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

Lucas Rodrigues Nascimento; Layla Alvarenga da Silva; João Victor Matos Araújo Barcellos; Luci Fuscaldi Teixeira-Salmela

doi:10.1016/j.physio.2020.08.002

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

Physiotherapy. 2020 Dec:109:43-53. doi: 10.1016/j.physio.2020.08.002. Epub 2020 Aug 20.

Authors

Lucas Rodrigues Nascimento¹, Layla Alvarenga da Silva², João Victor Matos Araújo Barcellos³, Luci Fuscaldi Teixeira-Salmela⁴

Affiliations

¹ Center 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. Electronic address: lrn@ufmg.br.
² Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil. Electronic address: layla.alvarenga@hotmail.com.
³ Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil. Electronic address: joao.victormatos@outlook.com.
⁴ NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Electronic address: lfts@ufmg.br.

PMID: 33120054
DOI: 10.1016/j.physio.2020.08.002

Abstract

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.

Keywords: Balance; Cerebrovascular accident; Gait; Orthosis; Rehabilitation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Combined Modality Therapy
Electric Stimulation Therapy*
Foot Orthoses*
Gait Disorders, Neurologic / therapy*
Humans
Postural Balance*
Randomized Controlled Trials as Topic
Stroke Rehabilitation / methods*
Walking Speed*