Gait training interventions for patients with stroke in India: A systematic review

Background: Gait is considered to be the most important determinant of functional independence in activities of daily living. The challenges faced by stroke survivors in India differ from the western population due to economic, cultural, and geographical factors and this, in turn, may influence the choice of intervention. Hence, there is a need to understand the current gait training trends for stroke survivors in low resource settings like India. Research question: To systematically review the literature on interventional strategies for improving gait among stroke survivors in India. Methods: Six databases were searched to identify RCTs delivering gait training to stroke survivors having some gait deficits in terms of speed or any other kinematic parameters. Studies of the English language from India were included. Two independent reviewers screened, extracted data, and assessed the study quality. A descriptive synthesis was undertaken and the data was summarized. Results: Of 2112 potentially relevant articles, 12 studies with a total of 412 participants were included after title, abstract and full-text screening. Studies tested the efficacy of interventions such as mirror therapy, motor imagery, transcutaneous electrical nerve stimulation, strengthening, and task-based training. The outcome measures were kinematic gait-analysis, gait velocity, Functional Ambulation Categories, Timed Up and Go, Fugl-Meyer Assessment. From the results of this review, active task-based gait training and strengthening along with motor priming seems to be the most tested interventions. Future studies may need to design interventions targeting both impairment and function to bring about maximum improvement in gait after stroke. Significance: Reviews addressing gait practices in developing countries for people with stroke are scarce. The present review would assist physiotherapists in developing countries to utilize evidence-based criteria for the selection of gait training approaches post-stroke. Due to the environmental and contextual demands, the effect of interventions for recovery among stroke survivors should be improvised in low resource settings. This review can be a source of recommendation in giving effective strategies for clinical practice.