Effects of gait training on sand on improving the walking ability of patients with chronic stroke:a randomized controlled trial.

The sample was small, and only 28 of the 30 recruited patients were analysed. The sand and firm-ground groups did not differ significantly on either outcome, so the study cannot show that sand training is better than firm-ground training. The paper does not identify a primary outcome, so it is unclear whether the between-group null result or the within-group improvements should be treated as the main finding. The experimental group walked barefoot while the control group wore thin shoes, and the authors note this may have influenced the results. The study did not measure ankle mobility, muscle strength, or muscle activity, so the proposed mechanisms are conjectural. Participants could already walk independently, including with aids, so results may not apply to more severely impaired patients.

Do not conclude that sand gait training is better than firm-ground training. The groups did not differ significantly on either walking measure, and the sand group also trained barefoot while the control group wore shoes, so the effect of the ground cannot be separated from those conditions.