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Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research.

Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research.
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Prenton S, Hollands KL, Kenney LPJ, Onmanee P,


Prenton S, Hollands KL, Kenney LPJ, Onmanee P, (click to view)

Prenton S, Hollands KL, Kenney LPJ, Onmanee P,

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Journal of rehabilitation medicine 50(2) 129-139 doi 10.2340/16501977-2289
Abstract
OBJECTIVE
To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.

DATA SOURCES
MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.

STUDY SELECTION
One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.

DATA EXTRACTION
One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.

DATA SYNTHESIS
Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4-6 weeks’ use (p = 0.49) showed equal improvement for both devices.

CONCLUSION
Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

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