Rehabilitation interventions for foot drop in neuromuscular disease

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Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003908.

Rehabilitation interventions for foot drop in neuromuscular disease.

Sackley C, Disler P, -Stokes L, Wade D.

BACKGROUND: " Foot drop " or " Floppy foot drop " is the term commonly

used to describe weakness or contracture of the muscles around the

ankle joint. It may arise from many neuromuscular diseases.

OBJECTIVES: To conduct a systematic review of randomised trials of

treatment for footdrop resulting from neuromuscular disease.

SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease

Group Trials Register (July 2005), MEDLINE (January 1966 to July

2005), EMBASE (January 1980 to July 2005), AMED (January 1985 to

July 2005) and CINAHL databases (January 1982 to July 2005).

SELECTION CRITERIA: Randomised and quasi-randomised trials of

physical, orthotic and surgical treatments for footdrop resulting

from lower motor neuron or muscle disease and related contractures

were included. People with primary joint disease were excluded.

Interventions included a 'wait and see' approach, physiotherapy,

orthotics, surgery and pharmacological therapy. The primary outcome

measure was ability to walk whilst secondary outcome measures

included dorsiflexor torque and strength, measures of 'activity'

and 'participation' and adverse effects.

DATA COLLECTION AND ANALYSIS: Methodological quality was evaluated

by two authors using the van Tulder criteria. Three studies with

altogether 139 participants were included in the review.

Heterogeneity of the studies precluded pooling the data.

MAIN RESULTS: Early surgery did not significantly affect walking

speed in a trial including 20 children with Duchenne muscular

dystrophy. After one year, the mean difference (MD) of the 28 feet

walking time was 0.00 seconds (95% confidence interval (CI) -0.83 to

0.83) and the MD of the 150 feet walking time was -2.88 seconds,

(95% CI -8.18 to 2.42). In a trial with altogether 26 participants

with Charcot-Marie-Tooth disease (hereditary motor and sensory

neuropathy), long-term strength training significantly increased

walking speed on a 6 metre timed walk (MD -0.70 seconds, 95% CI -

1.17 to -0.23) but not on a 50 metre timed walk (MD -1.9 seconds,

95% CI -4.09 to 0.29). In a trial of a 24-week strength training

programme in 28 participants with myotonic dystrophy, there was no

significant change in walking speed on either a 6 or 50 metre walk.

AUTHORS' CONCLUSIONS: Using the primary outcome of ability to walk,

only one study demonstrated a positive effect and that was an

exercise programme for people with Charcot-Marie-Tooth disease.

Surgery was not significantly effective in children with Duchenne

Muscular Dystrophy. More evidence generated by methodologically

sound trials is required.