Walking ability of stroke patients: efficacy of tibial nerve blocking and a polypropylene ankle-foot orthosis.
OBJECTIVE
To investigate the efficacy of tibial nerve blocking by percutaneous radiofrequency thermocoagulation and an ankle-foot orthosis on the walking ability of stroke patients with a spastic equinus or equinovarus foot.


METHODS
A placebo-controlled randomized clinical trial with a 2 x 2 factorial design and with a 3-month follow-up.


METHODS
Outpatient clinic of a department of rehabilitation medicine.


METHODS
Sixty stroke patients (17 women, 43 men) with a median age of 58 years and a median period of 34 months poststroke were allocated to one of four treatment groups.


METHODS
Changes in walking ability (measured with the Sickness Impact Profile category "ambulation"; possible score range, 0% to 100%) and walking speed after 3 months.


RESULTS
With respect to walking ability, the efficacy of thermocoagulation as compared with placebo thermocoagulation was .56% (95% confidence interval [CI] -3.01% to 4.13%), whereas the efficacy of the ankle-foot orthosis as compared with the placebo ankle-foot orthosis was 2.72% (95% CI -.94% to 6.38%). To study the potential synergistic effect of both treatments, a multivariate model was used; interaction between both treatments was small, .83% (95% CI -6.73% to 8.40%). Analysis restricted to the compliers (n = 30) showed an increased efficacy of thermocoagulation and a decreased efficacy of the ankle-foot orthosis. The changes in comfortable and maximal safe walking speed were less than .10m/sec and were neither clinically nor statistically significant (the median baseline values for the total group were .42m/sec and .56m/sec, respectively).


CONCLUSIONS
No support was found for the beneficial effects of either thermocoagulation of the tibial nerve or a polypropylene ankle-foot orthosis in 5 degrees of dorsiflexion on the walking ability of stroke patients.
Beckerman
H
H
Department of Rehabilitation Medicine. Academisch Ziekenhuis Vrije Universiteit Amsterdam, The Netherlands.
Becher
J
J
Lankhorst
G J
GJ
Verbeek
A L
AL
D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009407:Nerve Block / Q000379:methods*; D009989:Orthotic Devices; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D018434:Sickness Impact Profile; D013979:Tibial Nerve / Q000502:physiology*; D016138:Walking / Q000502:physiology*