Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis

Purpose: To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments. Methods: PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible. Results: Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19–0.88), timed-up and go test (SMD: −0.45, CI: −0.67 to −0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25–2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53–1.28), Timed Up-Stairs (SMD: −0.35, CI: −0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38–0.92). Heterogeneity was non-significant for all outcomes (I ² < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others. Conclusions: An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATION An AFO can improve functional performance and ambulation in survivors of strokes. Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured. There was no evidence as to the effectiveness of specific AFO designs over others.