Abstract

ObjectivesThe purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation.Subjects and MethodsThis study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission.ResultsIn this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001).ConclusionsThese data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

Highlights

  • These data suggest that stroke survivors may have better functional recovery if they are prescribed an ankle–foot orthoses (AFOs) than if they are not prescribed an AFO

  • Previous recommendations identify the use of ankle–foot orthoses (AFOs) as a feasible option in the rehabilitation of patients with hemiplegia after stroke

  • Teasell et al researched factors associated with AFO use in stroke patients undergoing rehabilitation, and showed that AFO use was associated with lower admission and discharge Functional Independence Measure (FIM) [21]

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Summary

Introduction

Previous recommendations identify the use of ankle–foot orthoses (AFOs) as a feasible option in the rehabilitation of patients with hemiplegia after stroke. A National Health Service Quality Improvement Scotland scoping exercise identified the use of AFOs following stroke as a clinical improvement priority, leading to the development of a best practice statement on AFO use after stroke [1]. Some rehabilitation practitioners avoid using AFOs due to personal preferences. Biomechanical gait analyses have shown AFOs to improve ankle and knee kinematics in stroke patients [2]. A previous meta-analysis showed that AFOs improve walking ability, gait speed, and balance after stroke [3]. Another report suggested that AFOs potentially reduce the risk of falls in stroke patients with hemiplegia [4]

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