Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis

Abstract

Purpose

To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments.

Methods

PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible.

Results

Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19–0.88), timed-up and go test (SMD: −0.45, CI: −0.67 to −0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25–2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53–1.28), Timed Up-Stairs (SMD: −0.35, CI: −0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38–0.92). Heterogeneity was non-significant for all outcomes (I² < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others.

Conclusions

An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.

IMPLICATIONS FOR REHABILITATION

• An AFO can improve functional performance and ambulation in survivors of strokes.

• Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.

• There was no evidence as to the effectiveness of specific AFO designs over others.

Keywords:

• Orthosis
• cerebrovascular accident
• walking
• mobility
• function
• gait

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Acknowledgments

The authors would like to thank Dr. Corien Nikamp for providing additional data for the meta-analysis.

Author contributions

A.D. and T.K. drafted the study protocol, developed the search strategy, and wrote the initial draft. S.Y, SM.L, M.O, and A.A. revised the content. All authors were involved in revising, drafting the final review, and approving the final manuscript. A.D. conducted all analyses and takes responsibility for the precision of findings.

Disclosure statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.