The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke. Data sources: PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019. Review methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low. Conclusion: Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.

Recommendations to improve insurance coverage for physiotherapy services in Iran: A multi-criteria decision making approach

“…During the interviews, providers and faculty-members also underlined the importance of physiotherapy services after stroke and traumatic events. As shown by evidence, if physiotherapy interventions are provided at golden time (6 months after stroke or 12 months after traumatic injuries), many side effects are thwarted [21,52]. Therefore, these services may be other potential interventions to be considered by health insurers.…”

“…Therefore, moving towards an insurance mechanism is the inevitable option to nance health care services such as physiotherapy. Even if preventive, curative, and rehabilitative effects of physiotherapy interventions have been so far con rmed by relevant evidence [20][21][22][23], their insurance coverage still low in Iran like many other countries [10]. Nowadays, fragmentation in nancing and provision of physiotherapy services, like other Iranian health sub-systems, is leading to unnecessary duplication.…”

Recommendations to improve the insurance coverage for physiotherapy services in Iran A multi-criteria decision making approach

“…During the interviews, providers and faculty-members described the importance of physiotherapy after stroke and trauma. As shown by evidence, if physiotherapy interventions are provided in golden time (6-month after stroke or 12-month after trauma injury), many side effects are prevented [18,45].…”

“…Therefore, moving to insurance mechanism is the inevitable option to financing the health care services such as physiotherapy. Although the preventive, curative, and rehabilitative effects of physiotherapy interventions were confirmed by the relevant evidence [17][18][19][20], their insurance coverage still is weak in Iran like many other countries [10]. Nowadays, fragmentation in financing and providing of physiotherapy services, like other Iranian health sub-systems, leads to duplication and unnecessary waste.…”

Financing of physical rehabilitation services in Iran: a stakeholder and social network analysis

“…As a result, these services may have significant advantages for individuals, society, and also national economies [7][8][9]. Additionally, physical rehabilitation services also have preventive effects [10,11] and facilitate the hospital discharge process [12,13]. Therefore, not only does the provision of affordable physical rehabilitation services not impose any significant financial pressure on the health sector, but also it can be a rational investment [14][15][16].…”