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 0.56% (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 -0.94% to 6.38%). To study the potential synergistic effect of both treatments, a multivariate model was used; interaction between both treatments was small, 0.83% (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 0.10m/sec and were neither clinically nor statistically significant (the median baseline values for the total group were 0.42m/sec and 0.56m/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.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher