Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research
Sarah Prenton, Kristen L. Hollands, Laurence P.J. Kenney, Pornsuree Onmanee
School of Human and Health Sciences, University of Huddersfield, HD1 3DH Huddersfield, United Kingdom. E-mail: firstname.lastname@example.org
Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.
Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.
Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.
Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.
Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices.
Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.
Foot-drop, where it is difficult to lift your foot up during walking, is a common problem for people who have brain or spinal cord disorders. We reviewed the randomised controlled trial evidence that compared ankle-foot orthoses and functional electrical stimulation after they were worn for a period of time but then removed to see if either or both had any effects on walking. We found 7 randomised controlled trials with 464, mainly stroke, participants which made this comparison. This review statistically showed that functional electrical stimulation and ankle-foot orthoses are equally effective at increasing walking speed. What the randomised controlled trials could not tell us was how the increased walking speed was achieved or whether the increased walking speed meant that users were able to do more in their own environments. We concluded that before better guidance about which to use could be developed future trials are needed that collect different measures. These randomised controlled trials need to include participants with a variety of brain and spinal cord disorders.