Abstract
We conducted a meta-analysis to investigate the effectiveness of ankle–foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger’s test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34–0.66; P < 0.00001; I2, 0%), cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001; I2, 0%), step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003; I2, 2%), stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003; I2, 7%), Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01; I2, 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001; I2, 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001; I2, 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03; I2, 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.
Introduction
Stroke is a neurological disease whose sequelae are associated with physical disabilities1. Gait limitations are noted in > 50% of patients with stroke, and these limitations may be attributable to motor or proprioceptive impairment, spasticity, and balancing problems2. Impaired gait function after stroke strongly contributes to overall patient disability and increases the risk of falls3. Weakness in the ankle dorsiflexors is frequently observed after a stroke, which is one of the major factors hindering gait function4. Because of ankle dorsiflexor weakness, bodily instability occurs during the stance phase of gait, and the foot is dragged along the ground during the swing phase5. With this instability and foot dragging, walking becomes unsafe5. In clinical practice, ankle–foot orthoses (AFOs) are recommended for improving the gait limitations of patients. However, some clinicians have reported that AFOs can hinder the natural walking patterns of patients with stroke or hemiplegia6,7,8.
Some previously published systematic reviews or meta-analyses have assessed the effect of AFO on gait function in patients with stroke. In 2013, Tyson et al. found that AFO was effective in improving gait function but only evaluated the kinematics and oxygen consumption9. In 2018, Daryabor et al. reported that any type of AFO could improve foot drop but did not proceed with statistical analysis10. In 2020, Darybor et al., in a systematic review, reported that AFO could improve walking energy costs in patients with stroke in the short term11, and Shahabi et al. reported that AFO could improve walking speed in patients with stroke, but other gait-related factors were not analyzed12.
In our meta-analysis for a detailed evaluation of the effectiveness of AFO, we attempted to examine various gait-related variables, including walking speed, cadence, step length, stride length, stride time, Timed up-and-go test (TUG), functional ambulation category (FAC), body sway, ankle sagittal plane angle at initial contact, knee sagittal plane angle at toe-off, and hip sagittal plane angle at toe-off.[…]
TBI Rehabilitation 