Canes may not improve spatiotemporal parameters of walking after stroke: a systematic review of cross-sectional within-group experimental studies

To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority.IMPLICATIONS FOR REHABILITATIONA single-point cane may not improve spatiotemporal parameters of walking after stroke.Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking.Canes may be prescribed without the fear of negatively impairing walking kinematics. A single-point cane may not improve spatiotemporal parameters of walking after stroke. Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking. Canes may be prescribed without the fear of negatively impairing walking kinematics.

本研究旨在探讨使用手杖是否可改善脑卒中（stroke）患者的步行时空参数（spatiotemporal parameters），具体包括步行速度、步长（stride length）、步频（cadence）与步行对称性（symmetry）。研究人员在8个数据库中开展了文献检索。试验干预方案为使用手杖步行。本研究共关注4项结局指标：步行速度、步长、步频及步行对称性。最终纳入12项符合要求的研究。
9项研究结果显示，与不使用手杖相比，脑卒中患者使用单点手杖（single-point cane）步行时，步行速度较不使用者慢0.01m/s（标准差（Standard Deviation，SD）0.06）。2项研究结果显示，使用单点手杖的患者步频降低（均数差（Mean Difference，MD）-5步/分钟，标准差SD 2），同时步长增加（均数差MD 0.08m，标准差SD 0.01）。3项研究结果显示，与不使用手杖相比，使用四点手杖（four-point cane）步行时，患者步行速度较不使用者慢0.06m/s（SD 0.07）。4项研究结果显示，与使用四点手杖相比，使用单点手杖步行时，患者步行速度较四点手杖使用者快0.06m/s（SD 0.04）。其余结局指标的研究结果尚未得出明确结论。
整体研究结果显示，与不使用手杖相比，使用单点手杖未能对步行时空参数产生有临床意义的改善，而使用四点手杖则会使步行时空参数略有降低。与使用四点手杖相比，使用单点手杖的患者步行速度略快，但现有证据尚不足以支持其此项优势。
康复应用启示：
单点手杖或无法改善脑卒中患者的步行时空参数。使用四点手杖可能会轻度降低患者的步行时空参数。临床中开具手杖处方时，无需担忧其会对步行运动学（walking kinematics）产生负面影响。
单点手杖或无法改善脑卒中患者的步行时空参数。使用四点手杖可能会轻度降低患者的步行时空参数。临床中开具手杖处方时，无需担忧其会对步行运动学产生负面影响。