Functional electrical stimulation for foot drop in multiple sclerosis: a systematic review and meta-analysis of the impact on gait speed

Linda Miller, Angus McFadyen, Anna C. Lord, Rebecca Hunter, Lorna Paul, Danny Rafferty, Roy Bowers, Paul Mattison

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Abstract

Objective
To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests.

Data sources
Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, Pubmed) and reference lists were searched.

Study selection
Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included.

Data extraction
Data were independently extracted and recorded. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) tool.

Data synthesis
Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed with regards to the impact of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t = 2.14, p = 0.016) with a mean increase in gait speed of 0.05 meters per second (m/s) and ongoing orthotic effect (t = 2.81, p = 0.003) with a mean increase of 0.08m/s. There were no initial or ongoing effect on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests.

Conclusions
FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully-powered randomized controlled trials comparing FES with alternative treatments are required.
Original languageEnglish
Pages (from-to)1435-1452
Number of pages18
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number7
Early online date11 Jan 2017
DOIs
Publication statusPublished - Jul 2017

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Keywords

  • multiple sclerosis
  • functional electrical stimulation
  • gait speed
  • systematic review
  • electric stimulation
  • gait disorders
  • neurologic
  • rehabilitation
  • walking

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