Comparing the Effect of Implanted Peroneal Nerve Stimulation and Ankle-Foot Orthosis on Gait Kinematics in Chronic Hemiparesis: A Randomized Controlled Trial.
Emilie Hutin, Mouna Ghédira, Maria Vinti and 3 others
PMID 37548420WHAT IT FOUND
For people with chronic hemiparesis, implanted peroneal nerve stimulation and ankle-foot orthosis did not differ in change in comfortable walking speed when the device was on.
Both devices improved walking speed, cadence, step length and ankle position during use.
Key findings
01The primary outcome showed no between-group difference in the change in comfortable walking speed from OFF to ON at M3.
02Pooled across groups, device-on walking speed was 0.76 ± 0.30 m/s compared with 0.69 ± 0.28 m/s device-off, and maximal ankle dorsiflexion was -1 ± 7° compared with -7 ± 7° device-off.
03AFO decreased mean dorsiflexion speed from 11.4 ± 9.1°/s OFF to 4.6 ± 4.7°/s ON, while SIS-FES remained stable at 13.9 ± 8.8°/s OFF and 13.7 ± 8.8°/s ON.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 24 participants were analysed, although 27 were randomized and the planned sample size was 25 per group. The expected number of subjects was not reached during the 3-year inclusion period. Everyday device use at home was not controlled. Associated rehabilitation care was not controlled, even though participants were asked to leave it unchanged. Participants walked at a comfortable speed of less than 0.7 m/s on average, so results may not apply to faster walkers. All participants could walk 50 m with or without an assistive device, so it says little about patients who cannot walk that distance.
The easy way to misread this
Do not conclude that implanted stimulation is better than an ankle-foot orthosis because it preserves dorsiflexion speed. The primary comparison of change in comfortable walking speed was null, and the dorsiflexion speed finding was secondary in a small trial.