Early specialist orthotic interventions for the lower limb in adult stroke patients: a systematic literature review
Keywords:Orthotics, Stroke, Early intervention, Mobility, Rehabilitation, Lower limb, Contracture
Background Stroke is a leading cause of long-term disability worldwide, estimated to affect up to 50% of stroke survivors. Many stroke survivors use orthotic splints and braces to help address difficulties with mobility and gait dysfunction both early after the stroke event and longer-term.
Objectives The aim of this systematic review was to identify, synthesise and appraise the evidence on early orthotic involvement for the lower limb following stroke.
Study design Systematic literature review
Methods We conducted a systematic search of electronic databases including: AMED (1985 to present; CINAHL (1982 to present); EMBASE (1980 to present); MEDLINE (1949 to present); PsycINFO (1967 to present). The search took place on 18/10/2019. Included studies evaluated an early orthotic intervention designed to either promote mobility or reduce secondary complications after stroke. Articles were screened for inclusion by two independent reviewers.
Results This review included six articles from one research group in the Netherlands. Methodological quality was considered good in each of the included studies. Limitations include small sample size, restricted descriptions of the intervention and short-term follow-ups.
Conclusion This systematic review suggests that earlier lower limb orthotic interventions can result in improved walking speed and balance, and enhanced ability to perform activities of daily living in the early weeks post-stroke. Future research would benefit from considering wider orthotic and orthotist intervention with larger sample sizes and longer-term outcomes.
Rago F. Disability after a stroke. The Stroke Foundation. 2021. Available from: https://thestrokefoundation.org/disability-after-a-stroke/
Bowers R, Ross K. Development of a best practice statement on the use of ankle-foot orthoses following stroke in Scotland. Prosthet Orthot Int. 2010 Sep;34(3):245-53. doi: 10.3109/03093646.2010.486392. PMID: 20528684.
International Society for Prosthetics and Orthotics. Report of a consensus conference on the orthotic management of stroke patients. (Condie E, Cambell J, Martina J, editors.). Copenhagen; 2004.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O'Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014 Jan 18;383(9913):245-54. doi: 10.1016/s0140-6736(13)61953-4. Erratum in: Lancet. 2014 Jan 18;383(9913):218. PMID: 24449944; PMCID: PMC4181600.
The Stroke Association. State of the nation: Stroke statistics. London; 2018. Available from: https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf
The British Association of Prosthetists and Orthotists. Orthotic Treatment: Stroke Rehabilitation. Paisley; 2014. Available from: https://www.bapo.com/resources/professional-affairs-resources/
Golding-Day MR, Walker MF, Whitehead PJ. Orthotic intervention following stroke: a survey of physiotherapist, occupational therapist and orthotist practice and views in the UK. International Journal of Therapy and Rehabilitation. 2022 Jun 2;29(6):1–16.
Tamburella F, Moreno JC, Iosa M, Pisotta I, Cincotti F, Mattia D, Pons JL, Molinari M. Boosting the traditional physiotherapist approach for stroke spasticity using a sensorized ankle foot orthosis: A pilot study. Top Stroke Rehabil. 2017;24:447–456.
Tyson SF, Sadeghi-Demneh E, Nester CJ. A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke. Clin Rehabil. 2013;27:879–891.
Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. A very early rehabilitation trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. Health Technol Assess (Rockv). 2017;21:1–119.
Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, Krakauer JW, Boyd LA, Carmichael ST, Corbett D, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke [Internet]. 2017 July 1 [cited 2022 June 23];12:444–450. Available from: https://journals.sagepub.com/doi/10.1177/1747493017711816?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Golding-Day M, Prince N, Walker M, Thomas S, Horne J, Thomas L. In adult stroke patients does early specialist orthotic intervention improve functional mobility and reduce complications in the lower limb when compared to usual care? PROSPERO. 2020;CRD4202020:1–4.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6:e1000097.
Nikamp C, Buurke J, van der Palen J, Hermans H. Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial. Clin Rehabil. 2017;31:798–808.
Nikamp C, Buurke J, van der Palen J, Hermens H, Rietman J. Six-month effects of early or delayed provision of an ankle-foot orthosis in patients with (sub)acute stroke: a randomized controlled trial. Clin Rehabil. 2017;31:1616–1624.
Nikamp C, Hobbelink M, van der Palen J, Hermens H, Rietman J, Buurke J. A randomized controlled trial on providing ankle-foot orthoses in patients with (sub)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing. Gait Posture. 2017;55:15–22.
Nikamp C, van der Palen J, Hermens H, Rietman J, Buurke J. The influence of early or delayed provision of ankle-foot orthoses on pelvis, hip and knee kinematics in patients with sub-acute stroke: A randomized controlled trial. Gait Posture. 2018;63:260–267.
Nikamp C, Buurke J, Schaake L, van der Palen J, Rietman J, Hermens H. Effect of long-term use of ankle-foot orthoses on tibialis anterior muscle electromyography in patients with sub-acute stroke: A randomized controlled trial. J Rehabil Med. 2019;51:11–17.
Nikamp CDM, Hobbelink MSH, van der Palen J, Hermens HJ, Rietman JS, Buurke JH. The effect of ankle-foot orthoses on fall/near fall incidence in patients with (sub-)acute stroke: A randomized controlled trial. PLoS One. 2019;14:e0213538.
Tyson SF, Kent RM. Effects of an ankle-foot orthosis on balance and walking after stroke: A systematic review and pooled meta-analysis. Arch Phys Med Rehabil. 2013;94:1377–1385.
Ramstrand N, Ramstrand S. AAOP State-of-the-Science Evidence Report: The Effect of Ankle-Foot Orthoses on Balance—A Systematic Review. J Prosthetics Orthot [Internet]. 2010 October 2:P4–P23. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=113564466&site=ehost-live
Ferreira LAB, Neto HP, Grecco ACG, Christovao TCL, Duarte NA-C, Lazzari RD, Galli M, Oliveira CS. Effect of ankle-foot orthosis on gait velocity and cadence of stroke patients: A systematic review. J Phys Ther Sci. 2013;25:1503–1508.
Leung J, Moseley A, J. L. Impact of ankle-foot orthoses on gait and leg muscle activity in adults with hemiplegia. Physiotherapy. 2003;89:39–60.
Lan Y, Xu G, Huang D, Mao Y, Chen S, Pei Z, Zeng J. Association between improved trunk stability and walking capacity using ankle-foot orthosis in hemiparetic patients with stroke: evidence from three-dimensional gait analysis. Chin Med J (Engl) [Internet]. 2013;126:3869–3873. Available from: http://www.cmj.org/ch/reader/create_pdf.aspx?file_no=2013-0921&year_id=2013&quarter_id=20&falg=1
Carse B, Bowers R, Meadows BC, Rowe P. The immediate effects of fitting and tuning solid ankle-foot orthoses in early stroke rehabilitation. Prosthet Orthot Int [Internet]. 2015;39:454–462. Available from: http://poi.sagepub.com/content/by/year
Wang H, Huang D. The effect of using the AFO in the early time on the walking ability in the hemiplegic stroke patients. Chinese J Rehabil Med. 2006;21:582–584.
Tyson SF, Vail A, Thomas N, Woodward-Nutt K, Plant S, Tyrrell PJ. Bespoke versus off-the-shelf ankle-foot orthosis for people with stroke: randomized controlled trial. Clin Rehabil [Internet]. 2018;32:367–376. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emexa&NEWS=N&AN=623851961
How to Cite
Copyright (c) 2022 Journal of the International Foot & Ankle Foundation
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.