Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
John Cavenagh, MBA, PhD, PA-C
OBJECTIVE: The objective of this selective EBM review is to determine whether or not dynamic ankle foot orthotics (DAFO) improve gait in pediatric patients with spastic diplegic cerebral palsy (CP).
STUDY DESIGN: Review of two randomized controlled trials with crossover from 2009 and 2015 and one blinded randomized controlled trial from 2006.
DATA SOURCES: All articles were presented in English and were taken from peer reviewed sources using PubMed and Google Scholar. All articles were published between 2006-2016.
OUTCOMES: Outcomes of investigation measured are quantitative walking velocity measured via gait analysis and functional ability during ambulation using the Gross Motor Function Measurement-88 scoring system.
RESULTS: Wren et al found that there was a statistically significant increase in walking velocity while wearing DAFOs when compared to walking barefoot and also with different type of ankle foot orthoses. Bjornson et al found statistically significant improvements in the Gross Motor Function Measurement-88 scores when wearing DAFOs than when barefoot or wearing a simulated placebo device. Smith et al. found overall improvements in gait while wearing DAFOs and an increase in velocity after consistent month-long use of DAFOs, but the increase was not statistically significant.
CONCLUSIONS: These three studies show that DAFOs provide tangible benefit to individuals with spastic diplegic cerebral palsy. All 3 studies showed overall gait or functional improvements in those wearing dynamic ankle foot orthotics when compared against either themselves or age-matched controls regardless of the length of time the devices were worn with 2 of the studies showing statistically significant results. Further research can help to further clarify the efficacy of DAFOs within the pediatric population as a whole.
Valentine, Matthew F., "Do dynamic ankle foot orthotics (DAFO) improve gait in pediatric patients with spastic diplegic cerebral palsy (CP)?" (2018). PCOM Physician Assistant Studies Student Scholarship. 309.