Ankle-foot orthoses and continuous functional electrical stimulation improve walking speed after stroke: a systematic review and meta-analyses of randomized controlled trials

Foot-drop is a common impairment after stroke, which reduces walking ability. To examine the efficacy of interventions aimed at reducing foot-drop, i.e., ankle-foot orthoses and functional electrical stimulation, on walking speed and balance after stroke. MEDLINE, EMBASE, Cochrane, PsycINFO, and PED...

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Bibliographic Details
Published in:Physiotherapy 2020-12, Vol.109, p.43-53
Main Authors: Nascimento, Lucas Rodrigues, da Silva, Layla Alvarenga, Araújo Barcellos, João Victor Matos, Teixeira-Salmela, Luci Fuscaldi
Format: Article
Language:English
Subjects:
Balance
Cerebrovascular accident
Combined Modality Therapy
Electric Stimulation Therapy
Foot Orthoses
Gait
Gait Disorders, Neurologic - therapy
Humans
Orthosis
Postural Balance
Randomized Controlled Trials as Topic
Rehabilitation
Stroke Rehabilitation - methods
Walking Speed
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Summary:Foot-drop is a common impairment after stroke, which reduces walking ability. To examine the efficacy of interventions aimed at reducing foot-drop, i.e., ankle-foot orthoses and functional electrical stimulation, on walking speed and balance after stroke. MEDLINE, EMBASE, Cochrane, PsycINFO, and PEDro databases. The review included only parallel, randomized trials. Participants were ambulatory adults after stroke. The experimental interventions were the use of an ankle-foot orthosis or functional electrical stimulation. Outcome data related to walking speed and balance were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of trials was assessed by the PEDro scores and the quality of evidence was determined according the Grading of Recommendations Assessment, Development, and Evaluation system. Eleven trials involving 1135 participants were included. The mean PEDro score of the trials was 5.8 (ranging from 4 to 7). Ankle-foot orthoses (MD 0.24m/s; 95% CI 0.06 to 0.41) and functional electrical stimulation (MD 0.09m/s; 95% CI 0.03 to 0.14) significantly increased walking speed, compared with no intervention/placebo. Results regarding balance were inconclusive. Ankle-foot orthoses were not superior to functional electrical stimulation for improving walking speed (MD 0.00m/s; 95% CI -0.06 to 0.05) or balance (MD 0.27 points on the Berg Balance Scale; 95% CI -0.85 to 1.39) after stroke. This systematic review provided moderate-quality evidence that both ankle-foot orthoses and functional electrical stimulation improve walking speed after stroke, but the effects on balance remain unclear. PROSPERO CRD42019130988
ISSN:0031-9406
1873-1465
DOI:10.1016/j.physio.2020.08.002