A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke

Tyson, Sarah; Sadeghi-Demneh, Ebrahim; Nester, Christopher

doi:10.1177/0269215513486497

Cited by 168 publications

(135 citation statements)

References 30 publications

(136 reference statements)

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“…659 A recent meta-analysis and systematic review suggested the potential mechanism(s) associated with the above effects by demonstrating a positive effect of an AFO on ankle kinematics, knee kinematics in stance phase, kinetics, and energy cost. 658 Two RCTs 763,764 showed that after 3 months of AFO use, AFO users had better mobility while wearing the AFO. One small RCT 764 found that although a dynamic hinged AFO improved ambulatory function over a standard AFO, it induced some dependence; the standard AFO group performed better after 3 months of use when walking without any orthosis.…”

Section: Level Of Evidencementioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,179

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Level Of Evidencementioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,179

840

View full text Add to dashboard Cite

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“…4,17,21 A systematic review of questionnaires that was used to assess patient satisfaction with any limb orthoses found that 63% of the 106 included papers used questionnaires that had been developed for the specific study rather than validated measures, indicating that our findings related to orthoses for knee instability is a broader issue in the field. 79 …”

Section: Findings In the Context Of Other Studiesmentioning

confidence: 99%

“…However, the focus was on gait biomechanics, and the effects and acceptability of long-term usage have not been evaluated. 21 A Cochrane review 22 has investigated any intervention for CMT disease and identified a single controlled study of foot orthoses (FOs); however, the device was not being used for knee instability -although FOs can influence the alignment of the knee on the coronal plane, they do not correct sagittal plane knee instability. A review of non-surgical interventions for people with CMT disease did not identify any studies evaluating an orthotic device.…”

Section: Previous Research On Effectivenessmentioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis – a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.ResultsQualitative study – a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients’ prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review – a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis – in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553.ConclusionsVarious types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.LimitationsThe population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.Future workFuture work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.Study registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Further research can help to identifythe best candidates for CF bracing by allowing for longitudinal use of the devices, thus allowing for motor learning in the orthoses. There is currently a dearth of literature with regards to muscle activity in orthoses due in large part to study design [17,18]. However, there is potential muscle activity can be enhance with proper orthosis selection [4].…”

Section: Discussionmentioning

confidence: 99%

Application of Carbon Fiber Ankle Foot Orthoses to Enhance Gait Outcomes for Individuals with Neurologic Gait Dysfunction

Sm¹

2017

Phys Med Rehabil Int

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Introduction: There is evidence that ankle foot orthoses (AFO) designs can impact gait outcomes for patients with neurologic dysfunction. Few studies have examined the benefits of different materials such as CF orthoses compared to plastic orthoses. This is a critical need in view of the difference in expense and complexity of fabricating CF AFOs compared to more traditional, less expensive polypropylene devices. Objective:The purpose of this study is to highlight excellent gait outcomes resulting from transitioning individuals from polypropylene AFOs and peroneal nerve stimulators to custom-fabricated CF AFOs in individuals with neurological impairments. Materials and Methods:The participants included 13 individuals with neurologic gait dysfunction who were transitions from polypropylene AFOs to custom-fabricated CF orthoses. All of these individuals were experienced users of previous devices, either polypropylene or peroneal nerve stimulator. In order to highlight the effects of the orthoses while minimizing the effects of the physical therapy interventions, each participant received between 1 and 4 physical therapy sessions with the new orthoses before the data was collected.Results: All 13 participants demonstrated improvements in their step length and gait velocity from initial to final condition. Many of the participants experienced improved step symmetry as well. Conclusions:The participants in this study showed a positive trend for improvements in step length, step length differential, and gait velocity with the use of the CF AFOs. This clinical tool has the potential to significantly augment the treatment of these individuals and is an important avenue of future research.

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A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke

Abstract: An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.

Cited by 168 publications

References 30 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Application of Carbon Fiber Ankle Foot Orthoses to Enhance Gait Outcomes for Individuals with Neurologic Gait Dysfunction

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