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

CRD COMMENTARY: The aims were stated and inclusion criteria defined in terms of study design, participants, and intervention. Outcomes were not defined a priori. Two databases were searched and studies in any of four languages were eligible. No attempt was made to locate unpublished material and as acknowledged by the authors, publication bias was a possibility. Methods used to select studies were not described. Study validity was systematically evaluated, though methods used were not described. Relevant details of the primary studies were presented in tabular format. Given the heterogeneity among studies in intervention, patient characteristics and outcomes, it is doubtful whether pooling the data to estimate medians was appropriate. Potential sources of heterogeneity among studies were mentioned in the discussion and included differences across studies in terms of orthosis type, surgery, training period and duration of intervention. In summarising results from the review, attention was not drawn to better sources of evidence and results were not considered separately for controlled and uncontrolled studies. The authors' conclusion as to the poor quality of evidence was supported. In view of the poor quality of studies, any other conclusions must be interpreted with caution.