Effects of carbon versus plastic ankle foot orthoses on gait outcomes and energy cost in patients with chronic stroke.
Diana Rimaud, Rodolphe Testa, Guillaume Y Millet and 1 others
PMID 39175453WHAT IT FOUND
The composite ankle-foot orthosis did not outperform the custom-made plastic one on walking distance, speed, or energy cost in 15 chronic stroke patients.
Both, however, beat no orthosis. Patients preferred the composite.
Key findings
01The composite AFO and the plastic AFO produced no significant difference in 6MWT distance (296.8 m vs 301.9 m) or energy cost (0.23 vs 0.23 ml O2/kg/m). Both were significantly better than no AFO (269 m; energy cost 0.27).
02Energy cost of walking was 15% lower with both AFOs (0.23 ml O2/kg/m) than without (0.27 ml O2/kg/m), p = 0.024 for both comparisons.
03Satisfaction was significantly higher for the composite AFO on 'bigger steps' (p = 0.03) and 'less fatigue' (p = 0.02). 67% of patients chose to keep the composite AFO at the end of the study.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 15 patients, all from a single rehabilitation unit, so the results may not generalise to more severe or more varied stroke populations. The study was non-blinded: patients knew which orthosis they were wearing, which could influence self-paced walking and satisfaction ratings. The composite AFO was familiarised for only 2 weeks. Longer-term comfort, durability, and gait effects are unknown. The subgroup analysis (knee hyperextension vs flexed knee) is post-hoc and based on 6 vs 0 and 4 vs 0 patients, far too small to guide individual prescribing. The composite AFO was an off-the-shelf product with limited customisation (trimmable footplate only), so the finding applies to that specific device, not to all composite AFOs.
Declared interests
Thuasne SAS, the manufacturer of the SpryStep composite AFO used in the study, funded the research. The funding mainly covered the gait analysis platform costs.
The easy way to misread this
Do not read the knee-hyperextension subgroup as a general prescribing rule. All 6 patients with knee hyperextension walked faster with the composite AFO, while all 4 with a flexed knee did not. With 15 patients total, this split is too small to guide individual decisions.
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