A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke: SWIFT Cast Trial.
BACKGROUND
Timely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic.


OBJECTIVE
To evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery.


METHODS
This was a randomized controlled, observer-blind trial. Participants (n = 105) were recruited 3 to 42 days poststroke. All received conventional physical therapy (CPT) that included use of "off-the-shelf" and orthotist-made AFOs. People allocated to the experimental group also received a SWIFT Cast for up to 6 weeks. Measures were undertaken before randomization, 6 weeks thereafter (outcome), and at 6 months after stroke (follow-up). The primary measure was walking speed. Clinical efficacy evaluation used analysis of covariance.


RESULTS
Use of a SWIFT Cast during CPT sessions was significantly higher (P < .001) for the SWIFT Cast (55%) than the CPT group (3%). The CPT group used an AFO in 26% of CPT sessions, compared with 11% for the SWIFT Cast group (P = .005). At outcome, walking speed was 0.42 (standard deviation [SD] = 0.37) m/s for the CPT group and 0.32 (SD = 0.34) m/s for the SWIFT Cast group. Follow-up walking speed was 0.53 (SD = 0.38) m/s for the CPT group and 0.43 (0.34) m/s for the SWIFT Cast group. Differences, after accounting for minimization factors, were insignificant at outcome (P = .345) and follow-up (P = .360).


CONCLUSIONS
SWIFT Cast did not enhance the benefit of CPT, but the control group had greater use of another AFO. However, SWIFT Cast remains a clinical option because it is low cost and custom-made by therapists who can readily adapt it during the rehabilitation period.
University of East Anglia, Norwich, UK v.pomeroy@uea.ac.uk.
Valerie M
VM
Pomeroy
University of Strathclyde, Glasgow, UK.
Philip
P
Rowe
University of East Anglia, Norwich, UK.
Allan
A
Clark
University of East Anglia, Norwich, UK University of Leeds, UK.
Andrew
A
Walker
University of Strathclyde, Glasgow, UK.
Andrew
A
Kerr
University of East Anglia, Norwich, UK.
Elizabeth
E
Chandler
Stroke Managed Clinical Network NHS Lanarkshire, Airdrie, UK.
Mark
M
Barber
University of Cambridge and INSERM U894, Hopital Sainte-Anne, Sorbonne Paris Cité, Paris, France.
Jean-Claude
JC
Baron
D000368:Aged; D000842:Ankle; D002370:Casts, Surgical; D005081:Exercise Therapy; D005528:Foot; D006801:Humans; D008875:Middle Aged; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
orthotics; physical therapy; rehabilitation; stroke; walking