Journal CME, July 2022: The Effect of Ankle-foot Orthosis on Ankle Kinematics in Individuals after Stroke: A Systematic Review and Metaanalysis-Journal CME. July 2022: The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and metaanalysis

Journal CME. July 2022: The effect of ankle-foot orthosis on ankle kinematics in individuals after stroke: A systematic review and metaanalysis

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The systematic review and meta-analysis by Yoshitaka Wada and colleagues examined the impact of ankle-foot orthosis (AFO) on ankle kinematics and patient-important outcomes in stroke survivors. The researchers utilized a rigorous methodology including randomized controlled trials (RCTs) and randomized crossover trials up to May 2020 from databases like CENTRAL, MEDLINE, and EMBASE. Fourteen trials with 282 stroke patients were included for analysis, focusing on dorsiflexion angle during the swing phase, walking ability, quality of life, and adverse events.<br /><br />Key findings from the review are:<br />- AFO increased the dorsiflexion angle during walking by 3.7 degrees (95% CI, 2.0-5.3), though with low certainty of evidence.<br />- AFO slightly improved walking ability, increasing walking speed by 0.09 m/s (95% CI, 0.06-0.12), also with low certainty of evidence.<br /><br />Despite improvements in ankle kinematics and walking speed, no studies addressed the effects of AFO on quality of life, adverse events, fall frequency, or activities of daily living. The evidence was limited primarily to short-term effects. The authors highlighted the importance of future high-quality studies to ascertain long-term effects of AFO on stroke survivors' gait and related outcomes.<br /><br />Strengths of this systematic review include the exclusive focus on RCTs and the use of the GRADE approach for assessing evidence certainty. Limitations include the predominance of immediate effect measurements and the difficulty in defining long-term outcomes due to the crossover trial designs.<br /><br />In conclusion, while AFO appears to offer short-term benefits in improving ankle dorsiflexion and walking speed for stroke survivors, the evidence remains of low certainty, and further research is necessary to establish the long-term effectiveness and impact on broader patient-important outcomes. This research underscores the potential role of AFO in enhancing post-stroke rehabilitation, pending more rigorous future studies.

Keywords

ankle-foot orthosis

stroke survivors

ankle kinematics

walking ability

dorsiflexion angle

systematic review

meta-analysis

randomized controlled trials

quality of life

long-term effects