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

Pomeroy, Valerie M.; Rowe, Philip; Clark, Allan; Walker, Andrew; Kerr, Andrew; Chandler, Elizabeth; Barber, Mark; Baron, Jean-Claude; Anderson, Lindsay; Dounavi, Myrto-Despoina; Earl, Leo; Gregory, Sheila; Havis, Claire; Horton, Simon; Jones, P. Simon; Kaliarntas, Konstantinos; Kennedy, Niamh; Lane, Kathleen; Legg, David; Marrapu, Siva T.; McColl, Emma; Moran, Hannah; Schutt, Hannah; Smith, Jessica; Ugboule, U. Chris

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.

Citation

Pomeroy, V. M., Rowe, P., Clark, A., Walker, A., Kerr, A., Chandler, E., Barber, M., Baron, J.-C., Anderson, L., Dounavi, M.-D., Earl, L., Gregory, S., Havis, C., Horton, S., Jones, P. S., Kaliarntas, K., Kennedy, N., Lane, K., Legg, D., Marrapu, S. T., …Ugboule, U. C. (2016). A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke: SWIFT Cast Trial. Neurorehabilitation and Neural Repair, 30(1), 40-48. https://doi.org/10.1177/1545968315583724

• Journal Article Type: Article
• Acceptance Date: Dec 15, 2014
• Online Publication Date: Apr 30, 2015
• Publication Date: Jan 1, 2016
• Deposit Date: Jun 19, 2018
• Publicly Available Date: Jun 19, 2018
• Journal: Neurorehabilitation and Neural Repair
• Print ISSN: 1545-9683
• Electronic ISSN: 1552-6844
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: 1
• Pages: 40-48
• DOI: https://doi.org/10.1177/1545968315583724
• Keywords: Rehabilitation; Neurology; Clinical Neurology
• Public URL: http://researchrepository.napier.ac.uk/Output/953206
• Contract Date: Jun 19, 2018