Measurement Technologies for Ankle-Dorsiflexion Function After Stroke: A Systematic Review and Meta-Analysis of...

Ankle dorsiflexion plays a vital role in ensuring safe and effective walking post-stroke, yet the best methods for assessing it and their clinical significance are still uncertain. This research compiles the existing sensor-based technologies used to measure ankle dorsiflexion in adults who have experienced a stroke and examines how these measurements correlate with walking performance. It also compares these findings with traditional clinical evaluation methods like manual muscle testing (MMT). We conducted a systematic search of PubMed, IEEE Xplore, and the Cochrane Library (2000-2025) for both observational and experimental studies that utilized sensor-based techniques (such as handheld or isokinetic dynamometry, load cells, and proprioceptive devices) to quantify ankle dorsiflexion and reported their relationship with gait outcomes. Additionally, studies employing conventional, non-instrumented clinical grading (e.g., ankle-dorsiflexor MMT) were included if they explored the connection between ankle function and gait, although these were not included in the quantitative analysis. Eighteen studies involving 783 stroke survivors met the inclusion criteria and were evaluated using the Newcastle-Ottawa Scale. Generally, individual studies found a positive association between ankle-dorsiflexor strength and both gait speed and endurance, although some negative correlations were noted. The strength and sometimes direction of these associations varied depending on the sensing technology, dorsiflexion index, gait outcome, and stroke chronicity. Overall, the current evidence indicates a generally positive but highly variable relationship between ankle dorsiflexion measurements and gait post-stroke, emphasizing the need to identify sources of variability and to create standardized, clinically applicable sensor-based assessment protocols.