A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke: SWIFT Cast Trial. (January 2016)

• Record Type: Journal Article
• Authors: Pomeroy, Valerie M.; Rowe, Philip; Clark, Allan; Walker, Andrew; Kerr, Andrew; Chandler, Elizabeth; Barber, Mark; Baron, Jean-Claude
• Other Names: Anderson Lindsay non-byline-author.; Dounavi Myrto-Despoina non-byline-author.; Earl Leo non-byline-author.; Gregory Sheila non-byline-author.; Havis Claire non-byline-author.; Horton Simon non-byline-author.; Jones P. Simon non-byline-author.; Kaliarntas Konstantinos non-byline-author.; Kennedy Niamh non-byline-author.; Lane Kathleen non-byline-author.; Legg David non-byline-author.; Marrapu Siva T. non-byline-author.; McColl Emma non-byline-author.; Moran Hannah non-byline-author.; Schutt Hannah non-byline-author.; Smith Jessica non-byline-author.; Ugboule U. Chris non-byline-author.
• Is Part Of: Neurorehabilitation & neural repair. Volume 30:Number 1(2016)
• Page Start: 40
• Page End: 48
• Publication Date: 2016-01
• Subjects: rehabilitation -- stroke -- orthotics -- physical therapy -- walking; Nervous system -- Diseases -- Patients -- Rehabilitation -- Periodicals; Brain damage -- Patients -- Rehabilitation -- Periodicals; Spinal cord -- Wounds and injuries -- Patients -- Rehabilitation -- Periodicals; Nervous system -- Regeneration -- Periodicals; Neuroplasticity -- Periodicals; 616.804305
• DOI: 10.1177/1545968315583724
• Languages: English
• ISSNs: 1545-9683

Abstract

Background . Timely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic. Objective . To evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery. Methods . This was a randomized controlled, observer-blind trial. Participants (n = 105) were recruited 3 to 42 days poststroke. All received conventional physical therapy (CPT) that included use of "off-the-shelf" and orthotist-made AFOs. People allocated to the experimental group also received a SWIFT Cast for up to 6 weeks. Measures were undertaken before randomization, 6 weeks thereafter (outcome), and at 6 months after stroke (follow-up). The primary measure was walking speed. Clinical efficacy evaluation used analysis of covariance. Results . Use of a SWIFT Cast during CPT sessions was significantly higher ( P < .001) for the SWIFT Cast (55%) than the CPT group (3%). The CPT group used an AFO in 26% of CPT sessions, compared with 11% for the SWIFT Cast group ( P = .005). At outcome, walking speed was 0.42 (standard deviation [SD] = 0.37) m/s for the CPT group and 0.32 (SD = 0.34) m/s for the SWIFT Cast group. Follow-up walking speed was 0.53 (SD = 0.38) m/s for the CPT group and 0.43 (0.34) m/s for the SWIFT Cast group. Differences, after accounting for minimization factors, were insignificant at outcome ( P = .345) and follow-up ( P = .360). Conclusion and implications . SWIFT Cast did not enhance the benefit of CPT, but the control group had greater use of another AFO. However, SWIFT Cast remains a clinical option because it is low cost and custom-made by therapists who can readily adapt it during the rehabilitation period.