Functional electrical stimulation versus ankle foot orthoses for foot-drop : a meta-analysis of orthotic effects

Prenton, S; Hollands, K; Kenney, LPJ

Abstract

Objective: To compare the effects on walking of functional
electrical stimulation (FES) and ankle foot orthoses for footdrop of central neurological origin, assessed in terms of unassisted walking behaviours compared with assisted walking following a period of use (combined-orthotic effects).
Data sources: MEDLINE, AMED, CINAHL, Cochrane Central
Register of Controlled Trials, Scopus, REHABDATA,
PEDro, NIHR Centre for Reviews and Dissemination and
clinicaltrials.gov, plus reference list, journal, author and citation searches.
Study selection: English language comparative randomized
controlled trials (RCTs).
Data synthesis: Seven RCTs were eligible for inclusion. Two
of these reported different results from the same trial and
another 2 reported results from different follow-up periods
and were therefore combined, resulting in 5 synthesized
trials with 815 stroke participants. Meta-analyses of data
from the final assessment in each study and 3 overlapping
time-points showed comparable improvements in walking
speed over 10 m (p = 0.04–0.79), functional exercise capacity (p = 0.10–0.31), timed up-and-go (p = 0.812 and p = 0.539) and perceived mobility (p = 0.80) for both interventions.
Conclusion: Data suggest that, in contrast to assumptions
that predict FES superiority, ankle foot orthoses have equally positive combined-orthotic effects as FES on key walking measures for foot-drop caused by stroke. However, further long-term, high-quality RCTs are required. These should focus on measuring the mechanisms-of-action; whether there is translation of improvements in impairment to function, plus detailed reporting of the devices used across diagnoses. Only then can robust clinical recommendations be made.

• Journal Article Type: Article
• Acceptance Date: Jul 15, 2016
• Online Publication Date: Aug 22, 2016
• Publication Date: Oct 5, 2016
• Deposit Date: Sep 8, 2016
• Publicly Available Date: Sep 8, 2016
• Journal: Journal of Rehabilitation Medicine
• Print ISSN: 1650-1977
• Electronic ISSN: 1651-2081
• Publisher: Foundation for Rehabilitation Information
• Volume: 48
• Issue: 8
• Pages: 646-656
• DOI: https://doi.org/10.2340/16501977-2136
• Publisher URL: http://dx.doi.org/10.2340/16501977-2136
• Related Public URLs: http://www.medicaljournals.se/jrm/