A randomized controlled evaluation of the efficacy of an ankle-foot cast on walking recovery early after stroke: SWIFT cast trial

Valerie M. Pomeroy*, Philip Rowe, Allan Clark, Andrew Walker, Andrew Kerr, Elizabeth Chandler, Mark Barber, Jean-Claude Baron, Lindsay Anderson, Myrto-Despoina Dounavi, Leo Earl, Sheila Gregory, Claire Havis, Simon Horton, P. Simon Jones, Konstantinos Kaliarntas, Niamh Kennedy, Kathleen Lane, David Legg, Siva T. MarrapuEmme McColl, Hannah Moran, Hannah Schutt, Jessica Smith, U. Chris Ugboule (sic)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)


BackgroundTimely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic. 
ObjectiveTo evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery. 
MethodsThis 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. 
ResultsUse 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 implicationsSWIFT 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.
Original languageEnglish
Pages (from-to)40-48
Number of pages9
JournalNeurorehabilitation and Neural Repair
Issue number1
Early online date30 Apr 2015
Publication statusPublished - 1 Jan 2016


  • Rehabilitation
  • Stroke
  • Orhotics
  • Physical therapy
  • Walking


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