Effectiveness of backward walking training on spatial-temporal gait characteristics: A systematic review and meta-analysis.

BACKGROUND: Backward walking training (BWT) is thought to affect gait biomechanics, but relevant evidence has been sparse and inconclusive.

OBJECTIVE: This study systematically reviewed and quantified the effectiveness of BWT on spatial-temporal gait characteristics (STGC).

METHODS: A keyword and reference search of interventions on BWT was conducted in five bibliographic databases: PubMed, Web of Science, SPORTDiscus, CINAHL, and Cochrane Library for articles published until November, 2017. Two reviewers independently screened titles, abstracts, and full texts of all articles and jointly decided the final pool. A standardized form was used to extract data from each included article. Meta-analysis was conducted to estimate the pooled effect of BWT on STGC.

RESULTS: Eleven studies met the eligibility criteria and were included in the review. All studies reported some positive influences of BWT on STGC relative to forward walking training (FWT) and/or control. Compared to FWT, BWT was associated with an increase in forward gait speed by 0.69 (95% confidence interval [CI] = 0.12, 1.25) m/s and stride length by 0.51 (95% CI = 0.22, 0.80) cm. Compared to control, BWT was associated with an increase in forward gait speed by 1.00 (95% CI = 0.36, 1.64) m/s.

CONCLUSIONS: BWT could improve participants' STGC and be potentially useful in neurological rehabilitation. However, current evidence remains preliminary. The effects found could merely be due to differences in training intensity between the FWT and BWT, and thus, may not reflect actual differences between training in different walking directions. Future studies are warranted to elucidate the pathways linking BWT to gait biomechanics.