Despite their limitations, functional electrical stimulation (FES) and AFOs are both endorsed in the management of foot drop. However, current guidelines do not provide clinicians with a clear patient pathway. Toward this end, a team from the University of Huddersfield, School of Human and Health Sciences, Department of Health Sciences, Health and Rehabilitation Division; and the University of Salford, School of Health Sciences, both located in England, conducted a literature review to compare the effects on walking of FES and AFOs for foot drop of central neurological origin. The comparison was assessed in terms of unassisted walking behaviors and assisted walking following a period of use (combined-orthotic effects).
Nine electronic databases were searched: MEDLINE (Ovid), AMED (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, and clinicaltrials.gov. A search strategy including controlled vocabularies related to “electric stimulation,” “walking,” and “nervous system diseases,” and terms such as “foot drop” and “electric* stimulat*” were used with no date limits. Searches for reference list, citation, key author, and journal were also completed and all searches were limited to the English language. Seven randomized controlled trials (RCTs) were eligible for inclusion. Two of these reported different results from the same trial and another two reported results from different follow-up periods and were therefore combined, resulting in five synthesized trials with 815 participants who had suffered strokes. Meta-analyses of data from the final assessment in each study and three overlapping time points showed comparable improvements in walking speed over 10m, functional exercise capacity, timed up and go, and perceived mobility for both interventions.
According to the researchers, data suggests that AFOs have equally positive combined-orthotic effects as FES on key walking measures for foot drop caused by stroke. Before robust clinical recommendations can be made, however, they recommend further long-term, high-quality RCTs that focus on measuring the mechanisms of action and determining whether there is translation of improvements in impairment to function, and detailed reporting of the devices used across diagnoses.
The study was e-published ahead of print on August 22 in the Journal of Rehabilitation Medicine.
