Home Based Rehabilitation in Children and Adolescents with Cystic Fibrosis: A Systematic Review with Meta-Analysis and Grade Recommendations

Objective: The objective of this study is to elucidate the effectiveness of home based rehabilitation (HBR) and compare its results with those obtained in conventional rehabilitation (CR) programs, carried out in clinics and/or outpatient clinics. Methods: Searches were conducted in five databases of randomized clinical trials. Study selection, data extraction, and assessment of the methodological quality of included studies were conducted independently by two reviewers, with discrepancies resolved by a third reviewer. Results: The results demonstrate post-intervention values favorable to the use of HBR when compared to control group in the outcomes of forced expiratory volume in 1 second (FEV1) (MD = 14% CI: 5.42 to 22.58, p = 0.001), forced vital capacity (FVC) (MD = 8.00% CI: 0.83 to 15.17, p = 0.03) and quality of life by the Cystic Fibrosis Questionnaire - revised in the categories (Child version score (MD = 0.71%CI: 0.15 to 1.27, p = 0.01) and "Parent version score" (MD = 0.67%CI: 0.11 to 1.23, p = 0.02). Furthermore, we noticed an increase in the distance covered in the 6-minute walk test (MD= 34.75%CI: -8.00 to 77.50, p = 0.14), in favor of HBR. Conclusions: We found that supervised or partially supervised HBR promotes improvements in FEV1, FVC and related quality of life in children and/or adolescents with cystic fibrosis.