Comparison between a novel helical and a posterior ankle-foot orthosis on gait in people with unilateral foot drop: a randomised crossover trial.
Biomechanics
Foot drop
Neuromuscular disease
Orthotic devices
Peripheral neuropathy
Six-minute walk test
Journal
Journal of neuroengineering and rehabilitation
ISSN: 1743-0003
Titre abrégé: J Neuroeng Rehabil
Pays: England
ID NLM: 101232233
Informations de publication
Date de publication:
11 05 2023
11 05 2023
Historique:
received:
20
04
2022
accepted:
26
04
2023
medline:
15
5
2023
pubmed:
12
5
2023
entrez:
11
5
2023
Statut:
epublish
Résumé
Neuromuscular disease and peripheral neuropathy may cause drop foot with or without evertor weakness. We developed a helical-shaped, non-articulated ankle-foot orthosis (AFO) to provide medial-lateral stability while allowing mobility, to improve gait capacity. Our aim was to evaluate the effect of the helical AFO (hAFO) on functional gait capacity (6-min walk test) in people with peripheral neuropathy or neuromuscular disease (NMD) causing unilateral drop foot and compare with a posterior leaf spring AFO (plsAFO). Secondary aims were to compare functional mobility, 3D kinematic and kinetic gait variables and satisfaction between the AFOs. Single centre, randomised crossover trial from January to July 2017 in 20 individuals (14 with peripheral neuropathy and 6 with NMD, 12 females, mean age 55.6 years, SD 15.3); 10 wore the hAFO for the first week and 10 wore the plsAFO before switching for the second week. The 6-min walk test (6MWT), Timed Up and Go (TUG) test and 3D gait analysis were evaluated with the hAFO, the plsAFO and shoes only (noAFO) at inclusion and 1 week after wearing each orthosis. Satisfaction was evaluated with the Quebec user evaluation of satisfaction with assistive technology (QUEST). Median [interquartile range] 6MWT distance was greater with the hAFO (444 m [79]) than the plsAFO (389 m [135], P < 0.001, Hedge's g = 0.6) and noAFO (337 m [91], P < 0.001, g = 0.88). TUG time was shorter with the hAFO (8.1 s [2.8]) than the plsAFO (9.5 s [2.6], P < 0.001, g = - 0.5) and noAFO (10.0 s [2.6]), P < 0.001, g = - 0.6). The plsAFO limited plantarflexion during the loading response (plsAFO - 7.5 deg [6.0] vs. noAFO -13.0 deg [10.0], P = 0.0007, g = - 1.0) but the hAFO did not (- 11.0 deg [5.1] vs. noAFO, P = 0.05, g = - 0.5). Quasi-stiffness was lower for the hAFO than plsAFO (P = 0.009, g = - 0.7). The dimensionless eversion moment was higher (though not significantly) with the hAFO than noAFO. Neither orthosis reduced ankle power (P = 0.34). Median total QUEST score was higher for the hAFO (4.7 [0.7]) than the plsAFO (3.6 [0.8]) (P < 0.001, g = 1.9). The helical orthosis significantly and considerably improved functional gait performance, did not limit ankle mobility, increased lateral stability, though not significantly, and was associated with greater patient satisfaction than the posterior leaf spring orthosis. Trial registration The trial began before registration was mandatory.
Sections du résumé
BACKGROUND
Neuromuscular disease and peripheral neuropathy may cause drop foot with or without evertor weakness. We developed a helical-shaped, non-articulated ankle-foot orthosis (AFO) to provide medial-lateral stability while allowing mobility, to improve gait capacity. Our aim was to evaluate the effect of the helical AFO (hAFO) on functional gait capacity (6-min walk test) in people with peripheral neuropathy or neuromuscular disease (NMD) causing unilateral drop foot and compare with a posterior leaf spring AFO (plsAFO). Secondary aims were to compare functional mobility, 3D kinematic and kinetic gait variables and satisfaction between the AFOs.
METHODS
Single centre, randomised crossover trial from January to July 2017 in 20 individuals (14 with peripheral neuropathy and 6 with NMD, 12 females, mean age 55.6 years, SD 15.3); 10 wore the hAFO for the first week and 10 wore the plsAFO before switching for the second week. The 6-min walk test (6MWT), Timed Up and Go (TUG) test and 3D gait analysis were evaluated with the hAFO, the plsAFO and shoes only (noAFO) at inclusion and 1 week after wearing each orthosis. Satisfaction was evaluated with the Quebec user evaluation of satisfaction with assistive technology (QUEST).
RESULTS
Median [interquartile range] 6MWT distance was greater with the hAFO (444 m [79]) than the plsAFO (389 m [135], P < 0.001, Hedge's g = 0.6) and noAFO (337 m [91], P < 0.001, g = 0.88). TUG time was shorter with the hAFO (8.1 s [2.8]) than the plsAFO (9.5 s [2.6], P < 0.001, g = - 0.5) and noAFO (10.0 s [2.6]), P < 0.001, g = - 0.6). The plsAFO limited plantarflexion during the loading response (plsAFO - 7.5 deg [6.0] vs. noAFO -13.0 deg [10.0], P = 0.0007, g = - 1.0) but the hAFO did not (- 11.0 deg [5.1] vs. noAFO, P = 0.05, g = - 0.5). Quasi-stiffness was lower for the hAFO than plsAFO (P = 0.009, g = - 0.7). The dimensionless eversion moment was higher (though not significantly) with the hAFO than noAFO. Neither orthosis reduced ankle power (P = 0.34). Median total QUEST score was higher for the hAFO (4.7 [0.7]) than the plsAFO (3.6 [0.8]) (P < 0.001, g = 1.9).
CONCLUSIONS
The helical orthosis significantly and considerably improved functional gait performance, did not limit ankle mobility, increased lateral stability, though not significantly, and was associated with greater patient satisfaction than the posterior leaf spring orthosis. Trial registration The trial began before registration was mandatory.
Identifiants
pubmed: 37170277
doi: 10.1186/s12984-023-01184-x
pii: 10.1186/s12984-023-01184-x
pmc: PMC10176820
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
63Informations de copyright
© 2023. The Author(s).
Références
Prosthet Orthot Int. 2009 Sep;33(3):192-7
pubmed: 19658009
J Biomech. 2020 Jan 23;99:109533
pubmed: 31791632
J Am Geriatr Soc. 1991 Feb;39(2):142-8
pubmed: 1991946
Arch Phys Med Rehabil. 2007 Jan;88(1):120-3
pubmed: 17207687
Clin Biomech (Bristol, Avon). 2015 Jul;30(6):572-7
pubmed: 25911204
J Am Geriatr Soc. 2006 May;54(5):743-9
pubmed: 16696738
Muscle Nerve. 2017 Feb;55(2):202-205
pubmed: 27356926
Eur J Phys Rehabil Med. 2010 Sep;46(3):355-61
pubmed: 20927001
PLoS One. 2017 Oct 3;12(10):e0185641
pubmed: 28972994
Muscle Nerve. 2017 Mar;55(3):333-337
pubmed: 27421252
J Orthop Res. 1990 May;8(3):383-92
pubmed: 2324857
Dtsch Arztebl Int. 2019 May 17;116(20):347-354
pubmed: 31288916
J Orthop Sports Phys Ther. 2011 May;41(5):319-27
pubmed: 21335930
Eur J Phys Rehabil Med. 2013 Apr;49(2):169-78
pubmed: 23138679
Mult Scler Relat Disord. 2020 Feb;38:101490
pubmed: 31715504
Neurosurgery. 2017 Mar 1;80(3):380-385
pubmed: 27352275
J Rehabil Med. 2014 Sep;46(8):768-72
pubmed: 24953375
Muscle Nerve. 2012 Oct;46(4):512-9
pubmed: 22987691
Muscle Nerve. 2021 Jan;63(1):40-45
pubmed: 32696510
J Biomech. 2002 Apr;35(4):543-8
pubmed: 11934426
Clin Biomech (Bristol, Avon). 2007 Oct;22(8):905-16
pubmed: 17686557
Sci Rep. 2021 Aug 5;11(1):15879
pubmed: 34354172
Am J Respir Crit Care Med. 2002 Jul 1;166(1):111-7
pubmed: 12091180
Clin Rehabil. 2013 Oct;27(10):879-91
pubmed: 23798747
Muscle Nerve. 2014 Aug;50(2):273-7
pubmed: 24375426
Eur J Phys Rehabil Med. 2008 Mar;44(1):27-31
pubmed: 18385625
PM R. 2009 Jun;1(6):524-9
pubmed: 19627941
Gait Posture. 2018 May;62:268-279
pubmed: 29587246
Physiother Res Int. 2012 Dec;17(4):191-9
pubmed: 22228620
ScientificWorldJournal. 2014;2014:867869
pubmed: 24892102
PLoS One. 2013;8(3):e59935
pubmed: 23555839
Gait Posture. 2008 Jul;28(1):175-7
pubmed: 18255293
Prosthet Orthot Int. 2016 Apr;40(2):158-69
pubmed: 25428901
PM R. 2015 Mar;7(3):264-9
pubmed: 25134853
Prosthet Orthot Int. 2006 Aug;30(2):145-54
pubmed: 16990225