Walking ability of stroke patients: efficacy of tibial nerve blocking and a polypropylene ankle-foot orthosis
Deutscher übersetzter Titel: | Gehfaehigkeit von Schlaganfallpatienten: Wirksamkeit einer Blockade des N. tibialis und einer Polypropylen-Sprunggelenkorthese |
---|---|
Autor: | Beckerman, H.; Becher, J.; Lankhorst, G.J.; Verbeek, A.L.M. |
Erschienen in: | Archives of physical medicine and rehabilitation |
Veröffentlicht: | 77 (1996), 11, S. 1144-1151, Lit. |
Format: | Literatur (SPOLIT) |
Publikationstyp: | Zeitschriftenartikel |
Medienart: | Gedruckte Ressource |
Sprache: | Englisch |
ISSN: | 0003-9993, 1532-821X |
Schlagworte: | |
Online Zugang: | |
Erfassungsnummer: | PU199705205094 |
Quelle: | BISp |
Abstract des Autors
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 2x2 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. Verf.-Referat