A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke SWIFT Cast Trial

But the primary endpoint was wrong, it should have been walking without the cast or AFO.
This just invites dependence on walking aides. And if our doctors/researchers would solve/prevent the neuronal cascade of death our walking recovery would be so much easier.  But that won't occur until we depose the existing stroke leadership.
http://nnr.sagepub.com/content/30/1/9?etoc

1. Valerie M. Pomeroy, PhD1⇑
2. Philip Rowe, PhD2
3. Allan Clark, PhD1
4. Andrew Walker, PhD1,3
5. Andrew Kerr, PhD2
6. Elizabeth Chandler, MSc1
7. Mark Barber, MD4
8. Jean-Claude Baron, MD, ScD5
9. On Behalf of the SWIFT Cast Investigators

1. ¹University of East Anglia, Norwich, UK
2. ²University of Strathclyde, Glasgow, UK
3. ³University of Leeds, UK
4. ⁴Stroke Managed Clinical Network NHS Lanarkshire, Airdrie, UK
5. ⁵University of Cambridge and INSERM U894, Hopital Sainte-Anne, Sorbonne Paris Cité, Paris, France

1. Valerie M. Pomeroy, PhD, Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Queens Building, Norwich Research Park, NR4 7TJ, UK. Email: v.pomeroy@uea.ac.uk

Abstract

Background. Timely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic.  

Objective. To evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery. Methods. This was a randomized controlled, observer-blind trial. Participants (n = 105) were recruited 3 to 42 days poststroke. All received conventional physical therapy (CPT) that included use of “off-the-shelf” and orthotist-made AFOs. People allocated to the experimental group also received a SWIFT Cast for up to 6 weeks. Measures were undertaken before randomization, 6 weeks thereafter (outcome), and at 6 months after stroke (follow-up). The primary measure was walking speed. Clinical efficacy evaluation used analysis of covariance.  

Results. Use of a SWIFT Cast during CPT sessions was significantly higher (P < .001) for the SWIFT Cast (55%) than the CPT group (3%). The CPT group used an AFO in 26% of CPT sessions, compared with 11% for the SWIFT Cast group (P = .005). At outcome, walking speed was 0.42 (standard deviation [SD] = 0.37) m/s for the CPT group and 0.32 (SD = 0.34) m/s for the SWIFT Cast group. Follow-up walking speed was 0.53 (SD = 0.38) m/s for the CPT group and 0.43 (0.34) m/s for the SWIFT Cast group. Differences, after accounting for minimization factors, were insignificant at outcome (P = .345) and follow-up (P = .360).  

Conclusion and implications. SWIFT Cast did not enhance the benefit of CPT, but the control group had greater use of another AFO. However, SWIFT Cast remains a clinical option because it is low cost and custom-made by therapists who can readily adapt it during the rehabilitation period.