Is rhythmic auditory stimulation the most effective therapy for functional ambulation after stroke? A systematic review

Abstract Background Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet a systematic overview is currently lacking. This study aims to summarize and evaluate the available evidence about the efficacy of RAS for functional ambulation, consider the use of walking assistive devices during the assessment or the intervention in stroke patients, and to find out if the effect of RAS and music-based RAS differs depending on the stroke brain site and affected area. Methods The Pubmed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients. Results Nineteen articles were included (916 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may are as good as other complementary therapies (horse-riding and visual cueing). Conclusions Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings. PROSPERO registration number : CRD42021277940