Evaluation methods to assess the efficacy of equinovarus foot surgery on the gait of post-stroke hemiplegic patients: A literature review

Abstract

IntroductionThe aim of this study was to realize a systematic review of the different ways, both clinical and instrumental, used to evaluate the effects of the surgical correction of an equinovarus foot (EVF) deformity in post-stroke patients.MethodsA systematic search of full-length articles published from 1965 to June 2021 was performed in PubMed, Embase, CINAHL, Cochrane, and CIRRIE. The identified studies were analyzed to determine and to evaluate the outcomes, the clinical criteria, and the ways used to analyze the impact of surgery on gait pattern, instrumental, or not.ResultsA total of 33 studies were included. The lack of methodological quality of the studies and their heterogeneity did not allow for a valid meta-analysis. In all, 17 of the 33 studies involved exclusively stroke patients. Ten of the 33 studies (30%) evaluated only neurotomies, one study (3%) evaluated only tendon lengthening procedures, 19 studies (58%) evaluated tendon transfer procedures, and only two studies (6%) evaluated the combination of tendon and neurological procedures. Instrumental gait analysis was performed in only 11 studies (33%), and only six studies (18%) combined it with clinical and functional analyses. Clinical results show that surgical procedures are safe and effective. A wide variety of different scales have been used, most of which have already been validated in other indications.DiscussionNeuro-orthopedic surgery for post-stroke EVF is becoming better defined. However, the method of outcome assessment is not yet well established. The complexity in the evaluation of the gait of patients with EVF, and therefore the analysis of the effectiveness of the surgical management performed, requires the integration of a patient-centered functional dimension, and a reliable and reproducible quantified gait analysis, which is routinely usable clinically if possible.

Automatic gait events detection with inertial measurement units: healthy subjects and moderate to severe impaired patients

“…Gait analysis using IMU has gained widespread popularity, and several algorithms have been developed and demonstrated their efficacy in detecting gait events (GEs) of healthy individuals [ 4 , 13 , 24 , 44 ]. In clinical settings, measuring gait performance provides valuable additional information about walking activity and spontaneous gait characteristics, such as in the follow-up of neurological patients [ 5 , 18 , 45 ] or in preoperative examinations [ 46 , 47 ]. While some teams use only trunk wearable sensors that provide global features such as smoothness [ 48 ], a more precise analysis requires GE detection, which can be done with two separate IMUs on each lower limb [ 47 ].…”

Inertial Measurement Units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients

“…As previously shown in a literature review [7], the impact on patients' overall gait is very di cult to quantify clinicall, making it di cult to establish a standardized method for evaluating the e cacy of SEVF surgery after stroke. Most of the scales lack speci city, and the most promising option appears to be the Goal Attainment Scale [5,9,39,40].…”

“…Gait assessment of hemiplegic post-stroke patients with SEVF is a real challenge in clinical practice. There is currently no simple, reproducible, objective, and quanti able way to assess gait in its entirety in clinical practice [7]. For this reason the evaluation of the result is therefore mainly based today on a subjective functional evaluation, with the Goal Attainment Scale appearing as the most reliable tool [8][9][10].…”

“…Neuro orthopaedic surgery for SEVF encompasses a combination of tendon and nerve procedures performed by a single team [5,6]. It provides a satisfactory functional result in most cases, even if precise assessment remains di cult and complex to reproduce [7].…”

“…In order to assess the reliability and consistency of semiogram in the peri-operative evaluation of post-stroke SEVF, we compare in this article the results obtained with the semiogram and the functional evaluation usually performed [7]. Our main objective is to evaluate the gait analysis obtained by IMU before and after surgical management of SEVF in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort.…”