Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke: a systematic review with meta-analysis and meta-regression of recent randomized controlled trials

Abstract

Purpose

To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke.

Methods

We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes.

Results

Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes.

Conclusion

Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.

Implications for rehabilitation

• Treadmill walking training is effective for improving balance and motor functions.

• Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.

• Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.

Keywords:

• Overground walking
• physical activity
• stroke
• treadmill walking
• walking training

Author contributions

Conceptualization was done by Félix Nindorera, Ildephonse Nduwimana, Jean-Louis Thonnard, and Oyéné Kossi. Protocol draft was done by Félix Nindorera, Ildephonse Nduwimana, Jean-Louis Thonnard, and Oyéné Kossi. Development of the search strategy was done by Félix Nindorera, Ildephonse Nduwimana, and Oyéné Kossi. Data extraction and synthesis was done by Félix Nindorera, Ildephonse Nduwimana. Writing of the original draft was done by Félix Nindorera. Writing – review & editing was done by Félix Nindorera, Ildephonse Nduwimana, Jean-Louis Thonnard, and Oyéné Kossi. Supervision by Oyéné Kossi.

Disclosure statement

The authors report no declarations of interest.

Additional information

Funding

Authors are grateful to « Association pour la Promotion de l’Éducation et de la Formation à l'Étranger (APEFE) » and « Wallonie-Bruxelles International (WBI) » for their scholarships to Nindorera F, and Ildephonse Nduwimana I.