https://doi.org/10.1177/0269215518801430 Clinical Rehabilitation 1–12 © The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0269215518801430 journals.sagepub.com/home/cre CLINICAL REHABILITATION The effectiveness of backward walking as a treatment for people with gait impairments: a systematic review and meta-analysis Tharani Balasukumaran , Benita Olivier and Mokgobadibe Veronica Ntsiea Abstract 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. Keywords Backward walking, retro walking, gait impairment, systematic review, meta-analysis. Date received: 23 February 2018; accepted: 26 August 2018 Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Corresponding author: Tharani Balasukumaran, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Email: tharanimpt@gmail.com 801430CRE 0 0 10.1177/0269215518801430Clinical RehabilitationBalasukumaran et al. research-article 2018 Original Article