Outcome measures and motion capture systems for assessing lower limb orthosis-based interventions after stroke: a systematic review

Abstract

Purpose

To review and categorize, according to the International Classification of Functioning, the outcome measures, and motion capture systems for studying the evidence-based practice of orthotic-based interventions in post-stroke gait rehabilitation.

Methods

An electronic literature search was conducted up to February 2018 in Web of Science, Scopus, MEDLINE and Physiotherapy Evidence Database. Randomized trials measuring activity, impairment or participation outcome measures for studying the evidence-based practice of orthoses in gait rehabilitation after an acute or chronic stroke were identified. The studies were assessed through the Cochrane risk-of-bias tool by three authors. Information about stroke’s stage, assessment protocol (goal, timing and motion capture system), orthosis configuration and outcome measures were extracted.

Results

Eighteen randomized trials, including 387 post-stroke adults, mostly in the chronic stage, were selected. They assessed 39 outcomes, mainly activity outcome measures such as spatiotemporal (72.2%), kinematic (44.4%) and functional (33.3%) outcomes. Gait speed was the primary outcome in most studies. Participation (22.2%) and impairment (16.7%) outcome measures were less explored. Mostly, non-portable motion capture systems were employed opposing the freely-use of the wearable orthosis. The detection bias risk and the shortage of baseline and follow-up outcome measures affected the studies’ assessment quality.

Conclusions

Studies showed heterogeneity in selecting outcomes and timings for assessment. There is evidence for assessing the evidence of orthosis-based gait rehabilitation after stroke through activity outcome measures, primarily the gait speed, recorded by non-wearable motion capture systems. A unified methodology considering wearable sensors for tracking baseline and follow-up measures is needed.

Implications for rehabilitation

• There is evidence on use activity outcome measures to assess the meaningful evidence-based practice of orthosis-based gait rehabilitation in post-stroke.

• Gait speed was the primary outcome measure most reported.

• There is limited evidence on use impairment and participation outcome measures to measure meaningful changes due to orthotic-based rehabilitation.

• Outcome measures were mainly recorded by non-wearable motion capture systems.

Keywords:

• Stroke
• gait rehabilitation
• wearable orthosis
• outcome measures
• gait assessment

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the FCT – Fundação para a Ciência e Tecnologia – under Grant SFRH/BD/108309/2015; by FEDER Funds through the Programa Operacional Regional do Norte and national funds from FCT with the project SmartOs –Controlo Inteligente de um Sistema Ortótico Ativo e Autónomo-under Grant NORTE-01-0145-FEDER-030386; by Spanish Ministry of Economy and Competitiveness under Grant RYC-2014-16613.