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. DATA SOURCES: EBSCO Megafile, AMED, Cochrane, Scopus, PEDro, OTSeeker and PsychBITE databases were searched to identify relevant studies. REVIEW 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 to 0.41)). Five studies provided follow-up data at > 3 to 6 months, which demonstrated sustained benefits (SMD 0.32 (0.16 to 0.48)). Subgroup analysis revealed studies using exercise alone were not effective (SMD 0.19 (-0.11 to 0.49)), but those incorporating behavioural change techniques (SMD 0.27 (0.12 to 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.

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