BACKGROUND: Backward walking (BW) and action observation training may potentially help people at risk of falls. Moreover, action observation training could be a potential intervention to improve gait after a stroke. AIM: We aimed to identify the effects of BW action observational training (BWOT) on gait parameters and balance in chronic stroke patients. DESIGN: Randomized, controlled study. SETTING: Rehabilitation center. POPULATION: Twenty-four chronic stroke patients were randomly assigned to BWOT (N. = 12) and landscape observational training (LOT) (N. = 12) groups. METHODS: The BWOT group performed BW after watching a video of a BW, while the LOT group performed BW training after watching a video of a landscape. Both groups received traditional therapy for 5 days per week and BWOT for 3 days a week for 4 weeks. The primary and secondary outcomes were gait and balance, respectively. Static balance was measured using the 5 Times Sit-To-Stand Test (5TSTS), the center of pressure (COP) displacement, and weight distribution (WD) of the affected side. Dynamic balance was measured using the activity-specific balance confidence (ABC) scale. RESULTS: The BWOT group showed significant improvements in gait velocity (p = 0.001, eta2 = 0.470), step length (p = 0.007, eta2 = 0.313), stride lengths (p < 0.002, eta2 = 0.431), 5TSTS (p = 0.021, eta2 = 0.231), COP velocity (p = 0.022, eta2 = 0.226), length (p = 0.001, eta2 = 0.504), WD of the affected side (p = 0.033, eta2 = 0.193), and ABC score (p = 0.023, eta2 = 0.226) than the LOT group. CONCLUSIONS: The 4-week BWOT training program significantly improved the gait parameters and static and dynamic balance in stroke patients. CLINICAL REHABILITATION IMPACT: BWOT is an accessible and effective method of rehabilitation training that can also be applied to conventional therapy as a useful method for improving the gait and balance after stroke.

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