Articulated ankle-foot orthoses associated with home-based task-specific training improve functional mobility in patients with stroke: a randomized clinical trial

• Published in: Topics in stroke rehabilitation pp. 1 - 14
• Main Authors: Paula, Gabriela Vieira de, Luvizutto, Gustavo José, Miranda, Luana Aparecida, Regina da Silva, Taís, Silva, Lucas Tadeu Carvalho, Winckler, Fernanda Cristina, Modolo, Gabriel Pinheiro, Chiloff, Cristiane Lara Mendes, Zanati Bazan, Silméia Garcia, Costa, Rafael Dalle Molle da, Martin, Luis Cuadrado, Bazan, Rodrigo
• Format: Journal Article
• Language: English
• Published: England 11-09-2024
• Subjects: functional mobility; ankle-foot orthosis; international classification of functioning; quality of life; Randomized controlled trial; stroke; disability, and health checklist
• ISSN: 1074-9357; 1945-5119; 1945-5119
• DOI: 10.1080/10749357.2024.2399467

We compared fixed and articulated ankle-foot orthoses (AFOs) in home-based mobility tasks to assess short-term mobility, dynamic balance, quality of life, anxiety/depression, disability level, stroke severity, autonomy, human functioning, and patient satisfaction.
This was a two-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, and a complete case analysis involving patients with chronic stroke. The participants were randomized into two groups: fixed (
 = 24) and articulated (
 = 23) AFOs. The AFOs were custom-fabricated, and both groups performed four-week home-based mobility tasks five days weekly. Primary outcome measures included changes in balance and mobility assessed using the Tinetti Performance-Oriented Mobility Assessment (POMA), Timed Up and Go (TUG) test, and Functional Ambulation Category (FAC). Secondary outcomes included quality of life, anxiety/depression, disability, stroke severity, autonomy, human functioning, and patient satisfaction.
In a between-group comparison, after adjusting for age, sex, stroke severity, and thrombolysis, the articulated AFO group showed better performance in the TUG test (
 = 0.020; d = 0.93), POMA-Gait (
 = 0.001; d = 0.53), POMA-Total (
 = 0.048; d = 0.98), and FAC (
 = 0.003; d = 1.03) than the fixed AFO group. Moreover, significant difference was noted in human functioning (moving around using equipment)between the groups (
 = 0.047; d = 92).
A program involving home-based mobility tasks and articulated AFOs improved functional mobility after stroke.