title: Studies examining the efficacy of ankle foot orthoses should report activity level and mechanical evidence.
abstract: Ankle Foot Orthoses (AFOs) to promote walking ability are a common treatment in patients with neurological or muscular diseases. However, guidelines on the prescription of AFOs are currently based on a low level of evidence regarding their efficacy. Recent studies aiming to demonstrate the efficacy of wearing an AFO in respect to walking ability are not always conclusive. In this paper it is argued to recognize two levels of evidence related to the ICF levels. Activity level evidence expresses the gain in walking ability for the patient, while mechanical evidence expresses the correct functioning of the AFO. Used in combination for the purpose of evaluating the efficacy of orthotic treatment, a conjunct improvement at both levels reinforces the treatment algorithm that is used. Conversely, conflicting outcomes will challenge current treatment algorithms and the supposed working mechanism of the AFO. A treatment algorithm must use relevant information as an input, derived from measurements with a high precision. Its result will be a specific AFO that matches the patient's needs, specified by the mechanical characterization of the AFO footwear combination. It is concluded that research on the efficacy of AFOs should use parameters from two levels of evidence, to prove the efficacy of a treatment algorithm, i.e., how to prescribe a well-matched AFO.
authors.affiliation: Department of Rehabilitation Medicine, Research Unit MOVE, VU University Medical Center, Amsterdam, The Netherlands. j.harlaar@vumc.nl
authors.forename: Jaap
authors.initials: J
authors.lastname: Harlaar
authors.forename: Merel
authors.initials: M
authors.lastname: Brehm
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
authors.forename: Daan J J
authors.initials: DJ
authors.lastname: Bregman
authors.forename: Jaap
authors.initials: J
authors.lastname: Buurke
authors.forename: Fred
authors.initials: F
authors.lastname: Holtkamp
authors.forename: Vincent
authors.initials: V
authors.lastname: De Groot
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
mesh_terms: D000465:Algorithms; D000843:Ankle Joint; D001696:Biomechanical Phenomena / Q000502:physiology; D019317:Evidence-Based Medicine; D033023:Foot Joints; D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D009135:Muscular Diseases / Q000534:rehabilitation; D009422:Nervous System Diseases / Q000534:rehabilitation; D009989:Orthotic Devices; D016896:Treatment Outcome