{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T06:37:18Z","timestamp":1793601438532,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>The objective was to examine the effects of backward walking training for improving walking speed and balance in children with cerebral palsy. A systematic review of randomized trials was conducted. Trials had to include children with cerebral palsy, with a Gross Motor Function Classification System, between I and III, that delivered backward walking training as a solo intervention or in combination with forward walking training. The outcomes of interest were walking speed and balance. The methodological quality of included trials was assessed by the PEDro scale, and the quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight papers, involving 156 participants, were included. Using random-effects meta-analysis, we estimated that backward walking training improved walking speed by 0.10\u2005m\/s [95% confidence interval (CI) 0.05\u20130.16] and by 2 points on the Pediatric Balance Scale (0\u201356) (95% CI 1.5\u20132.2) more than forward walking training. We also estimated that the addition of backward walking training increased walking speed by 0.20\u2005m\/s (95% CI 0.07\u20130.34) and reduced the angular excursion of the center of gravity by 0.5\u2009degrees (95% CI \u22120.7 to \u22120.3). The quality of the evidence was classified as low to moderate. In conclusion, overall, backward walking training appears to be as effective or slightly superior to forward walking training for improving walking speed in children with CP. The addition of backward walking training statistically significantly and clinically important enhanced benefits on walking speed.<\/jats:p>","DOI":"10.1097\/mrr.0000000000000598","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T10:37:03Z","timestamp":1692095823000},"page":"300-307","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Addition of backward walking training to forward walking training improves walking speed in children with cerebral palsy: a systematic review with meta-analysis"],"prefix":"10.1097","volume":"46","author":[{"given":"K\u00eania K.P.","family":"Menezes","sequence":"first","affiliation":[{"name":"NeuroGroup, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Avelino","sequence":"additional","affiliation":[{"name":"NeuroGroup, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas R.","family":"Nascimento","sequence":"additional","affiliation":[{"name":"NeuroGroup, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais"},{"name":"Center of Health Sciences, Department of Physiotherapy, Universidade Federal do Esp\u00edrito Santo, Vit\u00f3ria, Esp\u00edrito Santo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"R1-20250525","first-page":"8","article-title":"A report: the definition and classification of cerebral palsy April 2006.","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev Med Child Neurol Suppl"},{"key":"R2-20250525","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1111\/dmcn.12017","article-title":"A systematic review of risk factors for cerebral palsy in children born at term in developed countries.","volume":"55","author":"McIntyre","year":"2013","journal-title":"Dev Med Child Neurol"},{"key":"R3-20250525","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.21037\/tp.2020.01.01","article-title":"Cerebral palsy in children: a clinical overview.","volume":"9","author":"Patel","year":"2020","journal-title":"Transl Pediatr"},{"key":"R4-20250525","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/B978-0-444-63916-5.00020-3","article-title":"Cerebral palsy.","volume":"159","author":"Morgan","year":"2018","journal-title":"Handb Clin Neurol"},{"key":"R5-20250525","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1469-8749.2008.03250.x","article-title":"Walking function, pain, and fatigue in adults with cerebral palsy: a 7-year follow-up study.","volume":"51","author":"Opheim","year":"2009","journal-title":"Dev Med Child Neurol"},{"key":"R6-20250525","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1469-8749.2001.tb00719.x","article-title":"Adults with cerebral palsy: a survey describing problems, needs, and resources, with special emphasis on locomotion.","volume":"43","author":"Andersson","year":"2001","journal-title":"Dev Med Child Neurol"},{"key":"R7-20250525","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1111\/j.1469-8749.2001.tb00755.x","article-title":"Functional status of adults with cerebral palsy and implications for treatment of children.","volume":"43","author":"Bottos","year":"2001","journal-title":"Dev Med Child Neurol"},{"key":"R8-20250525","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/j.1365-2214.2010.01121.x","article-title":"Domains of importance for parents, medical professionals and youth with cerebral palsy considering treatment outcomes.","volume":"37","author":"Vargus-Adams","year":"2011","journal-title":"Child Care Health Dev"},{"key":"R9-20250525","doi-asserted-by":"crossref","first-page":"1971","DOI":"10.3109\/09638280902874204","article-title":"A systematic review of the effectiveness of treadmill training for children with cerebral palsy.","volume":"31","author":"Willoughby","year":"2009","journal-title":"Disabil Rehabil"},{"key":"R10-20250525","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1249\/JES.0000000000000000","article-title":"Steps forward in understanding backward gait: from basic circuits to rehabilitation.","volume":"42","author":"Hoogkamer","year":"2014","journal-title":"Exerc Sport Sci Rev"},{"key":"R11-20250525","first-page":"451","article-title":"The effect of repeated bouts of backward walking on physiologic efficiency.","volume":"16","author":"Childs","year":"2002","journal-title":"J Strength Cond Res"},{"key":"R12-20250525","first-page":"165","article-title":"Variability of lower extremity joint kinematics during backward walking in a virtual environment.","volume":"14","author":"Katsavelis","year":"2010","journal-title":"Nonlinear Dynamics Psychol Life Sci"},{"key":"R13-20250525","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/0269215518790053","article-title":"Effects of backward gait training on balance, gross motor function, and gait in children with cerebral palsy: a systematic review.","volume":"33","author":"Elnahhas","year":"2019","journal-title":"Clin Rehabil"},{"key":"R14-20250525","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence.","volume":"64","author":"Balshem","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"R15-20250525","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1249\/MSS.0b013e3181a0c95c","article-title":"American College of Sports Medicine position stand. Exercise and physical activity for older adults.","volume":"41","author":"Chodzko-Zajko","year":"2009","journal-title":"Med Sci Sports Exerc"},{"key":"R16-20250525","first-page":"CD013045","article-title":"Paracetamol, NSAIDS and opioid analgesics for chronic low back pain: a network meta-analysis.","volume":"2018","author":"Bagg","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"R19-20250525","first-page":"CD002014","article-title":"Behavioural treatment for chronic low-back pain.","volume":"2010","author":"Henschke","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"R20-20250525","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.physio.2019.10.002","article-title":"Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials.","volume":"107","author":"Nascimento","year":"2020","journal-title":"Physiother"},{"key":"R21-20250525","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1177\/0269215516656468","article-title":"Effectiveness of backward walking training on walking ability in children with hemiparetic cerebral palsy: a randomized controlled trial.","volume":"31","author":"Abdel-Aziem","year":"2017","journal-title":"Clin Rehabil"},{"key":"R22-20250525","first-page":"2042","article-title":"Impact of backward gait training on mediolateral stability index in children with hemiparesis.","volume":"2","author":"Abdou","year":"2014","journal-title":"J Med Sci Clin Res"},{"key":"R23-20250525","doi-asserted-by":"crossref","first-page":"535","DOI":"10.15621\/ijphy\/2016\/v3i5\/117435","article-title":"Impact of body weight supported backward treadmill training on walking speed in children with spastic diplegia.","volume":"3","author":"Ayoub","year":"2016","journal-title":"Int J Physiother"},{"key":"R24-20250525","doi-asserted-by":"crossref","first-page":"292","DOI":"10.18857\/jkpt.2019.31.5.292","article-title":"Effects of backward walking training with task orientation on the functional gait of children with spastic hemiplegia.","volume":"31","author":"Choi","year":"2019","journal-title":"J Kor Phys Ther"},{"key":"R25-20250525","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.3390\/healthcare9091191","article-title":"A Backward walking training program to improve balance and mobility in children with cerebral palsy.","volume":"9","author":"Choi","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"R26-20250525","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1177\/0269215514547654","article-title":"Effect of backward walking training on postural balance in children with hemiparetic cerebral palsy: a randomized controlled study.","volume":"29","author":"El-Basatiny","year":"2015","journal-title":"Clin Rehabil"},{"key":"R27-20250525","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.gaitpost.2018.07.171","article-title":"Effects of backward-downhill treadmill training versus manual static plantar flexor stretching on muscle-joint pathology and function in children with spastic Cerebral Palsy.","volume":"65","author":"H\u00f6sl","year":"2018","journal-title":"Gait Post"},{"key":"R28-20250525","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.16965\/ijpr.2017.194","article-title":"Conditioning effects of backward treadmill training in children with spastic diplegic cerebral palsy.","volume":"5","author":"Sanad","year":"2017","journal-title":"Int J Physiother Res"},{"key":"R29-20250525","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1080\/09593985.2016.1206155","article-title":"The effects of backward walking training on balance and mobility in an individual with chronic incomplete spinal cord injury: a case report.","volume":"32","author":"Foster","year":"2016","journal-title":"Physiother Theory Pract"},{"key":"R30-20250525","doi-asserted-by":"crossref","first-page":"657","DOI":"10.3389\/fneur.2019.00657","article-title":"Effects of therapeutic exercise intensity on cerebral palsy outcomes: a systematic review with meta-regression of randomized clinical trials.","volume":"10","author":"Hsu","year":"2019","journal-title":"Front Neurol"},{"key":"R31-20250525","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.jphys.2020.04.001","article-title":"Repetitions and dose in stroke rehabilitation.","volume":"66","author":"Dorsch","year":"2020","journal-title":"J Physiother"},{"key":"R32-20250525","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jphys.2017.05.011","article-title":"Publishing code: an initiative to enhance transparency of data analyses reported in Journal of Physiotherapy.","volume":"63","author":"Herbert","year":"2017","journal-title":"J Physiother"}],"container-title":["International Journal of Rehabilitation Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MRR.0000000000000598","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T20:03:38Z","timestamp":1748203418000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MRR.0000000000000598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,15]]},"references-count":30,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1097\/mrr.0000000000000598","relation":{},"ISSN":["0342-5282"],"issn-type":[{"value":"0342-5282","type":"print"}],"subject":[],"published":{"date-parts":[[2023,8,15]]}}}