Effect of ankle-foot orthoses on gait, balance and gross motor function in children with cerebral palsy: a systematic review and meta-analysis

Objective: To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. Data sources: Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. Review methods: Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. Results: Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD=0.88, P<0.001) and gait speed (SMD=0.28, P<0.001), and decreased cadence (SMD=-0.72, P<0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD=0.30, P=0.004), E (SMD=0.28, P=0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD=0.57, P<0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD=1.65, P<0.001) and during swing (SMD=1.34, P<0.001), and decreased ankle power generation in stance (SMD=-0.72, P<0.001) in children with equinus gait. Conclusion: In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.