Activity- and exercise-based home rehabilitation improves daily function in older adults, meta-analysis finds

Högstedt et al. (BMC Geriatrics; PMID 42380867) conducted a systematic review and meta-analysis of 27 randomised controlled trials totalling 4,948 participants, all community-dwelling adults aged 65 and over with low physical performance. Activity-based home rehabilitation improved basic activities of daily living (standardised mean difference 0.29, moderate-certainty evidence) but not instrumental activities of daily living. Exercise-based home rehabilitation improved both basic activities of daily living (SMD 0.43) and physical performance (SMD 0.20), though certainty was rated low due to imprecision and risk of bias. Reablement-based approaches — goal-oriented support focused on restoring independence in daily tasks without a structured activity or exercise component — showed no statistically significant effect on selected daily-living tasks or physical performance. [Meta-analysis]

This is among the largest and most methodologically rigorous evidence bases available on the design of home rehabilitation for older adults. The authors grade the certainty of the underlying evidence as moderate for activity-based approaches and low to very low for exercise-based and reablement-based approaches, reflecting heterogeneity across the pooled trials rather than a single definitive verdict. The trials themselves are drawn from multiple health systems; no separate international comparator is reported beyond the pooled trial evidence itself, and none is invented here. The meta-analysis stands as the strongest available benchmark for this specific question.

The distinction the evidence draws is a practical one for service design: community rehabilitation provision built around activity- or exercise-based home programmes has a real, if moderate-to-low certainty, evidence base behind it; provision built solely around reablement does not, on this synthesis. Services commissioning reablement-only support as their primary model for home rehabilitation are not supported by this evidence base for improving basic activities of daily living or physical performance, and should review provision in that light.