The effect of an ankle-foot orthosis on walking ability in chronic stroke patients: a randomized controlled trial.
OBJECTIVE
Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFO) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients.


METHODS
Cross-over design with randomization for the interventions.


METHODS
Twenty chronic stroke patients, wearing an AFO for at least six months, were included. Walking ability was operationalized as comfortable walking speed, scores on the timed up and go (TUG) test and stairs test. Patients were measured with and without their AFO, the sequence of which was randomized. Additionally, subjective impressions of self-confidence and difficulty of the tasks were scored. Clinically relevant differences based on literature were defined for walking speed (20 cm/s), the TUG test (10 s). Gathered data were statistically analysed using a paired t-test.


RESULTS
The mean difference in favour of the AFO in walking speed was 4.8 cm/s (95% CI 0.85-8.7), in the TUG test 3.6 s (95% CI 2.4-4.8) and in the stairs test 8.6 s (95% CI 3.1-14.1). Sixty-five per cent of the patients experienced less difficulty and 70% of the patients felt more self-confident while wearing the AFO.


CONCLUSIONS
The effect of an AFO on walking ability is statistically significant, but compared with the a priori defined differences it is too small to be clinically relevant. The effect on self-confidence suggests that other factors might play an important role in the motivation to use an AFO.
de Wit
D C M
DC
Roessingh Research and Development, Roessinghbleekweg 33B, 7522 AH Enschede, The Netherlands. dcmdewit.boz@hetnet.nl
Buurke
J H
JH
Nijlant
J M M
JM
Ijzerman
M J
MJ
Hermens
H J
HJ
D000328:Adult; D000368:Aged; D000842:Ankle / Q000503:physiopathology; D018592:Cross-Over Studies; D005260:Female; D005528:Foot / Q000503:physiopathology; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006429:Hemiplegia / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology*