Stroke-related factors associated with gait asymmetry in ambulatory stroke survivors: A systematic review and meta-analysis

Background: Gait asymmetry, characterized by spatial (e.g., step length) and temporal (e.g., swing time) differences between the paretic and non-paretic limbs, is common after stroke. Despite increasing research on gait asymmetry, its associations with stroke-related factors remain unclear. Research question: This systematic review and meta-analysis aimed to investigate these associations and provide insights for post-stroke rehabilitation. Methods: A comprehensive search of PubMed, MEDLINE, CINAHL, and Scopus identified observational studies published between January 2000 and June 2024. Studies examining the relationship between stroke-related factors and post-stroke gait asymmetry were included. Meta-analyses were performed on factors with sufficient data, extracting correlation coefficients (r) to estimate effect sizes. Results: Fourteen studies met inclusion criteria, with eight studies (n = 468 participants) included in meta-analyses. Temporal asymmetry was significantly associated with lower limb motor and sensory deficits (r = −0.73; 95 % CI: −0.88 to −0.57; p < 0.01), leg strength (r = −0.50; 95 % CI: −0.64 to −0.36; p < 0.01), spasticity (r = 0.51; 95 % CI: 0.31–0.72; p < 0.01), and overall motor performance (r = −0.68; 95 % CI: −0.74 to −0.61; p < 0.01). Spatial asymmetry was significantly associated with leg strength (r = −0.31; 95 % CI: −0.45 to −0.17; p < 0.01), spasticity (r = 0.67; 95 % CI: 0.49–0.85; p < 0.01), and overall lower limb impairments (r = −0.44; 95 % CI: −0.64 to −0.23; p < 0.01). Significance: Lower limb motor and sensory deficits, along with overall motor performance, were the factors most strongly associated with temporal asymmetry. Spasticity and/or contracture was the factor most strongly associated with spatial asymmetry. These findings highlight the need to assess and manage gait asymmetry separately in post-stroke rehabilitation.