Walking ability of stroke patients: Efficacy of tibial nerve blocking and a polypropylene ankle-foot orthosis

• Published in: Archives of physical medicine and rehabilitation Vol. 77; no. 11; pp. 1144 - 1151
• Main Authors: Beckerman, Heleen, Becher, Jules, Lankhorst, Gustaaf J., Verbeek, AndréL.M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.1996; Elsevier
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Catheter Ablation - adverse effects; Cerebrovascular Disorders - rehabilitation; Female; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nerve Block - methods; Neurology; Orthotic Devices; Outcome Assessment (Health Care); Patient Compliance; Sickness Impact Profile; Tibial Nerve - physiology; Vascular diseases and vascular malformations of the nervous system; Walking - physiology; Ability; Human; Nervous system diseases; Stroke; Tibial nerve; Orthosis; Propylene polymer; Blocking; Cardiovascular disease; Cerebral disorder; Thermocoagulation; Vascular disease; Walking; Tip foot; Ankle joint; Cross varus; Reeducation; Treatment; Central nervous system disease; Rehabilitation; Cerebrovascular disease
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/S0003-9993(96)90138-0

Objective: To investigate the efficacy of tibial nerve blocking by percutaneous radiofrequency thermocoagulation and an ankle-foot orthosis on the walking ability of stroke patients with a spastic equinus or equinovarus foot. Design: A placebo-controlled randomized clinical trial with a 2 × 2 factorial design and with a 3-month follow-up. Setting: Outpatient clinic of a department of rehabilitation medicine. Subjects: Sixty stroke patients (17 women, 43 men) with a median age of 58 years and a median period of 34 months poststroke were allocated to one of four treatment groups. Main Outcome Measures: Changes in walking ability (measured with the Sickness Impact Profile category “ambulation”; possible score range, 0% to 100%) and walking speed after 3 months. Results: With respect to walking ability, the efficacy of thermocoagulation as compared with placebo thermocoagulation was .56% (95% confidence interval [CI]−3.01% to 4.13%), whereas the efficacy of the ankle-foot orthosis as compared with the placebo ankle-foot orthosis was 2.72% (95% CI −.94% to 6.38%). To study the potential synergistic effect of both treatments, a multivariate model was used; interaction between both treatments was small, .83% (95% CI −6.73% to 8.40%). Analysis restricted to the compliers ( n = 30) showed an increased efficacy of thermocoagulation and a decreased efficacy of the ankle-foot orthosis. The changes in comfortable and maximal safe walking speed were less than .10m/sec and were neither clinically nor statistically significant (the median baseline values for the total group were .42m/sec and .56m/sec, respectively). Conclusion: No support was found for the beneficial effects of either thermocoagulation of the tibial nerve or a polypropylene ankle-foot orthosis in 5 degrees of dorsiflexion on the walking ability of stroke patients.