The effects of knee-ankle-foot orthoses in the treatment of Duchenne muscular dystrophy: review of the literature

Objective: A systematic review of the available literature on the effective ness of knee-ankle-foot orthoses in the treatment of Duchenne muscular dyst rophy. Design: A computer search was carried out (MEDLINE 1966-97, CINAHL 1982-97) using the key words muscular dystrophy, rehabilitation, locomotion, braces or orthotic devices. References in relevant publications and nonindexed jo urnals were also examined. Criteria to include and exclude articles were fo rmulated. We used a systematic review procedure to evaluate the literature. Seven methodological criteria were formulated. Results: Thirty articles describing 35 studies met the inclusion criteria f or our review, nine studies were selected based on completeness of informat ion on study population, treatment and quantitative presentation of the eff ect outcome. Operations on the lower limbs were performed on most patients. A concomitant programme of rehabilitation was not described thoroughly. A percentage success of treatment was calculated for eight studies. Median pe rcentage after one year was 75.1, after two years 47.9 and after three year s 24.3. The median for the means of independent walking was 24 months, the median for the means of assisted walking was 36.2 months and the median for the means of standing ability was 50.5 months duration. Conclusion: The scientific strength of the studies reviewed is poor. It see ms that the use of knee-ankle foot orthoses can prolong assisted walking an d standing, but it is uncertain whether it can prolong functional walking. The boys that benefit most have a relatively low rate of deterioration, are capable of enduring an operation and are well motivated.