FES cost effective for treatment of foot drop

BOSTON — Functional electronic stimulation in patients with stroke, multiple sclerosis and other neurological disorders was shown to be a cost effective treatment for foot drop, according to results from a 10- year follow-up of patients using the Odstock Dropped Foot Stimulator in the UK. Paul Taylor, CFts, National Clinical FES Centre, Salisbury District Hospital, Salisbury, UK, presented the Howard R. Thranhardt award winning lecture at the American Orthotic & Prosthetic Association National Assembly here.

Evidence justifying the use of functional electronic stimulation (FES) has “up to now has all been short-term evidence, collected in trials maybe as long as a few months or a year. There’s evidence for increased walking speed and increased distance walked…and less effort and reduction in oxygen consumption,” Taylor said.

The study included 127 patients enrolled in 1999; of these 62 had had stroke and 39 had multiple sclerosis. Patients incurred an average of 10.9 treatment sessions. They were followed at 6, 18, 44 and 72 weeks, and then every 6 months or a year thereafter until they stopped using the device. The main outcome measure was increased walking speed.

The researchers calculated Quality of Life Years (QALY), encompassing three dimensions: emotional distress, disability and pain. The QALY score for FES was based on walking speed.

“Walking speed has been related to functional ability by Perry, who defined two levels of walking speed, which are related to function,” Taylor said. “What the report did was calculate the number of people who changed their functional walking category based on the change in walking speed.”

Mean duration of FES use was 4.9 years. During this time, 45% of stroke patients increased walking speed and 52% improved their functional walking category. As well, 29% of patients with MS increased walking speed and 40% improved their functional walking category. “We didn’t find any correlation between time since stroke or time since diagnosis of MS and the length of time that FES was used for,” Taylor said.

Costs were tallied using clinic and hospital costs, equipment and consumables. The mean cost of treatment was £3,095 ($4,889), resulting in a mean cost per QALY of £15,406 ($24,336), which “was well within the willingness-to-pay threshold used by the UK National Health Service,” Taylor said. He noted that 26% of patients continued to use the device after a mean of 11.1 years.

For more information:

Taylor P. Long term use of FES for correction of dropped foot: a cost-effectiveness study. Presented at the American Orthotic & Prosthetic Association National Assembly 2012. Sept. 6-9. Boston.

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