Backward walking training is as effective as or better than forward walking training for improving walking speed after stroke: a systematic review with meta-analysis

In people who have had stroke, are the effects of backward walking comparable with forward walking for improving walking (i.e. speed, cadence, and stride length)? Does the addition of backward walking to forward walking help improve the benefits of forward walking? Are any benefits maintained beyond intervention? A systematic review of randomized trials, with adults following stroke, was developed. The intervention of interest was backward walking training, delivered either as a solo intervention or in combination with forward walking training. The outcome measures of interest were walking speed, cadence, and stride length. The effect of backward walking training is similar as or better than that of forward walking training for improving walking speed (MD 0.16 m/s, 95% CI 0.06 to 0.27), but results for cadence and stride length were very imprecise. The addition of backward walking training to forward walking training provided negligible effects on walking speed (MD 0.03 m/s, 95% CI 0.01 to 0.04), cadence (MD 5 steps/min, 95% CI 1 to 10), and stride length (MD 0.04 m, 95% CI −0.01 to 0.09). Maintenance of effects beyond the intervention period remains uncertain. This review provided moderate-quality evidence that backward walking training is slightly better than forward walking training for improving walking speed after stroke, but not when it is additional to forward walking training. Large and well-designed trials are warranted to strengthen the evidence regarding backward walking training, especially in the subacute phase after stroke.

针对脑卒中（stroke）患者，反向行走（backward walking）与正向行走（forward walking）在改善步行能力（即步行速度、步频与步长）方面的效果是否具有可比性？将反向行走训练加入正向行走训练方案，是否有助于强化正向行走的训练收益？干预带来的步行改善效果能否在干预结束后持续？
本研究针对脑卒中成年人群开展了一项随机对照试验（randomized trials）的系统综述（systematic review）。所关注的干预措施为反向行走训练，既可作为单一干预手段实施，也可与正向行走训练联合开展。本研究关注的结局指标包括步行速度、步频与步长。
反向行走训练改善步行速度的效果不劣于甚至优于正向行走训练（均数差MD=0.16m/s，95%置信区间CI：0.06~0.27），但针对步频与步长的研究结果精度极低。在正向行走训练基础上追加反向行走训练，对步行速度（MD=0.03m/s，95%CI：0.01~0.04）、步频（MD=5步/分钟，95%CI：1~10）及步长（MD=0.04m，95%CI：-0.01~0.09）的改善效果均微乎其微。干预结束后收益能否持续仍不明确。
本综述提供了中等质量证据，表明反向行走训练在改善脑卒中后步行速度方面略优于正向行走训练，但在正向行走训练基础上追加反向行走训练时则无此优势。未来仍需开展大规模、设计严谨的临床试验，以强化关于反向行走训练的证据基础，尤其针对脑卒中后亚急性期（subacute phase）人群。