title: Interventions to improve real-world walking after stroke: a systematic review and meta-analysis.
abstract: OBJECTIVE
  This study aimed to determine the effectiveness of current interventions to improve real-world walking for people with stroke and specifically whether benefits are sustained.
  
  
  METHODS
  EBSCO Megafile, AMED, Cochrane, Scopus, PEDRO, OTSeeker and Psychbite databases were searched to identify relevant studies.
  
  
  METHODS
  Proximity searching with keywords such as ambulat*, walk*, gait, mobility*, activit* was used. Randomized controlled trials that used measures of real-world walking were included. Two reviewers independently assessed methodological quality using the Cochrane Risk of Bias Tool and extracted the data.
  
  
  RESULTS
  Nine studies fitting the inclusion criteria were identified, most of high quality. A positive effect overall was found indicating a small effect of interventions on real-world walking (SMD 0.29 (0.17, 0.41)). Five studies provided follow-up data at >3-6 months, which demonstrated sustained benefits (SMD 0.32 (0.16, 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (-0.11, 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12, 0.41)) were.
  
  
  CONCLUSIONS
  A small but significant effect was found for current interventions and benefits can be sustained. Interventions that include behaviour change techniques appear more effective at improving real-world walking habits than exercise alone.
authors.affiliation: 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Stretton
authors.affiliation: 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand.
authors.forename: Suzie
authors.initials: S
authors.lastname: Mudge
authors.affiliation: 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand.
authors.forename: Nicola M
authors.initials: NM
authors.lastname: Kayes
authors.affiliation: 1 Centre for Person Centred Research, School of Clinical Sciences, AUT University, Auckland, New Zealand.|2 Health Research Council of New Zealand, Auckland, New Zealand.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: McPherson
mesh_terms: D000203:Activities of Daily Living; D001521:Behavior Therapy / Q000379:methods / Q000592:standards*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation / Q000379:methods / Q000592:standards*; D016138:Walking
keywords: Real world; behaviour change; occupational therapy; physical activity; physiotherapy; rehabilitation; stroke; walking