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.