use of functional scales such as WHODAS to compare the same disability in different neurological disorders.