Differences in activities of daily living between people with subacute stroke who received knee-ankle-foot and ankle-foot orthoses at admission.
Tomohiro Ota, Hiroyuki Hashidate, Natsuki Shimizu and 1 others
PMID 30349158WHAT IT FOUND
Stroke inpatients prescribed KAFO were more dependent in daily activities at admission than those prescribed AFO.
Bed, chair and wheelchair transfer scores, lower-limb motor stage and total independence were linked to which orthosis was chosen.
Key findings
01At admission, inpatients prescribed KAFO had lower total, motor and cognitive FIM scores and lower scores on every individual FIM item than inpatients prescribed AFO.
02Brunnstrom stage, total FIM, motor FIM and the bed-chair-wheelchair transfer item were associated with whether KAFO or AFO was prescribed after adjustment for age, gender, lesion side and time to prescription.
03The KAFO group had more participants with Brunnstrom stage I or II, while the AFO group had more with stage III.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The orthoses were not randomly assigned. Clinicians chose KAFO or AFO after evaluating standing and walking, so the groups differed before comparison and the analysis cannot separate the orthosis choice from the reason it was chosen. The study measured participants only at admission. It shows what ADL profile was associated with the orthosis already prescribed, not what happened after wearing KAFO or AFO. It was done in one rehabilitation hospital between 2006 and 2011 using traditional metal KAFO and AFO. Results may not apply to newer orthoses or other services. The authors did not examine impairments other than Brunnstrom stage or the effect of joint type on ADL characteristics. The findings do not explain which specific impairments drive the difference. The groups differed in age, gender, stroke type, lesion side, Brunnstrom stage and FIM scores. The regression adjusted only for some of these factors, and possible confounding remains. The paper says FIM scores were compared with Mann-Whitney U tests, but the results describe a two-sample t-test. This inconsistency makes the statistical reporting harder to check.
Declared interests
The authors declared no conflicts of interest, and the supplied text does not report a funding source.
The easy way to misread this
Do not read the lower FIM scores in the KAFO group as evidence that KAFO worsened ADL. The groups were already different at admission, and the orthosis was selected because of knee instability and transfer dependence, not assigned randomly.