Balasukumaran T, Olivier B, Ntsiea MV The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis. Clin Rehabil. 2018 Sep 19:269215518801430. doi: 10.1177/0269215518801430. (Systematic review)

OBJECTIVE: To investigate the effectiveness of backward walking in the treatment of people with gait impairments related to neurological and musculoskeletal disorders.

DESIGN: Systematic review and meta-analysis of randomized and quasi-randomized control studies.

DATA SOURCES: Searched from the date of inception to March 2018, and included PubMed, Scopus, Cochrane Library, PEDro, CINAHL, and the MEDLINE databases.

METHODS: Investigating the effects of backward walking on pain, functional disability, muscle strength, gait parameters, balance, stability, and plantar pressure in people with gait impairments. The PEDro scale was used to assess the quality. Similar outcomes were pooled by calculating the standardized mean difference.

RESULTS: Of the 21 studies (neurological 11 and musculoskeletal 10), 635 participants were included. The average PEDro score was 5.4/10. The meta-analysis demonstrated significant standardized mean difference values in favour of backward walking, with conventional physiotherapy treatment for two to four weeks to reduce pain (-0.87) and functional disability (-1.19) and to improve quadriceps strength (1.22) in patients suffering from knee osteoarthritis. The balance and stability in cases of juvenile rheumatoid arthritis, and gait parameters and muscle strength in anterior cruciate ligament injury improved significantly when backward walking was included as an exercise. There was no significant evidence in favour of backward walking in any of the other conditions.

CONCLUSION: The systematic review and meta-analysis suggests that backward walking with conventional physiotherapy treatment is effective and clinically worthwhile in patients with knee osteoarthritis. Insufficient evidence was available for the remaining gait impairment conditions and no conclusions could be drawn.

Discipline Area Score
Physician 7 / 7
Rehab Clinician (OT/PT) 6 / 7
Nurse 5 / 7
Comments from MORE raters

Nurse rater

This meta-analysis did not review papers where neurologic symptoms were the main illness treated with backwards walking. Rather, the studies done were for patients with musculoskeletal injuries. No proof of benefit to a neurologic population was established. Although the concept is intriguing, it needs further study.

Nurse rater

As a neurologist, these results are what I would have expected. The benefit of this article to me is that it provides evidence when I am asked to give an opinion or advice to my orthopaedic colleagues.

Nurse rater

I never heard of this methodology and I am sure others in my profession have not either. Therefore, I believe this article to be very relevant.

Rehab Clinician (OT/PT) rater

The key clinical messages are important albeit disappointing for the many conditions that use this treatment modality as a part of the rehabilitation process. 'In people with osteoarthritis of the knee, adding backward walking to conventional physiotherapy treatment may further reduce pain, functional disability and improve the strength of the quadriceps muscles. There is insufficient evidence pertaining to the safety and efficacy of backward walking in all of the other conditions that were studied'.
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