Difference in independent mobility improvement from admission to discharge between subacute stroke patients using knee-ankle-foot and those using ankle-foot orthoses.
Tomohiro Ota, Hiroyuki Hashidate, Natsuki Shimizu and 1 others
PMID 30154590WHAT IT FOUND
Patients prescribed knee-ankle-foot orthoses had smaller mobility improvements than those prescribed ankle-foot orthoses, but they also started with more severe impairments.
The orthosis type alone did not cause the difference; initial severity and age were strong predictors of recovery.
Key findings
01Improvement in mobility scores was significantly lower in the KAFO group compared to the AFO group, but the KAFO group had significantly lower baseline mobility and total FIM scores at admission.
02A much smaller proportion of patients in the KAFO group achieved independent walking at discharge (7%) compared to the AFO group (35%).
03Baseline severity factors, including age, motor paralysis stage, and initial FIM scores, were significantly correlated with the amount of mobility improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This was not a randomized trial; patients were prescribed KAFOs or AFOs based on clinical judgment, meaning the groups differed significantly in baseline severity. The study did not account for cognitive and emotional disabilities or comorbidities, which can influence recovery. The analysis cannot determine if the orthosis type contributed to the outcomes or if the difference was entirely due to the patients' initial severity.
Declared interests
None declared.
The easy way to misread this
Do not conclude that AFOs are superior to KAFOs for improving mobility. The patients in the KAFO group had more severe impairments at baseline, which explains their smaller gains and lower rate of independent walking.