Ankle-foot orthoses and continuous functional electrical stimulation improve walking speed after stroke: a systematic
Lucas Rodrigues Nascimento1, Layla Alvarenga da Silva2, João Victor Matos Araújo Barcellos2
1Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Background:
Foot-drop is a common impairment after stroke, which reduces walking ability.
Objective:
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.
Data Sources:
MEDLINE, EMBASE, Cochrane, PsycINFO, and PEDro databases.
Eligibility Criteria:
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.
Data Synthesis:
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.
Results:
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.
Conclusions:
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.
Systematic Review Registration Number:
PROSPERO CRD42019130988.
