Review article (meta-analysis)
Effects of an Ankle-Foot Orthosis on Balance and Walking After Stroke: A Systematic Review and Pooled Meta-Analysis

https://doi.org/10.1016/j.apmr.2012.12.025Get rights and content

Abstract

Objective

To determine the effectiveness of an ankle-foot orthosis (AFO) on mobility, walking, and balance in people with stroke.

Data Sources

The following databases were searched from inception to November 2011: Cochrane Stroke, Movement Disorders and Injuries Groups, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and the Physiotherapy Evidence Database. Previous reviews, reference lists, and citation tracking of the selected articles were screened, and the authors of selected trials were contacted for any further unpublished data.

Study Selection

Randomized controlled trials of AFOs in people with stroke, which measured balance, walking impairments, or mobility and were reported in English, were selected. Then we independently identified trials, extracted data, and assessed trial quality.

Data Extraction

Trials with a low risk of selection, performance, and attrition bias were selected for analysis. Information on the trial design, population recruited, intervention delivered, outcomes measured, and the mean ± SD values for the treatment and control groups were extracted.

Data Synthesis

Continuous outcomes were combined using weighted or standardized mean differences with 95% confidence intervals and a fixed-effect model. Thirteen trials with 334 participants were selected. The effect of an AFO on walking activity (P=.000–.001), walking impairment (P=.02), and balance (weight distribution) (P=.003) was significant and beneficial. The effect on postural sway (P=.10) and timed mobility tests (P=.07–.09) was nonsignificant, and the effect on functional balance was mixed. The selected trials were all crossover trials of the immediate effects; long-term effects are unexplored.

Conclusions

An AFO can improve walking and balance after stroke, but only the immediate effects have been examined. The effects and acceptability of long-term usage need to be evaluated.

Section snippets

Search strategy to identify relevant studies

The following trials registers and databases were searched: Cochrane Stroke, Movement Disorders and Injuries Groups, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and the Physiotherapy Evidence Database. All searches were completed in November 2011. To identify further published, unpublished, and ongoing trials, we searched the reference lists of the articles identified, review articles, and books, and contacted the lead authors of published studies, other researchers in field clinical and research

Description of studies

We screened 120 abstracts and the full texts of 43 articles and identified 13 trials involving 334 patients that met the inclusion criteria and were included in the analysis (see table 1). The aim of the selected trials was to assess the immediate or short-term effect of the AFOs, and testing was completed in a single testing session, thereby avoiding the contaminating effect from rehabilitation or spontaneous recovery and minimizing the random error caused by testing over a prolonged period.

Discussion

This systematic review assessed the effects of an AFO on balance, walking, and mobility for people with stroke. The available evidence suggests that an AFO can improve these factors, but only the immediate, short-term effects have been assessed. The effects on other aspects of mobility and balance (postural sway and timed mobility tests) showed a positive trend favoring an AFO but failed to reach statistical significance, while the effects on functional balance were mixed. The small numbers of

Conclusions

Using an AFO can make an immediate improvement in mobility (functional ambulation categories), walking (speed and step/stride length), and some aspects of balance (weight distribution in standing) while the AFO is worn. The AFO did not affect other aspects of mobility (timed stair climb and Timed Up & Go test) and balance (postural sway). The results support the use of an AFO to improve walking and some aspects of balance; however, the long-term effect of AFO usage has not been investigated,

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