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

Objective: To compare the randomized controlledtrial evidence for therapeutic effects on walking offunctional electrical stimulation and ankle foot orthosesfor foot drop caused by central nervous systemconditions. Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro,NIHR Centre for Reviews and Dissemination, Scopusand 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 papers reporting different measures from the same trial were grouped,resulting in 7 synthesized randomized controlledtrials (n= 464). Meta-analysis of walking speed atfinal assessment (p = 0.46), for stroke participants(p = 0.54) and after 4–6 weeks’ use (p = 0.49) showedequal 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 notshow whether this improvement translates into theuser’s own environment or reveal the mechanismsthat achieve that change. Future studies should focuson measuring activity, muscle activity and gaitkinematics. They should also report specific devicedetails, capture sustained therapeutic effects and involvea variety of central nervous system diagnoses