Clinical Effects of Auditory Feedback Interventions on Balance and Gait in Individuals with Stroke: A Systematic Review

Background/Objectives: Auditory feedback is used in stroke rehabilitation, but its effects may depend on the information conveyed and the rules governing signal delivery. This systematic review synthesized evidence on performance-contingent auditory feedback interventions for balance and gait in individuals with stroke, focusing on feedback targets and delivery characteristics. Methods: PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar were searched through 9 October 2026 for English-language randomized controlled trials (RCTs), including pilot RCTs, published between January 2015 and December 2025. The review was conducted in accordance with PRISMA 2020, registered in PROSPERO (CRD420261532210), and the findings were synthesized narratively. Results: Nine studies were included: two evaluated Adaptive Temporal Auditory Feedback, six evaluated Load-Contingent Auditory Feedback, and one evaluated Continuous Auditory Sonification. Some studies reported greater improvements than control groups in selected balance, gait, and functional mobility outcomes. Adaptive temporal interventions adjusted auditory signals according to gait performance, load-contingent interventions provided feedback on paretic-foot or cane loading, and continuous sonification mapped plantar-pressure characteristics to sound. PEDro scores ranged from 3 to 7 out of 10; RoB 2 identified some concerns in seven studies and high risk of bias in two. Conclusions: The available evidence does not establish the superiority of any feedback category. Future studies should investigate how feedback targets and delivery rules interact with patient characteristics and rehabilitation goals to inform individualized auditory feedback interventions.