Summary of: Stretton CM, Mudge S, Kayes NM, McPherson KM. Interventions to improve real-world walking after stroke: a systematic review and meta-analysis. Clin Rehabil. 2017;31:310-318.

Objective: To examine whether interventions that target walking in the real world are more effective than usual care or no intervention for improving actual walking behaviour in real-world settings in people with stroke.

Data sources: EBSCO Megafile, AMED, Scopus, Cochrane Database of Systemic Reviews, PEDro, OTseeker, and PsycBITE were searched from inception to November 2015. The database search was supplemented by hand searching.

Study selection: Randomised or quasi-randomised, controlled trials examining progressive task-oriented exercise interventions with or without behavioural change techniques. Studies had to have a usual care comparison group or a no-intervention/attention control group and measure the effects of the interventions on real-world walking (activity monitoring and/or self-report questionnaires).

Data extraction: Two reviewers extracted data. Methodological quality was assessed using the Cochrane Risk of Bias tool.

Data synthesis: Of the 4478 studies initially identified by the search, nine studies (10 treatment arms) with a total of 693 participants in the experimental group and 565 in the control group met the selection criteria and were included in the meta-analysis. Overall, the included studies were evaluated to have a low risk of bias. Based on the quantitative pooling of the available data from these trials, at post-intervention assessment there was a statistically significant difference in real-world walking in favour of the intervention group, by a standardised mean difference (SMD) of 0.29 (95% CI 0.17 to 0.41). Quantitative pooling of five studies with 3 to 6 month follow-up data found a SMD of 0.32 (95% CI 0.16 to 0.48) in favour of the intervention group. Pre-planned subgroup analysis found that interventions that incorporated at least one behaviour change technique were effective (SMD 0.27, 95% CI 0.12 to 0.43) whereas those without any behaviour change strategies were not effective (SMD –0.19, 95% CI –0.11 to 0.49).

Conclusion: Task-oriented exercise interventions alone appeared to be insufficient for improving real-world walking habits in people with stroke. Exercise and gait-oriented interventions that employed behaviour change techniques were more likely to be effective in changing real-world walking behaviour, but the estimated treatment effect was small.

Provenance: Invited. Not peer reviewed.