Carbon fiber ankle-foot orthoses in impaired populations: A systematic review.
Megan M Grunst, Robert C Wiederien, Jason M Wilken
PMID 36779973WHAT IT FOUND
Carbon fiber AFOs show generally positive outcomes (improved walking, reduced pain, better foot drop) in their target populations, but the evidence is mostly low-to-moderate quality with no RCTs, and results are device-specific and population-specific.
Key findings
01The IDEO, a stiff energy-storing orthosis, was associated with increased walking speed and reduced pain in military trauma patients, but it was used alongside a high-intensity rehabilitation program (the Return to Running pathway), so the contribution of the orthosis versus the program cannot be separated.
02Dorsiflexion-assist devices (ToeOff, WalkOn) and the Neuro Swing showed improved foot drop, balance, and reduced energy cost in neurological populations, but walking speed results for the Neuro Swing were conflicting across studies, and one study found only 1 of 6 children with cerebral palsy wore their prescribed orthosis the recommended amount of time.
03Most of the 78 included articles were of low to moderate overall quality, and the most common threat to internal validity was blinding of the intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
No protocol was prepared before the review was conducted. Most included articles were of low to moderate quality, with blinding of the intervention the most common internal validity threat. No randomized controlled trials were included in the evidence base. 28 of 78 articles did not adequately describe the carbon fiber AFO used, making it impossible to confirm what device was actually tested. No measures were taken to assess publication bias. The search was conducted in 2020, so more recent publications were not captured. Heterogeneity across device types, populations, and outcome measures prevented direct comparison or pooling of results.
Declared interests
The authors disclosed no potential conflicts of interest with respect to the research, authorship, or publication of this article.
The easy way to misread this
Do not read the IDEO's improved walking speed and reduced pain as evidence the orthosis alone produces these effects. The device was used alongside a high-intensity rehabilitation program (the Return to Running pathway), and the studies cannot separate the contribution of the orthosis from the program. The broader evidence base is also mostly low-to-moderate quality with no randomized controlled trials, so treat any single positive finding as hypothesis-generating rather than practice-changing.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →