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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

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,, 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:

© 2009 Neurology Section, APTA