Comparative Effects of Ankle-Foot Orthosis and Functional Electrical Stimulation on Gait Endurance and Participant Preference in Individuals with Foot Drop of Central Pathology: Systematic Review

IntroductionAnkle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aim of this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function.MethodsA literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements.ResultsTwenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES.ConclusionsOur review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO.Clinical RelevanceFor patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function.