02 Jul 2009

Research Review: Orthosis for upper and lower limbs following stroke - A Cochrane Review

Tyson SF, Kent RM. Orthotic devices after stroke and other non-progressive brain lesions. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003694.

Tyson and Kent (2009) undertook this Cochrane Review to examine the best available evidence regarding the effect of orthoses for the ankle or wrist in people with stroke or other brain-related neurological conditions. Orthoses are firm splits worn under clothes in order to provide support for joints or hold an limb in a preferred position during movement or rest. Tyson and Kent identified 14 clinical trials relevant to their review: 11 study related to ankle-foot orthoses (AFOs) and three studies related to orthoses for the wrist and hand.

Findings from studies on AFOs:
While there were some limitations to the studies that Tyson and Kent identified (e.g. they were all randomised cross-over studies with participants acting as their own controls and they all only looked at the immediate effect of AFO rather the health effects over long periods of time) the conclusion from this review were that AFOs were in general beneficial for people with leg and foot weakness following stroke. A meta-analysis of results from these studies demonstrated that the use of AFOs could increase speed of walking and improve balance in standing. In other words, if you or a patient of yours has balance and mobility problems following a stroke but has not yet tried an AFO, it would be worth doing so. Information about AFO can be provided by physiotherapy departments in your local DHB.

Findings from studies on upper limb orthosis:
Analysis of the three studies on use of wrist and hand orthosis however did not produce any statistically significant results. Wrist and hand orthosis were not shown to have any effect on hand function, range of movement of the hand or fingers, or on pain. While these studies were small, the sample sizes had been based on appropriate power calculations, meaning that if the orthosis were to have a clinically significant effect, the studies ought to have had enough people in them to detect such a difference. Tyson and Kent concluded that their review does not support the use of wrist and hand orthosis for people with stroke, but that further research needs to be conducted, particularly regarding the combination of wrist and hand orthosis with other interventions, such as botulinum toxin injections for spasticity or (I would argue) active exercise regimes.

This systematic review can be downloaded for free from the Cochrane Library, and a commentary on this review can be downloaded from the Cochrane Collaboration as a podcast.

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