Addition of backward walking training to forward walking training improves walking speed in children with cerebral palsy: a systematic review with meta-analysis.
Study Goal
The researchers aimed to determine whether backward walking training improves walking speed and balance in children with cerebral palsy (GMFCS levels I-III) compared to forward walking training.
Results Summary
Backward walking training improved walking speed by 0.10 m/s and balance by 2 points on the Pediatric Balance Scale compared to forward walking training. The addition of backward walking training further increased walking speed by 0.20 m/s and reduced center of gravity angular excursion by 0.5 degrees, though the quality of evidence was classified as low to moderate.
Population
Children with cerebral palsy (Gross Motor Function Classification System levels I-III), totaling 156 participants across eight studies.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
backward walking training | increase | walking speed | children with cerebral palsy | 0.10 m/s [95% confidence interval (CI) 0.05-0.16] | improved | #1 |
backward walking training | increase | balance | children with cerebral palsy | 2 points on the Pediatric Balance Scale (0-56) (95% CI 1.5-2.2) | improved | #2 |
addition of backward walking training | increase | walking speed | children with cerebral palsy | 0.20 m/s (95% CI 0.07-0.34) | increased | #3 |
addition of backward walking training | decrease | angular excursion of the center of gravity | children with cerebral palsy | 0.5 degrees (95% CI -0.7 to -0.3) | reduced | #4 |
backward walking training | increase | walking speed | children with CP | - | appears to be as effective or slightly superior to forward walking training for improving | #5 |
addition of backward walking training | increase | walking speed | - | - | statistically significantly and clinically important enhanced benefits on | #6 |
The objective was to examine the effects of backward walking training for improving walking speed and balance in children with cerebral palsy. A systematic review of randomized trials was conducted. Trials had to include children with cerebral palsy, with a Gross Motor Function Classification System, between I and III, that delivered backward walking training as a solo intervention or in combination with forward walking training. The outcomes of interest were walking speed and balance. The methodological quality of included trials was assessed by the PEDro scale, and the quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight papers, involving 156 participants, were included. Using random-effects meta-analysis, we estimated that backward walking training improved walking speed by 0.10 m/s [95% confidence interval (CI) 0.05-0.16] and by 2 points on the Pediatric Balance Scale (0-56) (95% CI 1.5-2.2) more than forward walking training. We also estimated that the addition of backward walking training increased walking speed by 0.20 m/s (95% CI 0.07-0.34) and reduced the angular excursion of the center of gravity by 0.5 degrees (95% CI -0.7 to -0.3). The quality of the evidence was classified as low to moderate. In conclusion, overall, backward walking training appears to be as effective or slightly superior to forward walking training for improving walking speed in children with CP. The addition of backward walking training statistically significantly and clinically important enhanced benefits on walking speed.