A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing

Corien Diana Maria Nikamp-Simons, Marte S.H. Hobbelink, Jacobus Adrianus Maria van der Palen, Hermanus J. Hermens, Johan Swanik Rietman, Jaap Buurke

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Abstract

Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (−3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and −6.1° (7.8) vs 2.6° (3.5), respectively), all p < 0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p ≤ 0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p = 0.026), stride duration (−0.08 s, p = 0.015) and single support duration (+1.0%, p = 0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. Trial registration number: NTR1930

Original languageEnglish
Pages (from-to)15-22
Number of pages8
JournalGait & posture
Volume55
DOIs
Publication statusPublished - 1 Jun 2017

Fingerprint

Foot Orthoses
Biomechanical Phenomena
Ankle
Randomized Controlled Trials
Stroke
Foot
Walking
Hip
Knee

Keywords

  • Ankle-foot orthosis
  • Gait analysis
  • Randomized controlled trial
  • Stroke rehabilitation
  • Timing of provision

Cite this

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title = "A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke: Short-term kinematic and spatiotemporal effects and effects of timing",
abstract = "Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (−3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and −6.1° (7.8) vs 2.6° (3.5), respectively), all p < 0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p ≤ 0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p = 0.026), stride duration (−0.08 s, p = 0.015) and single support duration (+1.0{\%}, p = 0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. Trial registration number: NTR1930",
keywords = "Ankle-foot orthosis, Gait analysis, Randomized controlled trial, Stroke rehabilitation, Timing of provision",
author = "Nikamp-Simons, {Corien Diana Maria} and Hobbelink, {Marte S.H.} and {van der Palen}, {Jacobus Adrianus Maria} and Hermens, {Hermanus J.} and Rietman, {Johan Swanik} and Jaap Buurke",
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T1 - A randomized controlled trial on providing ankle-foot orthoses in patients with (sub-)acute stroke

T2 - Short-term kinematic and spatiotemporal effects and effects of timing

AU - Nikamp-Simons, Corien Diana Maria

AU - Hobbelink, Marte S.H.

AU - van der Palen, Jacobus Adrianus Maria

AU - Hermens, Hermanus J.

AU - Rietman, Johan Swanik

AU - Buurke, Jaap

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (−3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and −6.1° (7.8) vs 2.6° (3.5), respectively), all p < 0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p ≤ 0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p = 0.026), stride duration (−0.08 s, p = 0.015) and single support duration (+1.0%, p = 0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. Trial registration number: NTR1930

AB - Initial walking function is often limited after stroke, and regaining walking ability is an important goal in rehabilitation. Various compensatory movement strategies to ensure sufficient foot-clearance are reported. Ankle-foot orthoses (AFOs) are often prescribed to improve foot-clearance and may influence these strategies. However, research studying effects of actual AFO-provision early after stroke is limited. We conducted an explorative randomized controlled trial and aimed to study the short-term effects of AFO-provision on kinematic and spatiotemporal parameters in patients early after stroke. In addition, we studied whether timing of AFO-provision influenced these effects. Unilateral hemiparetic patients maximal six weeks post-stroke were randomly assigned to AFO-provision: early (at inclusion) or delayed (eight weeks later). Three-dimensional gait-analysis with and without AFO in randomized order was performed within two weeks after AFO-provision. Twenty subjects (8 early, 12 delayed) were analyzed. We found significant positive effects of AFO-provision for ankle dorsiflexion at initial contact, foot-off and during swing (−3.6° (7.3) vs 3.0° (3.9); 0.0° (7.4) vs 5.2° (3.7); and −6.1° (7.8) vs 2.6° (3.5), respectively), all p < 0.001. No changes in knee, hip and pelvis angles were found after AFO-provision, except for knee (+2.3°) and hip flexion (+1.6°) at initial contact, p ≤ 0.001. Significant effects of AFO-provision were found for cadence (+2.1 steps/min, p = 0.026), stride duration (−0.08 s, p = 0.015) and single support duration (+1.0%, p = 0.002). Early or delayed AFO-provision after stroke did not affect results. In conclusion, positive short-term effects of AFO-provision were found on ankle kinematics early after stroke. Timing of AFO-provision did not influence the results. Trial registration number: NTR1930

KW - Ankle-foot orthosis

KW - Gait analysis

KW - Randomized controlled trial

KW - Stroke rehabilitation

KW - Timing of provision

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U2 - 10.1016/j.gaitpost.2017.03.028

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JF - Gait & posture

SN - 0966-6362

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