Comparison of KAFO and AFO for extension thrust pattern after stroke: a randomized N-of-1 trial

[Purpose] Extension thrust pattern (ETP) during the stance phase is a common gait deviation after stroke; however, there is no consensus regarding the optimal orthosis, such as knee-ankle-foot orthosis (KAFO) or ankle-foot orthosis (AFO). This study aimed to compare the effects of KAFO and AFO on ETP using an N-of-1 trial design. [Participant and Methods] A 54-year-old male with right thalamic hemorrhage and post-stroke hemiplegia participated in this study. A prospective multiple-crossover N-of-1 trial was conducted. Five intervention periods (3 consecutive days each) of KAFO and AFO use were randomly assigned, with a 1-day washout period between interventions. Hip, knee, and ankle joint angles during mid-stance, 10-m walking time, and step count were measured. [Results] KAFO use significantly reduced ankle plantar flexion compared with AFO. A particularly large effect size was observed for the ankle dorsiflexion angle. Improvements in walking time and step count were also noted with KAFO. [Conclusion] KAFO was more effective than AFO in improving ETP in this patient. Objective evaluation using an N-of-1 trial may support more appropriate orthotic selection in clinical practice.