Efeitos do feedback em tempo real durante o treinamento da marcha sobre parâmetros cinemáticos em indivíduos pós-AVC: uma revisão sistemática com metanálise de ensaios clínicos randomizados com recomendações GRADE

Abstract

Gait impairment is one of the most disabling consequences of stroke, significantly affecting independence and quality of life. Real-time biomechanical feedback has emerged as a potential strategy to enhance gait rehabilitation in post-stroke individuals by facilitating motor learning through external cues. The objective of this study was to investigate the effects of real-time feedback gait training on kinematic parameters in post-stroke individuals by a systematic review and meta-analysis of randomized clinical trials. The search was performed in: EMBASE, LILACS, PubMed Central (PMC), Medline (Ovid), Scopus, Web of Science, Pedro, Cochrane Central Register of Controlled Trials. We performed the online search until August, 2024. The following terms were used (Biofeedback or "Biofeedback, Psychology") and (Stroke or "Stroke Rehabilitation") and ("Gait" or "Gait Disorder, Neurologic" or "Gait analysis" or "Gait Analyses" or "Walking" or "Gait training" or "Gait retraining") or ("Biomechanical Phenomena") or (Kinematics) or (Biomechanics). Eligibility criteria: (1) randomized clinical trials, (2) comparing the effect of treadmill gait training without biofeedback; (3) having as outcome variables the measurements of kinematic variables obtained through capture by cameras or inertial measurement units and measurements of balance and independence in walking as well as daily living independence. Risk of bias assessed using the PEDro scale. PROSPERO registration (CRD42024554277). Five trials (n = 243 participants) were included. Meta-analyses showed no statistically significant differences between intervention and control groups for gait speed, step length, cadence, symmetry, swing phase, or balance (e.g., gait speed: MD = 0.04 m/s, 95% CI [-0.01; 0.10]; TUG: MD = -0.61 s, 95% CI [-3.95; 2.72]). Most outcomes showed low to moderate certainty of evidence. Heterogeneity ranged from low to high depending on the outcome. Treadmill gait training with real-time biomechanical feedback did not demonstrate clinically meaningful improvements in gait parameters compared to training without feedback. Current evidence suggests that biomechanical feedback, when applied in isolation and over short durations, may not be sufficient to enhance gait recovery in post-stroke individuals. Feedback may be more effective when integrated with multimodal rehabilitation approaches.