Effects of ankle-foot orthosis-related conditions on muscle activity, spasticity, and psychosocial outcomes after stroke: a systematic review and meta-analysis.

BACKGROUND: Ankle-foot orthoses (AFOs) are widely used after stroke to improve ankle stability, foot clearance, and gait performance. However, their effects on lower-limb muscle activity, spasticity, and psychosocial outcomes remain uncertain. OBJECTIVES: To evaluate the effects of AFO-related conditions on electromyographic muscle activity, spasticity, and psychosocial outcomes after stroke. METHODS: PubMed, MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched for studies involving adults with stroke that examined AFO-related conditions and reported electromyographic muscle activity, spasticity, or psychosocial outcomes. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS: Ten studies involving 931 participants were included. AFO-related conditions were associated with reduced lower-limb EMG activity (SMD =  -0.40, 95% CI - 0.74 to -0.06; p = 0.02; I2 = 11%) and spasticity (SMD =  -0.41, 95% CI - 0.77 to -0.05; p = 0.03; I2 = 0%). No significant pooled effect was observed for psychosocial outcomes (SMD = 0.04, 95% CI - 0.28 to 0.36; p = 0.79; I2 = 66%). CONCLUSIONS: AFO-related conditions may reduce lower-limb EMG activity and spasticity after stroke, whereas psychosocial effects remain unclear. Reduced EMG activity may reflect mechanical assistance but may also indicate reduced active dorsiflexor recruitment in individuals with residual voluntary ankle function. AFO prescription should therefore be individualized according to residual motor function, spasticity, gait stability, safety, patient preference, and rehabilitation goals.