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能否改善卒中后患者的步行时空参数（spatiotemporal parameters），具体包括步行速度、步长、步频与步行对称性。研究通过8个数据库开展文献检索，实验干预条件为使用手杖步行，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项相关研究。
9项研究结果显示，与不使用手杖相比，卒中患者使用单尖手杖（single-point cane）步行时速度减慢0.01 m/s（标准差SD 0.06）；2项研究表明，患者步频降低（均数差MD -5步/分钟，标准差SD 2），但步长增加（均数差MD 0.08 m，标准差SD 0.01）；3项研究显示，与不使用手杖相比，患者使用四脚手杖（four-point cane）步行时速度减慢0.06 m/s（标准差SD 0.07）；4项研究显示，与使用四脚手杖相比，患者使用单尖手杖步行时速度快0.06 m/s（标准差SD 0.04）。其余结局指标的研究结果尚无定论。
整体分析结果表明，与不使用手杖相比，使用单尖手杖未能显著改善患者的步行时空参数，而使用四脚手杖则会使该参数出现轻微下降；与四脚手杖相比，使用单尖手杖步行时患者速度略有提升，但现有证据尚不充分，无法证实其优越性。
【康复应用启示】
单尖手杖或无法改善卒中后患者的步行时空参数；使用四脚手杖可能会轻微降低步行时空参数；临床开具手杖处方时，无需担心其会对步行运动学产生负面影响。