Introduction: Backward walking over short distances is an integral part of walking in activities of daily living but has received little attention in the rehabilitation of stroke patients until recently. Backward walking training may improve muscle performance, proprioception, coordination, balance, and forward walking ability. Purpose: To review and analyse research on the effectiveness of backward walking training in patients after stroke. Methods: A literature search was performed in the PubMed, CINAHL and PEDro databases. The literature review included articles published in English before April 2022. Results: The literature review included seven randomised controlled trials with a total of 224 patients after stroke. Six studies included chronic stroke patients and one included acute stroke patients. Over-ground backward walking training was performed in three studies, and treadmill backward walking training with or without body weight support in four. Backward walking training was performed as a stand-alone therapy (two studies) or as an adjunctive therapy to the standard physiotherapy, rehabilitation or walking training (five studies). Results of the studies show the effectiveness of backward walking training for improving walking speed (six out of six studies), step and stride length (three out of four studies), step and stride duration (two out of three studies) and single and double limb support duration (two out of three studies). Backward walking training may also be effective for improving forward walking cadence (three out of five studies). Two out of two studies also reported the effectiveness of backward walking training for improving mobility, and two out of three studies for improving balance. Conclusion: Over-ground or treadmill backward walking training with or without body weight support, which lasts for at least four weeks with a frequency of three to five times a week and exercise units of at least thirty minutes, is an effective adjunctive therapy for improving forward walking, mobility, and balance of chronic stroke patients. The results of the included studies suggest greater effectiveness of treadmill backward walking training compared with over-ground backward walking training, but further studies with direct comparisons are needed.
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