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Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke

OBJECTIVE: (1) To study the effects of providing ankle-foot orthoses in subjects
with (sub)acute stroke; and (2) to study whether the point in time at which an
ankle-foot orthosis is provided post-stroke (early or delayed) influences these effects.
DESIGN: Randomized controlled trial. SETTING:
Rehabilitation centre.
SUBJECTS: Unilateral hemiparetic stroke subjects with indication for use of an
ankle-foot orthosis and maximal six weeks post-stroke. INTERVENTIONS: Subjects
were randomly assigned to: early provision (at inclusion; Week 1) or delayed
provision (eight weeks later; Week 9). OUTCOME MEASURES: 10-metre walk test,
6-minute walk test, Timed Up and Go Test, stairs test, Functional Ambulation
Categories, Berg Balance Scale, Rivermead Mobility Index and Barthel Index;
assessed in Weeks 1, 3, 9 and 11. RESULTS: A total of 33 subjects were randomized
(16 early, 17 delayed). Positive effects of ankle-foot orthoses were found two
weeks after provision, both when provided early (significant effects on all
outcomes) or delayed (Berg Balance Scale p = 0.011, Functional Ambulation
Categories p = 0.008, 6-minute walk test p = 0.005,
Timed Up and Go Test p =
0.028). Comparing effects after early and delayed provision showed that early
provision resulted in increased levels of improvement on Berg Balance Scale (+5.1
points, p = 0.002), Barthel Index (+1.9 points, p = 0.002)
and non-significant
improvements on 10-metre walk test (+0.14 m/s, p = 0.093) and Timed Up and Go
Test (-5.4 seconds, p = 0.087), compared with delayed provision. CONCLUSIONS: We
found positive effects of providing ankle-foot orthoses in (sub)acute stroke
subjects that had not used these orthoses before.

Langue : ANGLAIS

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