Effects of Gait Biofeedback Training on Spatiotemporal Gait Parameters in Stroke Survivors: A Systematic Review and...

Background: Stroke represents a major contributor to long-term disability and is commonly associated with impaired gait, balance, and mobility, which reduce independence and increase fall risk. Gait biofeedback training provides real-time performance-related feedback and may facilitate motor relearning. This study aimed to synthesize the available evidence of gait biofeedback training on spatiotemporal gait parameters in stroke survivors. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched up to 7 April 2026. RCTs involving stroke survivors with gait impairment that compared gait biofeedback training with non-biofeedback rehabilitation and reported spatiotemporal gait outcomes were included. Risk of bias and certainty of evidence were assessed using RoB-1 and GRADE, respectively. Meta-analyses were conducted using mean difference (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² and τ², and 95% prediction intervals (PI) were calculated where possible. Results: 10 RCTs involving 304 participants were included. Compared with control interventions, gait biofeedback training may improve gait velocity (MD = 9.78 cm/s, 95% CI 6.06 to 13.50, p < 0.001, 95% PI 2.14 to 17.41) and step length (MD = 5.88 cm, 95% CI 1.14 to 10.61, p = 0.01, 95% PI -10.18 to 21.94). However, the certainty of evidence was stronger for gait velocity than for step length. A significant effect on cadence was observed in the primary analysis, but this finding was unstable in the sensitivity analysis. No significant pooled effects were found for stride length or stance time. The wide PI for step length, stride length, and stance time indicates that the expected effects may vary across future clinical settings. Conclusions: Gait biofeedback training may improve gait velocity after stroke. Evidence for step length improvement is more tentative, while evidence for cadence, stride length, and stance time remains insufficient or unstable. Additional well-designed high-quality RCTs are needed to confirm these findings and determine optimal feedback modes and training protocols. The review was registered in PROSPERO (CRD420261354683).