Six-month effects of early or delayed provision of an ankle-foot orthosis in patients with (sub)acute stroke: a randomized controlled trial
- Authors: Corien DM Nikamp1,2, Jaap H Buurke1,2,Job van der Palen2,3,Hermie J Hermens1,2,Johan S Rietman1,2,4
1 Roessingh Research and Development, Enschede, The Netherlands2 University of Twente, Enschede, The Netherlands4 Roessingh Centre for Rehabilitation, Enschede, The Netherlands
3 Medisch Spectrum Twente, Enschede, The Netherlands
Summary: For determining the importance of an early orthotic treatment for gait rehabilitation after a stroke, 33 patients with acute or subacute stroke were provided with a simple ankle-foot orthosis. The patients were randomly divided in an early- (average of 32 days after the stroke) and a delayed-treated group, who received their orthoses eight weeks after the early-treated group. During a period of 26 weeks, the outcome was measured every two weeks using nine different functional tests and scores.
There were no differences between the early- and the delayed-treated group at the end of the study period of 26 weeks. Nevertheless, in the first three months after the orthosis provision the early-treated group’s balance, activities of daily living and walking abilities improved significantly compared to the patient group with the delayed orthotic treatment. Furthermore, independent walking was achieved about ten weeks earlier than in patients with a delayed orthosis provision. Reduced fall risk and improved walking speed enabled those patients to reach household ambulation about four to six weeks earlier. Although significant differences between an early and a delayed orthotic treatment were not detected after 26 weeks, these results might be clinically relevant since an early mobility might shorten the in-clinic stay and facilitate a more complex training within the rehabilitation.
Keywords: AFO, ankle-foot orthosis, stroke, six-month effect, timing of provision, randomized controlled trial