Timing of providing ankle-foot orthoses in stroke rehabilitation.

Background:
Ankle-foot orthoses (AFOs) are often used in the rehabilitation after stroke. The effects of AFOs are mainly studied performing cross-over studies to assess the immediate and short-term effects. Evidence for long-term effects, and especially research studying the timing of providing AFOs is lacking. In order to study the effects of timing of providing AFOs after stroke a new longitudinal research is proposed. In this explorative study acute stroke patients will be included and 2 intervention groups will be arranged. Both intervention groups will differ in the moment in which the AFO will be provided during the rehabilitation process.
Objective:
To study the effects of timing of providing AFOs on mobility related activities and activities of daily living in acute stroke patients in a rehabilitation setting. Secondary, the effects of timing of providing AFOs on walking impairments, occurrence of falls and fall related events and the effect on quality of life is studied.
Study design:
Longitudinal design with randomisation for the intervention, parallel groups.
Study population:
Acute stroke patients admitted into the Roessingh Rehabilitation Centre in Enschede will participate. Subjects with an indication to use an AFO because of problems with stability in stance, problems with footclearance during swing or problems with foot prepositioning in early stance will be included.
Intervention:
Timing of providing AFOs will be compared in 2 groups:

1. Providing an AFO within one week after admission into the rehabilitation centre (approximately 2 weeks after stroke);

2. Providing an AFO 8 weeks later.
Main study parameters/endpoints:
Mobility related activities and activities of daily living (clinical tests, questionnaires). Secondary study parameters are walking impairments (gait analysis, instrumented tests, clinical tests), occurrence of falls and fall related events and quality of life after stroke (questionnaires).

Early provision of AFOs (± 2 wks after stroke) is expected to positively affect walking impairments, mobility and activities of daily living after acute stroke compared to providing AFOs later on in the rehabilitation process (± 10 wks after stroke). Furthermore, early provision of AFOs is expected to positively affect falling and quality of life.

1. Gait analysis: in week 1, 9, 17, 26 and 52;

2. Clinical tests: during the first 18 weeks of the study: 2-week interval, and in week 26 and 52.

Timing of providing an ankle-foot orthosis during the rehabilitation after stroke.

Early provision of AFOs (± 2 weeks after stroke) will be compared with providing an AFO 8 weeks later.