EFFECTS OF ANKLE-FOOT ORTHOSES ON FUNCTION AND QUALITY OF LIFE IN PATIENTS POST STROKE
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Purpose: According to the Center for Disease Control and Prevention a person suffers a stroke every four minutes. Many patients post stroke experience a loss of motor control, hemiparesis, and gait impairments. In particular, weakness of dorsiflexor muscles leads to impaired gait pattern resulting in difficulty with toe clearance. Regaining the ability to walk in an efficient manner is a major goal for patients and therapists. Physiotherapists often recommend the use of an ankle-foot orthosis (AFO) to improve functional performance in patients post stroke. A variety of AFO's are utilized and determining which AFO is most effective can be arduous. The purpose of this critical appraised topic was to review current evidence for the effectiveness of AFO at improving gait impairments, functional mobility, and the subsequent impact on quality of life in the post stroke population. Methods: An extensive review of literature was conducted using CINAHL, Ovid, and PubMed with search key words: stroke, gait, AFO, function, quality of life and limited articles published from 2001 to 2012. A total of 228 articles from the literature review were subsequently analyzed by a team of 4 raters. The top 10 articles were selected for inclusion in this study based on: strength of research design, alignment with scope of review and use of specific outcome measures. Results: The use of AFO in patients post stroke results in: (1) improvements in gait velocity and ambulatory function when compared to barefoot and/or shoe walking (highest level of evidence); (2) improvements in balance and weight bearing on the affected leg (moderate level of evidence); (3) subjective reports from a majority of AFO users indicating improved confidence in walking and overall quality of life (low/moderate level of evidence primarily due to low number of studies) ; and (4) no sufficient evidence was presented to support the use of one specific type of AFO over others, however a debate concerning the use of solid AFO in acute stage followed by use of dynamic AFO in chronic stage post stroke was identified. Conclusions: Overall, the use of AFO in patients post stroke has low/moderate level of evidence for improvements in gait impairments and functional mobility as well as quality of life. To establish a higher level of evidence, larger sample size, random control studies using outcome measures targeting impairments, function and participation categories are needed.