Effectiveness of a night positioning programme on ankle range of motion in patients after hemiparesis: a prospective randomized controlled pilot study.

OBJECTIVE: To investigate the effect of night positioning on ankle motion in patients after stroke or brain injury.

DESIGN: Prospective randomized controlled pilot study with 3 groups: bivalve cast; pressure-relieving ankle-foot orthosis; and control.

SUBJECTS/PATIENTS: Adults (n = 46) in inpatient rehabilitation with lower extremity paresis following stroke or brain injury.

METHODS: Intervention group participants wore a custom bivalve cast or pre-fabricated orthosis 8-12 h/night. The primary outcome variable was passive ankle dorsiflexion. Muscle spasticity (Modified Ashworth Scale) and functional mobility (Functional Independence Measure) were also assessed.

RESULTS: No significant differences were found between groups for all outcome measures at the pilot sample size (p > 0.05). Control and pressure-relieving ankle-foot orthosis groups showed improvement in ankle dorsiflexion, and the bivalve cast group demonstrated a trend toward decreased spasticity. Positioning interventions were tolerated for approximately 11 h/night. Baseline range of motion was measured and a retrospective power analysis determined that a sample size of 234 is needed for 80% power to establish significance.

CONCLUSION: Future research with a larger sample size is re-commended to determine significance and whether a more specific subset of patients would benefit from night positioning to maximize treatment time during daytime therapy sessions.