Effectiveness of backward walking training in patients after stroke - literature review

Uvod: Hoja nazaj na kratke razdalje predstavlja sestavni del hoje med dejavnostmi vsakodnevnega življenja, vendar je bila vadba take hoje pri pacientih po možganski kapi do nedavnega deležna malo pozornosti. Z vadbo hoje nazaj naj bi pri pacientih po možganski kapi izboljšali mišično zmogljivost, propriocepcijo, koordinacijo, ravnotežje in tudi hojo naprej. Namen: Na podlagi pregleda in analize izsledkov raziskav ugotoviti učinkovitost vadbe hoje nazaj pri pacientih po možganski kapi. Metode dela: Literatura je bila iskana v podatkovnih zbirkah PubMed, CINAHL in PEDro. V pregled literature smo zajeli raziskave objavljene v angleškem jeziku do vključno aprila 2022. Rezultati: V pregled literature smo vključili sedem randomiziranih kontroliranih raziskav, v katerih so skupno zajeli 224 pacientov po možganski kapi. V šestih raziskavah so sodelovali preiskovanci v kronični fazi po možganski kapi in v eni raziskavi v akutni fazi po možganski kapi. V treh raziskavah so vadbo hoje nazaj izvajali po tleh, v štirih raziskavah po tekočem traku z razbremenitvijo telesne teže ali brez nje. Vadba hoje nazaj je bila izvedena kot samostojna terapija (dve raziskavi) ali kot dodatek k standardni fizioterapiji, rehabilitaciji ali vadbi hoje (pet raziskav). Rezultati raziskav so pokazali, da je vadba hoje nazaj učinkovita za izboljšanje naslednjih spremenljivk hoje naprej: hitrost hoje (šest od šestih raziskav), dolžina koraka in dvojnega koraka (tri od štirih raziskav), trajanje koraka in dvojnega koraka (dve od treh raziskav) ter trajanje enojne in dvojne opore (dve od treh raziskav). Nakazuje se tudi učinkovitost za izboljšanje kadence hoje naprej (tri od petih raziskav). V dveh od dveh raziskav so ugotovili tudi učinkovitost vadbe hoje nazaj za izboljšanje premičnosti in v dveh od treh raziskav za izboljšanje ravnotežja. Zaključek: Vadba hoje nazaj po tleh in po tekočem traku z razbremenitvijo telesne teže ali brez nje, ki traja vsaj štiri tedne s frekvenco vadbenih enot med trikrat do petkrat na teden ter vadbenimi enotami dolgimi vsaj 30 minut, predstavlja učinkovito dodatno obliko terapije za izboljšanje hoje naprej, premičnosti in ravnotežja pacientov v kronični fazi po možganski kapi. Nakazuje se večja učinkovitost vadbe hoje nazaj po tekočem traku kot vadbe take hoje po tleh, vendar bi bilo v prihodnje potrebno izvesti raziskave, ki bi to neposredno primerjale.Introduction: Backward walking over short distances is an integral part of walking in activities of daily living but has received little attention in the rehabilitation of stroke patients until recently. Backward walking training may improve muscle performance, proprioception, coordination, balance, and forward walking ability. Purpose: To review and analyse research on the effectiveness of backward walking training in patients after stroke. Methods: A literature search was performed in the PubMed, CINAHL and PEDro databases. The literature review included articles published in English before April 2022. Results: The literature review included seven randomised controlled trials with a total of 224 patients after stroke. Six studies included chronic stroke patients and one included acute stroke patients. Over-ground backward walking training was performed in three studies, and treadmill backward walking training with or without body weight support in four. Backward walking training was performed as a stand-alone therapy (two studies) or as an adjunctive therapy to the standard physiotherapy, rehabilitation or walking training (five studies). Results of the studies show the effectiveness of backward walking training for improving walking speed (six out of six studies), step and stride length (three out of four studies), step and stride duration (two out of three studies) and single and double limb support duration (two out of three studies). Backward walking training may also be effective for improving forward walking cadence (three out of five studies). Two out of two studies also reported the effectiveness of backward walking training for improving mobility, and two out of three studies for improving balance. Conclusion: Over-ground or treadmill backward walking training with or without body weight support, which lasts for at least four weeks with a frequency of three to five times a week and exercise units of at least thirty minutes, is an effective adjunctive therapy for improving forward walking, mobility, and balance of chronic stroke patients. The results of the included studies suggest greater effectiveness of treadmill backward walking training compared with over-ground backward walking training, but further studies with direct comparisons are needed