Ankle-foot orthosis improves walking ability of hemiplegic patients: a Meta-analysis

doi:10.3969/j.issn.2095-4344.2014.21.027

Abstract

Abstract:

BACKGROUND: Studies have shown that ankle-foot orthosis can increase the feedback on the input information from receptors in the skin of the foot and leg to improve the ankle joint position sense, and promote brain function reorganization.
OBJECTIVE: To systematically evaluate the effect of ankle-foot orthosis on the improvement of walking in hemiplegic patients.
METHODS: The Chinese Biomedical Literature Database, CNKI, WanFang Data and VIP database were searched for reports of randomized controlled trials of ankle-foot orthosis to improve walking ability in hemiplegic patients, from the date of establishment of each database to June 2013. The randomized controlled trials which met the criteria were included for the Meta-analysis.
RESULTS AND CONCLUSION: A total of 9 randomized controlled trials involving 456 patients were included. Meta-analysis showed that, compared with conventional treatment and drug therapy, ankle foot orthosis via the continuous treatment shows certain advantages to improve lower extremity motor function in hemiplegic patients, life skills and 10-meter maximum walking speed. Due to a limited number of included documents, the remaining indicators such as walking speed, stride difference and balance function were only for appropriate descriptive analysis. The results suggested that, by improving abnormal gait, walking speed, stride frequency, gait cycle, space asymmetry, ankle muscle spasms and balancing, the ankle-foot orthosis could achieve the goal of improving walking function. Ankle-foot orthoses could not be confirmed to exert the role in the following indicators, including time asymmetry, double support phase prolongation and stride length. This evidence shows that ankle-foot orthoses in hemiplegic patients may promote recovery of motor function of the lower limbs and activities of daily living to a certain extent, but the more high-quality, multi-center randomized controlled trials with large samples are necessary.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, orthopedic fixation devices, stroke, walking, evidence-based medicine

CLC Number:

R318

Liu Wei-hong, Liu Tao, Yi Li, Fu Li-na. Ankle-foot orthosis improves walking ability of hemiplegic patients: a Meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(21): 3438-3444.

Figures/Tables 7

2.3.3 限时步行功能检查法 2项研究采用限时步行功能检查法即10 m最大步行速度及6 min步行试验对步行速度进行了测定[6,8]，2项研究报道了踝足矫形器连续治疗8周，配戴时间大于2 h的结果，Meta分析结果显示在提高10 m最大步行速度方面，两组差异有显著性意义[加权均数差WMD=-1.10，95%可信区间(-1.38，-0.82)](图6)；2项研究报道了6 min步行试验结果[6,8]，2项研究间存在较大的异质性[P=0.15，I2=97%]，分析其异质性的原因，可能是2项研究分组不同，李哲等[6]的研究设计分组为动态踝足矫形器组、普通组及康复组，沈良册等[8]研究设计分组为改良型踝足矫形器组、普通组及康复组。故采用描述性分析，李哲等的研究结果表明，经连续治疗8周，每天配戴时间大于2 h，动态踝足矫形器组在6 min步行距离方面与其他两组相比较差异有显著性意义(P < 0.01)。沈良册等的研究结果表明，经连续治疗8周，每天配戴3 h，改良型踝足矫形器组在6 min步行距离方面与其他两组相比较，差异有显著性意义(P < 0.01或0.05)。 2.3.4 Berg平衡量表平衡功能评价 2项研究采用Berg平衡量表对偏瘫患者平衡功能进行了测定[5,9]，2项研究间存在较大的异质性[P=0.05，I2=73%]，分析其异质性的原因，王宏图[5]的研究纳入的患者Brunnstrom分级均小于 3级，而李冬梅等[9]的研究纳入的患者均可独立行走，2项研究基线存在一定差异，故采用描述性分析。王宏图等的研究提示，经连续治疗3个月，每天配戴时间2-10 h，踝足矫形器组平衡功能与对照组相比较差异有显著性意义(P < 0.05)。李冬梅等的研究提示，经连续治疗3个月，每天配戴时间大于4 h，踝足矫形器平衡功能与对照组相比较差异有显著性意义(P < 0.05)。 2.3.5 其他结局指标由于纳入研究数量有限及各研究评价方法差异较大，故仅作描述性分析如下：李冬梅等[9]的研究结果显示，采用踝足矫形器配合药物及康复治疗组对步速及左右步幅差的改善与均优于单纯药物配合康复治疗组(P < 0.05)。李迎光等[11]的研究结果显示，早期使用动态踝足矫形器组Fugl-Meyer量表平衡功能评分优于单纯康复治疗组(P < 0.05)。并且与对照组相比较，踝足矫形器治疗组能明显改善偏瘫患者的步行功能分级(P < 0.05)。王静等[10]的研究结果显示，与单纯药物配合康复治疗相比较，早期使用踝足矫形器配合药物及康复治疗能明显改善偏瘫患者的Brunnstrom运动功能，降低踝关节畸形发生率(P < 0.05)。覃佩红等[13]的研究结果显示，与常规康复治疗相比，改良式踝足矫形器能明显提高偏瘫患者步行功能分级(P < 0.01)。王宏图[5]的研究结果显示，早期使用轻型高温热塑踝足矫形器配合药物及康复连续治疗3个月或单纯药物配合康复治疗后：①采用英文原版RVGA量表进行步态分析，两组10 m自由步行速度、步频之间的差异有显著性意义(P < 0.05)，患侧跨步长之间差异无显著性意义(P > 0.05)，步态周期和患/健肢跨步长(空间不对称性)间的差异有显著性意义(P < 0.05)，双支撑相时间、双支撑相在步态周期中的百分比、患／健肢单支撑相比(时间不对称性)和患肢支撑相／摆动相间差异不显著(P > 0.05)。②两组下肢肌张力(改良Ashworth评测)和运动功能(以Brunnstrom分级评测)之间的比较差异无显著性意义(P > 0.05)。③生活能力改善方面采用简化SF-36量表中文版，结果提示两组患者在躯体角色、机体疼痛、总的健康、社会功能4个领域差异无显著性意义(P > 0.05)，而在躯体功能、活力、情绪角色、心理卫生4个领域及总分间的比较差异有显著性意义(P < 0.05)。但比较治疗前后SF-36量表各领域改善及总分改善时，则显示两组患者在躯体角色、机体疼痛、活力、心理卫生4个领域的改善差异无显著性意义(P > 0.05)；而在躯体功能、总的健康、社会功能、情绪角色4个领域的改善和总分的改善，治疗组明显好于对照组(P < 0.05)。"

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