Background: People after stroke have difficulty walking, with only 18% of people returning to community walking. They report a lack of confidence as barrier to community walking. Despite this, is it unknown whether improving ability to walk (i.e. walking training) additionally improves confidence. This review explores the effect of walking training on self-efficacy for people after stroke.
Methods: A systematic review of randomised controlled trials with meta-analysis guided by the Prisma statement. We searched MEDLINE, Cochrane, EMBASE, Emcare and PEDro databases. Trials were included if the participants were community dwelling adults after stroke, the intervention involved walking training and the trial reported a measure of self-efficacy related to walking.
Results: Eight trials were identified involving 513 participants. The average PEDro score was 7 out of 10. All studies compared walking training to nothing/sham or usual care. Walking training improved walking speed (MD 0.07, 95% CI 0.03 to 0.11, 7 trials, 333 participants). However, this training did not improve self-efficacy (SMD 0.06, 95% CI of -0.17 to 0.29, 6 trials, 180 participants).
Conclusion: Walking training alone does not improve self-efficacy in community-dwelling people after stroke. Strategies such as self-management and practice walking in the usual environment (e.g. outdoors), may be required to enhance self-efficacy after stroke.