Action observation training for improving walking ability and balance of stroke patients: A systematic review and meta-analysis

Objective: To determine the effect of action observation training on the walking ability and balance of stroke patients. Methods: PubMed, Cochrane Central Register of Controlled Trials, PEDro, and ScienceDirect databases were searched from database inception to March 2024. Randomized controlled trials (RCTs) published in English were included. Two independent reviewers assessed the methodological quality of the trials using the Joanna Briggs Institute (JBI) critical appraisal tool for RCTs and performed data extraction using the JBI data extraction form for observational/experimental studies. Review Manager 5.4 was used for quantitative analyses. Results: Fourteen RCTs with a total of 367 participants were included in this review. The average quality score of the studies was 8.4 out of 13. The pooled results showed a significant improvement in walking ability measured by the 10-Meter Walk Test (mean difference (MD) = 0.15; p = 0.0001), Timed Up and Go Test (MD = -2.58; p < 0.00001), Dynamic Gait Index (MD = 2.93; p = 0.007), and spatiotemporal gait parameters, including stride length (MD = 9.67; p < 0.0001), step length (MD = 4.41; p = 0.004), cadence (MD = 7.06; p = 0.0003), and gait velocity (MD = 9.31; p < 0.00001). A significant improvement was found in balance measured by the Limit of Stability (MD = 40.50; p < 0.00001), yet the Activities-specific Balance Confidence Scale showed no significant improvement (MD = 10.26; p = 0.10). Conclusions: Action observation training led to improvements in the walking ability of stroke patients. There is some evidence to suggest the effectiveness of action observation training for improving the balance ability of stroke patients, however, the number of studies is still very limited.