Ankle Dorsiflexor Strength on the Affected Side in Acute Stroke Patients is Related to the Use of Orthoses at Discharge: A Retrospective Cohort Study

Abstract

Objectives: Approximately 40% of stroke patients discharged from rehabilitation hospitals achieve restored gait using an ankle–foot orthosis. However, whether the use of lower-limb orthoses (LLO) at discharge is required is unknown in the acute phase. Therefore, it is difficult to explain the use of LLO to patients and their families. The aim of this study was to investigate the factors associated with the use of LLO at discharge based on acute functional impairment.

Methods: This study retrospectively investigated 152 patients who were transferred to a convalescent rehabilitation ward (CRW) after undergoing acute rehabilitation between 1 May 2009 and 31 March 2018 and regained gait ability. The user (U) group included patients who used LLO. Multivariate analysis was performed for factors related to acute functional impairment 1 week after starting physical therapy and the use of LLO at discharge from the CRW. The predictive performance of each factor was analyzed. Acute functional impairment was measured in terms of paralyzed lower-limb motor function, trunk function, non-paralyzed side function, and higher brain function.

Results: Seventy-four patients (49%) were in the U group, and acute functional impairment was more severe than that in the non-user group, except for the non-paralyzed side function. Multivariate analysis showed that a paralyzed ankle dorsiflexor muscle, as assessed by the foot pat test, was associated with LLO use at discharge (P=0.003).

Conclusions: A paralyzed dorsiflexor muscle during the acute phase is a factor that helps determine whether to use LLO at discharge from the CRW.