Effectiveness of an ankle–foot orthosis on walking in patients with stroke: a systematic review and meta-analysis

We conducted a meta-analysis to investigate the effectiveness of ankle–foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger’s test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34–0.66; P < 0.00001; I(2), 0%), cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001; I(2), 0%), step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003; I(2), 2%), stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003; I(2), 7%), Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01; I(2), 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001; I(2), 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001; I(2), 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03; I(2), 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.