The efficacy of lower limb orthoses on quality of life, well-being, and participation following stroke: A systematic review.

Only ten studies were found, and none were excluded despite low quality because the pool was too small to be selective. The studies used different designs, different outcome measures, and different follow-up periods, making it impossible to pool results or compare them directly. Most participants were recruited by convenience, and none of the studies blinded assessors or participants to the orthosis. Seven of the ten studies did not report a sample size calculation and were likely underpowered. Most studies did not describe the orthosis in enough detail (material, thickness, trimlines, casting angle, or FES parameters) to replicate the intervention. Stroke severity was not controlled for in most studies, and one study found that the group with lower QoL also had more severe strokes, which could explain the difference rather than the orthosis. Natural recovery over time may account for some of the improvement seen in the positive studies.

The authors reported no financial support and no conflicts of interest.

Do not read the FES advantage as proof that FES is better than AFOs for quality of life or participation. More studies used FES, the critical appraisal found concerns in every included study, and the review explicitly states there is no evidence to support one intervention over the other.