Effects of an ankle-foot orthosis on balance and walking after stroke: a systematic review and pooled meta-analysis

Objective: To determine the effectiveness of an ankle-foot orthosis (AFO) on mobility, walking, and balance in people with stroke.

Data sources: The following databases were searched from inception to November 2011: Cochrane Stroke, Movement Disorders and Injuries Groups, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and the Physiotherapy Evidence Database. Previous reviews, reference lists, and citation tracking of the selected articles were screened, and the authors of selected trials were contacted for any further unpublished data.

Study selection: Randomized controlled trials of AFOs in people with stroke, which measured balance, walking impairments, or mobility and were reported in English, were selected. Then we independently identified trials, extracted data, and assessed trial quality.

Data extraction: Trials with a low risk of selection, performance, and attrition bias were selected for analysis. Information on the trial design, population recruited, intervention delivered, outcomes measured, and the mean ± SD values for the treatment and control groups were extracted.

Data synthesis: Continuous outcomes were combined using weighted or standardized mean differences with 95% confidence intervals and a fixed-effect model. Thirteen trials with 334 participants were selected. The effect of an AFO on walking activity (P=.000-.001), walking impairment (P=.02), and balance (weight distribution) (P=.003) was significant and beneficial. The effect on postural sway (P=.10) and timed mobility tests (P=.07-.09) was nonsignificant, and the effect on functional balance was mixed. The selected trials were all crossover trials of the immediate effects; long-term effects are unexplored.

Conclusions: An AFO can improve walking and balance after stroke, but only the immediate effects have been examined. The effects and acceptability of long-term usage need to be evaluated.