Effect of using knee extension aid for gait training in subacute hemiplegia: a randomized controlled trial.
Minoru Murayama, Ayumu Hoshi
PMID 42544336WHAT IT FOUND
A 2-week gait training programme using a knee-extension aid with an AFO reduced knee flexion during terminal swing in 15 subacute hemiplegic patients.
The AFO-alone control group showed no change. The aid is a low-cost tool for therapists assisting from behind.
Key findings
01In the intervention group, the median knee joint angle during terminal swing decreased from 3.5° at baseline to −0.5° after 2 weeks of training with the knee extension aid and AFO, which the authors describe as an improvement of approximately 4° toward greater knee extension.
02In the control group, which trained with the AFO alone for the same 2-week period, no significant changes were observed in any gait phase, including terminal swing.
03The trial was run at five convalescent rehabilitation hospitals in Japan; 30 patients were randomly assigned using a random number table, 15 to the intervention group and 15 to the control group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Neither participants nor therapists were blinded, so expectation effects on both sides cannot be ruled out. The intervention group was assessed roughly 4 weeks earlier post-stroke than the control group (102.8 vs 127.2 days), which the authors acknowledge may have influenced outcomes. Convenience sampling at five hospitals in one country limits generalisability. Only 30 patients were randomised; the study was not powered to detect small effects in secondary phases. The 4° change in terminal-swing knee angle is the only significant finding, and the authors themselves question whether it is clinically meaningful. The device requires therapist skill to time correctly; the authors note therapists need to practise before clinical use. Knee angles were the only outcome measured; no gait speed, stride length, or functional-independence scores were reported.
Declared interests
Funded by JSPS KAKENHI (grant number 23K16657). The authors declare no conflicts of interest. The knee extension aid is a registered utility model (number 3232914) developed by the authors, which is a potential interest not separately flagged in the conflict-of-interest statement.
The easy way to misread this
Do not read the 4° reduction in terminal-swing knee flexion as evidence that the aid improves overall gait speed, stride length, or functional independence. The study measured only knee joint angles across gait phases, found no change in any other phase, and the authors themselves state it is uncertain whether 4° is clinically meaningful. The trial was unblinded, small (n = 30), used convenience sampling, and the two groups were assessed at different times post-stroke, so the between-group contrast is weakened even though the within-group change in the intervention arm reached significance.