Effect of Gait-Specific Weight-Bearing Interventions on Physical Performance Among Subjects with Stroke: A Systematic Review and Meta-analysis

Abstract

Background Postural instability, gait dysfunctions, and tendency to fall resulting from asymmetrical weight-bearing restrict balance and mobility functions among stroke survivors. Symmetrical weight-bearing is essential for restoring mobility functions following stroke. Strategies to improve symmetrical weight-bearing remain a challenge in stroke rehabilitation. Objective To explore the evidence regarding the effectiveness of weight-bearing interventions to improve physical performance among subjects with stroke. Methods Five databases, including PubMed, Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database (PEDro), Google Scholar, and OpenGrey, were screened for identifying published and unpublished studies from their inception and up to 2022. Studies investigating the effect of symmetrical weight-bearing interventions among stroke subjects using objective or self-reporting of physical function as an outcome tool were included. Ten articles with grade 1b level of evidence demonstrated an average PEDro score of 6.4. The risk of bias was moderate among the articles. Results Ten articles with 276 participants were included in this review. Meta-analysis performed using 9 articles report that gait-specific weight-bearing improved balance and gait velocity with an overall effect size of 1.35 (95% confidence interval: 0.88–1.81) and 0.66 (95% confidence interval: 0.20–1.13). However, the effect size of step length (0.51), cadence (0.26), and fall efficacy scale (0.21) indicates nonsignificant improvement. Conclusions This meta-analysis suggests that gait-specific weight-bearing strategies are effective in improving balance and speed of walking but did not improve other parameters of gait and risk of fall. These strategies could be used to improve the symmetrical weight-bearing of stroke subjects in rehabilitation settings who do not have access to technological assistance in rehabilitation.