Effect of types of ankle-foot orthoses on energy expenditure metrics during walking in individuals with stroke: a systematic review

Purpose: This systematic review is aimed at evaluating the efficacy of AFO types and comparison between them on the energy expenditure metrics of walking in individuals who had suffered a stroke with (sub)acute or chronic evolution. Methods: The following databases were searched; PubMed, Scopus, ISI Web of Knowledge, Embase and Cochrane Library based on the population intervention comparison outcome (PICO) method. Results: A total of 15 trials involving 195 participants were selected for the final evaluation. All trials, except one, examined individuals in chronic phase. Although the evidence from the selected studies was generally weak, the consensus was that an AFO may have a positive immediate effect on the energy expenditure metrics including energy cost, physiological cost index, mechanical work and vertical center of mass trajectory on the affected leg, in both overground walking and treadmill walking in adults with chronic stroke. There were insufficient studies to evaluate the medium term efficacy of wearing an AFO combined with gait training on metabolic cost parameters during ambulation. There were also insufficient studies for comparison among different designs of AFOs. Conclusions: An AFO can immediately improve energy expenditure metrics of walking in stroke survivors. There is a need for further well-designed randomized trials to evaluate long-term effect of gait training using AFOs and comparison among the different types of orthoses.IMPLICATIONS FOR REHABILITATION An AFO can immediately improve the energy expenditure metrics during walking after stroke. Measurement of energetic parameters of walking wearing a orthotic device such as an AFO can evaluate gait economy in stroke populations.