Efficacy of Knee–Ankle–Foot Orthosis on Functional Mobility and Activities of Daily Living in Patients with Stroke: A Systematic Review of Case Reports

Abstract

Objective: To synthesize available evidence from case reports regarding the efficacy of knee–ankle–foot orthosis (KAFO) on functional mobility and activities of daily living (ADL) in patients with stroke.
Methods: The following databases were searched, based on the Population Intervention Comparison Outcome (PICO) model: PubMed, CINAHL, Sco- pus, Cochrane Central Register of Controlled Trials, PEDro, Web of Science, and Igaku Chuo Zassi (in Japanese). Methodological quality was assessed using the CARE checklist.
Results: A total of 14 articles, including 15 cases, were selected. Clinically meaningful improvement in functional mobility was reported in 10 of 15 cases, measured using the Functional Ambulatory Category, Trunk Control Test, walking speed, and Berg Balance Scale. Clinically meaningful improvement in ADL was reported in 9 of 15 cases, measured using the Barthel Index and Functional Independent Measure. However, the methodological quality of the reviewed articles was low, with missing information on limitations of management, adverse events, and patient-reported outcomes.
Conclusion: This systematic review of case reports found a low level of evidence of the efficacy of KAFO in terms of improvement in functional mobility and ADL. Of value, this study revealed the optimal outcomes for measuring the efficacy of KAFO.

LAY ABSTRACT
For many years, rehabilitation experts have considered knee–ankle–foot orthosis (KAFO) therapy to be effective for patients with stroke. However, evidence regarding the efficacy of KAFO is unclear, since there is a lack of published high-quality studies. Recently, some case reports have been published claiming the efficacy of KAFO therapy. A systematic review was performed, which reviewed 14 case reports involving 15 patients. Improvements of functional mobility and activities of daily living were shown in 10 and 9 of the 15 patients, respectively. However, the methodological quality of the reviewed case reports was low. These findings present the current evidence from case reports regarding KAFO therapy in patients with stroke; however, the findings are insufficient to draw clear conclusions about the efficacy of such therapy. Of value, the study revealed the optimal outcome measures for use in measuring the effect of KAFO therapy, which can be used to facilitate high-quality future studies.