The effect of ankle‐foot orthosis on ankle kinematics in individuals after stroke: A systematic review and meta‐analysis

Abstract

Objective: To evaluate whether ankle-foot orthosis (AFO) has a beneficial effect on dorsiflexion angle increase during the swing phase among individuals with stroke and patient-important outcomes in individuals with stroke. Literature Survey: Randomized controlled trials (RCTs), randomized crossover trials, and cluster RCTs until May 2020 were researched through CEN-TRAL, MEDLINE, EMBASE, PEDro, CINAHL, and REHABDATA databases. Studies reporting on AFO use to improve walking, functional mobility, quality of life, and activity limitations and reports of adverse events in individuals with stroke were included. Methodology: Two independent reviewers extracted the data and assessed the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. Synthesis: Fourteen trials that enrolled 282 individuals with stroke and compared AFO with no AFO were included. Compared with no AFO, AFO could increase the dorsiflexion angle of ankle joints during walking (mean difference [MD, 3.7 ]; 95% confidence interval [CI], 2.0-5.3; low certainty of evidence). Furthermore, AFO could improve walking ability (walking speed) (MD, 0.09 [m/s]; 95% CI, 0.06-0.12; low certainty of evidence). No study had reported the effects of AFO on quality of life, adverse events, fall frequency, and activities of daily life. Conclusions: Our findings suggest that AFO improved ankle kinematics and walking ability in the short term; nonetheless, the evidence was characterized by a low degree of certainty.

Immediate effect of different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle on walking ability in individuals with chronic stroke: a randomized crossover trial

“…Although the change in spatiotemporal factors with improvement in the walking speed varies among reports 15) , walking speed is a combination of cadence multiplied by step length/stride length 16,17) , and cadence improvement with improvement in walking speed could be predicted. The American Heart Association/American Stroke Association guidelines 3) and a systematic review and meta-analysis 4) have emphasized the effect of AFO on stroke patients in ensuring toe clearance. The use of AFOs has been shown to increase the ankle dorsiflexion angle during the swing phase in stroke patients, which may promote effective toe clearance and reduced compensatory movements 4) .…”

“…The American Heart Association/American Stroke Association guidelines 3) and a systematic review and meta-analysis 4) have emphasized the effect of AFO on stroke patients in ensuring toe clearance. The use of AFOs has been shown to increase the ankle dorsiflexion angle during the swing phase in stroke patients, which may promote effective toe clearance and reduced compensatory movements 4) . In this study, the initial angle of the ankle joint of the AFO was dorsiflexed, which may have maintained toe clearance and led to a shortening of the affected side swing time (i.e., unaffected side single stance time).…”

“…Guidelines from the American Heart Association/American Stroke Association assert that using AFO prevents foot drop during the swing phase and improves the gait of stroke patients 3) . A systematic review and meta-analysis showed that AFOs increase the dorsiflexion angle of the ankle joints during walking and improve walking ability 4) .…”

The impact of ankle-foot orthosis's plantarflexion resistance on knee adduction moment in people with chronic stroke

“…AFOs can improve multiple aspects of gait such as temporospatial parameters, kinematics, kinetics, energy expenditure metrics, and functional performance in individuals poststroke. [1][2][3][4] A typical orthotic prescription for foot drop after stroke is a solid plastic AFO (i.e. a nonarticulated AFO), without a flexible joint at the ankle, which holds the toes up but allows very limited ankle movement.…”

Classification of Ankle Joint Stiffness during Walking to Determine the Use of Ankle Foot Orthosis after Stroke

“…An ankle foot orthosis (AFO) is a support device that can control the position and motion of the ankle by providing support for weak limbs or can position a limb into a more normal position. AFOs have been used in patients who have difficulty walking after stroke to improve gait patterns, gait speed, and energy expenditure [ 10 , 11 , 12 ]. An important characteristic of AFOs is stiffness, which involves a resistance to rotation at the ankle joint in the sagittal plane, as represented by the slope of the ankle moment versus the ankle angle curve of the AFO [ 13 ].…”