The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis

Balasukumaran, Tharani; Olivier, Benita; Ntsiea, Veronica

doi:10.1177/0269215518801430

Cited by 19 publications

(13 citation statements)

References 36 publications

(110 reference statements)

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“…Backward walking (BW) is an activity with additional complexity compared to regular forward walking (FW). Although some studies have shown that BW is a mirror image of FW, considering that initial contact during BW is done by the toe instead of the heel 17 , 18 . BW differs from FW in many aspects.…”

Section: Introductionmentioning

confidence: 99%

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Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability

Balasukumaran¹,

Gottlieb²,

Springer³

2020

Sci Rep

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Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and threedimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0-27.7%, 0-25.0% of gait cycle respectively, p < 0.001). However, there were no significant differences between groups in any of the measured outcomes. This indicates that subjects with chronic ankle instability adapt to self-selected speed backward walking similarly to healthy controls. Assessments with more challenging tasks, such as backward walking with dual task and backward walking at fast speed, may be more appropriate for testing gait impairments related to chronic ankle instability. Chronic ankle instability (CAI) may be present in up to 40% of individuals who have previously experienced lateral ankle sprain 1. CAI is characterized by repetitive episodes and subjective feeling of ankle 'giving way' , and symptoms such as pain, swelling and limited motion 2-4. Compared to healthy controls, individuals with CAI report quality-of-life deficits and functional limitations in addition to the physical impairments 2,5,6. While mechanical factors, such as ankle ligaments hyperlaxity, may be responsible for CAI in some patients 2 , it can occur even when the mechanical constraints at the ankle are intact 7. Recent evidence suggest that CAI can be explained by sensorimotor deficits 3,7,8. Arthrogenic neuromuscular inhibition 9,10 , ankle muscle weakness 4,11 , reduced ankle range of motion 3,9 , impaired sense of joint position 12 , and postural control are found in CAI. Altered movement patterns during functional tasks, including walking, are often described in individuals with CAI 13. During walking, subjects with CAI may exhibit typical kinematic patterns of increased ankle inversion and a laterally deviated center of pressure throughout the stance phase of gait 6. Conversely, Chinn et al. 5 reported that CAI subjects demonstrated more inversion while jogging but not while walking. Linear variability measures that investigated the amplitude of variability, such as coefficient of variation, and non-linear variability approaches that evaluated the dynamic aspects of variability using mathematical tools related to chaos theory, have both reported differences in gait variability between individuals with and without CAI. For examp...

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Section: Introductionmentioning

confidence: 99%

“…Overall, BW offer a unique challenge to balance and movement. Thus, BW is used increasingly in rehabilitation programs to promote balance control 17 .…”

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confidence: 99%

Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability

Balasukumaran¹,

Gottlieb²,

Springer³

2020

Sci Rep

Self Cite

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“…One systematic review was dedicated to the hand 70 ; and two were dedicated to diet 14,71 . The remaining focused on exercise 18,72e77 , including aquatic 78 and gait 79 . AMSTAR 2 scores were critically low (n ¼ 4), low (n ¼ 4), moderate (n ¼ 3) and high (n ¼ 2).…”

Section: Synthesis Papersmentioning

confidence: 99%

Osteoarthritis year in review 2019: rehabilitation and outcomes

Maly

Marriott

Chopp-Hurley

2020

Osteoarthritis and Cartilage

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Objective: Inactivity and obesity are risk factors for osteoarthritis (OA) progression. The purpose of this review was to highlight intervention parameters of exercise and lifestyle diet interventions on clinical outcomes in OA that were published over 15 months, starting January 1, 2018. Design: Systematic literature searches were performed in Medline (Pubmed, OVID), Scopus, CINAHL, CENTRAL and Embase from January 1, 2018 to April 1, 2019. Key words included osteoarthritis, exercise, physical activity, diet and nutrition. Randomized controlled designs and data synthesis papers (systematic reviews, meta-analyses, clinical guidelines) written in English, that included humans with OA of any joint were included. Trials were evaluated using the Physiotherapy Evidence Database (PEDro) critical appraisal tool and the Template for Intervention Description and Replication (TIDieR). Systematic reviews and meta-analyses were evaluated using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Intervention details (RCTs) and key finding from papers were summarized. Results: Of 540 titles and abstracts retrieved, 147 full articles were reviewed and 53 met the inclusion criteria, comprised of 39 RCTs and 14 synthesis papers. By addressing inactivity, exercise effectively improves clinical outcomes and, based on low-moderate quality evidence, without further damage to cartilage or synovial tissue. By comparison, much less work focused on minimizing obesity. Diet must be combined with exercise to improve pain, but alone, can improve physical function. Conclusions: Future work is necessary to identify the ideal exercise frequency and intensity and lifestyle diet intervention parameters. Improved adherence to reporting guidelines in future work will greatly enhance the OA rehabilitation field.

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“…e latest meta-analysis [21] showed that BW, as an adjunctive therapy, with conventional treatment was effective and worth to promote in patients with KOA. Furthermore, current evidence reveals that it had been considered as a potential strategy to improve balance performance and prevent falling for health subjects [22] and the people suffering from stroke [23], or cerebral palsy [24].…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Chen

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. Impaired static stability and proprioception have been observed in individuals with knee osteoarthritis (KOA), which serves as a major factor increasing risk of fall. This study aimed to investigate the effects of backward walking (BW) on static stability, proprioception, pain, and physical function in KOA patients. Methods. Thirty-two subjects with knee osteoarthritis were randomly assigned to either an BW group (BG, n = 16) or a control group (CG, n = 16). The participants in the BG received combination treatment of a 4-week BW training and conventional treatments, while those in the CG was treated with conventional treatments alone. All the participants were tested for the assessment of static stability [center of pressure (COP) sway, including sway length (SL, mm) and sway area (SA, mm2)] and proprioception [average trajectory error (ATE, %) and completion time (CT, second)]. Additionally, pain and knee function scores were measured by the numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, respectively. The assessments were conducted before and after intervention. Results. The COP sway (SA and SL), ATE, NRS, and WOMAC showed a significant decline at week 4 in the two groups in contrast to their baseline ( P < 0.05 ). Moreover, after 4-week intervention, the SA [(610.50 ± 464.26) mm2 vs. (538.69 ± 420.52) mm2], NRS [(1.56 ± 0.63) vs. (2.25 ± 0.86)], and WOMAC [(11.69 ± 2.50) vs. (16.19 ± 3.94)] showed a significantly greater decrease in the BG compared to the CG ( P < 0.05 , respectively). However, the proprioception (ATE and CT) was closely similar between both groups at week 4 ( P > 0.05 ). Conclusion. BW is an effective adjunct to conventional treatment in reducing pain, improving physical function and static stability for KOA patients. It should be taken into consideration when developing rehabilitation programs for people with KOA.

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The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis

Cited by 19 publications

References 36 publications

Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability

Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability

Osteoarthritis year in review 2019: rehabilitation and outcomes

The Efficacy of Backward Walking on Static Stability, Proprioception, Pain, and Physical Function of Patients with Knee Osteoarthritis: A Randomized Controlled Trial

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