A systematic literature review comparing ankle-foot orthoses and functional electrical stimulation in the treatment of patients with multiple sclerosis

Statistics reveal that approximately 2.5 million people have been diagnosed with MS worldwide. This research aimed to review all available literature on the use of Ankle-Foot Orthoses (AFO) and Functional Electrical Stimulation (FES) for the treatment of gait difficulties in MS. An extensive systematic search was carried out using the electronic databases Embase, Medline, CSA Illumina, DyNamed, The Cochrane Library, Science Direct, ISI Web of Knowledge and The Knowledge Network. Of the full texts sourced only 14 experimental papers were considered appropriate for critical appraisal in this literature review. The most reported outcomes were walking speed and energy expenditure. Six of the nine FES trials reported a statistically significant increase in walking speed while one reported a non-significant decrease. Of the four AFO trials, three reported an increase in walking speed, although only one was statistically significant, and one trial showed a decrease. Psychological Cost Index (PCI) was commonly utilised as an indication of energy expenditure. Two of the four AFO trials reported a decrease in PCI compared to four of the nine FES, (three significant). Only the direct comparison trial and two of the five AFO trials, reported on stance phase kinematics, with the others focusing on swing phase related outcomes. The variation in outcome measures makes comparison between AFO and FES challenging. This literature review highlights several limitations in the current evidence base, particularly a lack of baseline information regarding participants and interventions being investigated. Few studies adequately report the biomechanical effects of FES and AFO. The majority of the reviewed studies are of a low level of evidence. Considerably more research is required of an elevated standard to strengthen evidence to inform future clinical practice