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Overground Gait Training for Individuals with Chronic Stroke: A Cochrane Systematic Review

States, Rebecca A. PhD, MA; Salem, Yasser PT, PhD, NCS, PCS; Pappas, Evangelos PT, PhD, OCS

Journal of Neurologic Physical Therapy: December 2009 - Volume 33 - Issue 4 - pp 179-186
doi: 10.1097/NPT.0b013e3181c29a8c
Articles

Background and Purpose: Overground gait training—observation and cueing of patient’s walking pattern along with related exercises—forms a major part of rehabilitation services for individuals with chronic stroke in almost every setting. This report of a Cochrane systematic review assessed the effects of overground gait training on walking ability for individuals with mobility deficits subsequent to chronic stroke.

Data Sources: We searched the Cochrane Stroke Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, Science Citation Index Expanded, http://www.clinicaltrials.gov, among other databases through spring 2008. We also searched reference lists and contacted authors and trial investigators.

Review Methods: Only randomized controlled trials comparing overground physical therapy gait training with a placebo or no treatment condition were included.

Results: Nine studies involving 499 participants were included. We found no evidence of a benefit on walking function, the primary variable, based on three studies (n = 269). Some performance variables did show significant effects. Walking speed increased by 0.07 m/sec [95% confidence interval (CI), 0.05-0.10] based on seven studies (n = 396), Timed Up and Go test improved by 1.81 seconds (95% CI, −2.29 to −1.33) based on three studies (n = 118), and six-minute walk test increased by 26.06 m (95% CI, 7.14-44.97) based on four studies (n = 181).

Conclusions: We found insufficient evidence to determine whether overground physical therapy gait training benefits walking function in individuals with chronic stroke, although limited evidence suggests potential benefits for some performance variables. High-quality randomized controlled trials are needed to replicate and extend these findings.

Division of Physical Therapy (R.A.S., Y.S., E.P.) Long Island University, Brooklyn Campus, New York.

Address correspondence to: Rebecca A. States, E-mail: rstates@liu.edu

© 2009 Neurology Section, APTA