Home-Based Gait Interventions for Adults with Stroke: A Scoping Review.

Objective: To map the peer-reviewed literature regarding the methods and outcomes of home-based gait interventions for adults with stroke. Data Sources: PubMed, Cumulative Index To Nursing & Allied Health Literature, Cochrane, Scopus, and Web of Science were searched for relevant studies based on the terms "stroke," "gait," "home," and "treatment," filtered for 2015 to 2025 publications. Searches occurred on September 12, 2024, and were updated on January 10, 2025. Study Selection: Eligibility screening was performed in 2 stages: title/abstract screening and full-text review. In each stage, articles were screened against the inclusion/exclusion criteria by 2 independent reviewers. Data Extraction: Using a customized spreadsheet, we extracted characteristics of the studies, demographic and clinical participant characteristics, gait treatment and assessment methodologies, and reported outcomes. One author extracted the data, and a second cross-checked for accuracy. Data Synthesis: The titles/abstracts of 1923 articles were screened, and 116 articles underwent full-text review. Sixty-two studies met the eligibility criteria. The studies were conducted in 22 countries and included 3008 adults with chronic or subacute stroke. Home-based rehabilitation was used as a standalone treatment in 61% of studies and paired with or immediately after another rehabilitation intervention in 39% of studies. Gait treatment approaches included technology-integrated home programs (34%), home-use devices (19%), individualized home rehabilitation (15%), self-management or coaching-based programs (13%), home rehabilitation delivered by trained nonclinicians (11%), and task-specific training variations (8%). Gait speed and endurance were the most common assessments. Measurements frequently occurred in clinical settings. At least 60% of studies within each category reported statistically significant or clinically meaningful impacts on specific gait outcomes. Conclusions: Home-based rehabilitation demonstrates global interest. Current evidence related to gait treatment is heterogeneous and shows a prevalence of technology and innovation for the home. A substantial number of preliminary studies suggest emerging treatment methods requiring robust, larger studies to determine the most beneficial treatments and contexts.