Functional electrical stimulation versus ankle foot orthoses for foot-drop: A meta-analysis of orthotic effects.

Objective: To compare the effects on walking of functional electrical stimulation (FES) and ankle foot orthoses for foot-drop of central neurological origin, assessed in terms of unassisted walking behaviours compared with assisted walking following a period of use (combined-orthotic effects).

Data Sources: MEDLINE, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Scopus, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination and clinicaltrials.gov, plus reference list, journal, author and citation searches.

Study Selection: English language comparative randomized controlled trials (RCTs).

Data Synthesis: Seven RCTs were eligible for inclusion. Two of these reported different results from the same trial and another 2 reported results from different follow-up periods and were therefore combined, resulting in 5 synthesized trials with 815 stroke participants. Meta-analyses of data from the final assessment in each study and 3 overlapping time-points showed comparable improvements in walking speed over 10 m (p = 0.04-0.79), functional exercise capacity (p = 0.10-0.31), timed up-and-go (p = 0.812 and p = 0.539) and perceived mobility (p = 0.80) for both interventions.

Conclusion: Data suggest that, in contrast to assumptions that predict FES superiority, ankle foot orthoses have equally positive combined-orthotic effects as FES on key walking measures for foot-drop caused by stroke. However, further long-term, high-quality RCTs are required. These should focus on measuring the mechanisms-of-action; whether there is translation of improvements in impairment to function, plus detailed reporting of the devices used across diagnoses. Only then can robust clinical recommendations be made.