Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review

Can foot orthoses be an effective supplement to brace therapy for adolescent idiopathic scoliosis? A systematic review and meta-analysis of randomized controlled trials

BackgroundThe golden time for treatment of adolescent idiopathic scoliosis (AIS) is short, and how to effectively improve treatment outcomes to avoid surgery has been a focus of medical attention. Scoliosis orthoses are the preferred method of conservative treatment for AIS, but there are limitations in efficacy. Foot orthoses (FO) have gained traction in treating musculoskeletal disorders, potentially enhancing traditional brace therapy and offering renewed hope for AIS patients.ObjectiveThis study aimed to investigate whether a treatment regimen combined with FO would have a more positive impact on patients with AIS than using a scoliosis orthosis alone.MethodsPubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, and Wanfang Data were searched for relevant randomized controlled trials (RCTs) published up to August 20, 2024. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The quality of the outcomes was evaluated using the Grading, Assessment, Development, and Evaluation of Letters of Recommendation (GRADE). Statistical analyses were performed using Review Manager 5.3.ResultsCompared with scoliosis orthosis treatment alone, combined FO treatment significantly improved bilateral whole-foot pressure distribution（SMD = -0.38, 95% CI = [-0.70, -0.07], P = 0.02) and monopedal medial heel to lateral heel pressure ratio (M/L)（MD = -0.14, 95% CI = [-0.24, -0.04], P = 0.007), but failed to significantly improve the Cobb angle in patients with AIS（MD = -1.88, 95% CI = [-3.87, -0.10], P = 0.06) and the centre of pressure excursion index (CPEI)（MD = -1.36, 95% CI = [-2.85, -0.12], P = 0.07), also had no significant effect on quality of life. The RCTs exhibited a low risk of bias overall, with evidence quality ranging from low to moderate. No significant adverse effects were reported.ConclusionFO is a safe and effective intervention. Although its significant impact on improving the Cobb angle, CPEI, or quality of life was not definitively demonstrated, FO successfully optimised plantar pressure distribution and bilateral M/L balance. These improvements contribute to better static balance and postural stability in patients, suggesting FO as a promising complement to brace therapy.

Performance-based and patient-reported outcome measures for custom ankle-foot orthosis users: reliability, validity, and sensitivity evidence

PURPOSE

To evaluate the psychometric properties of performance and patient-reported outcome measures (PROMs) for custom ankle-foot orthosis (AFOs) users.

MATERIALS AND METHODS

Current AFO users completed two assessments one week apart; new AFO users completed an assessment before device delivery and at one- and two-months post-delivery.

RESULTS

Seventy current and 31 new users consented and provided data. We found evidence of minimal floor and ceiling effects for most PROMs; the exceptions were measures of service satisfaction. The Orthotics and Prosthetics Users' Survey (OPUS) Lower Extremity Functional Status (LEFS) measure demonstrated excellent test-retest reliability; the 5-level EuroQol (EQ-5D-5L), OPUS Health-Related Quality of Life, Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0), and PROMIS Physical Function measures demonstrated good reliability. Evidence of known-groups validity is provided by associations between obesity and walking speed. PROMs measuring physical function (LEFS, Rivermead Mobility Index (RMI), PROMIS Physical Function) correlated at least moderately with performance instruments. We observed moderate to large correlations between PROM and performance instrument changes for the EQ-5D-5L, LEFS, RMI, and PROMIS Physical Function.

CONCLUSIONS

Results provide evidence of test-retest reliability, construct validity, and sensitivity to change for some PROMs. PROMs and performance instruments provide overlapping but complementary evidence regarding the benefits of custom AFOs.

Influence of custom dynamic orthoses on tibiotalar joint reaction force and contact stress: A cadaveric study

Post-traumatic osteoarthritis (PTOA) often develops following tibial pilon fractures. Evidence suggesting PTOA development is driven by elevated articular contact stress from residual malreduction has led surgeons to strive for precise articular reduction, typically at the cost of extended operative time. Post-operative bracing using carbon fiber custom dynamic orthoses (CDOs) offers another means to decrease tibiotalar joint reaction force (JRF) and contact stress. The purpose of this cadaveric study was to measure how CDO stiffness influences ankle JRF and contact stress over the stance phase of gait. A servohydraulic load frame was used to test five cadaver ankles, with axial loading (240-330 N) and pneumatic actuation of the Achilles tendon (50-436 N) serving to quasi-statically model multiple points in the stance phase of gait. Three CDO rotational stiffness conditions were tested: (1) No CDO-0 Nm/deg, (2) low stiffness CDO-1.8 Nm/deg, and (3) moderate stiffness CDO-2.3 Nm/deg. JRF and contact stresses were measured using a piezoresistive pressure sensor inserted into the tibiotalar joint. An insole plantar pressure sensor placed between the cadaveric foot and CDO footplate measured limb/device interactions via the plantar center of pressure (COP). As limb loading progressed through stance, the plantar COP progressed from hindfoot to forefoot, as it would in normal gait. Both CDOs demonstrated decreases in JRF, reaching as high as 32% for the low CDO and 26% for the moderate CDO, with associated decreases in contact stress. This suggests that post-operative bracing could lessen PTOA risk after pilon fractures.

Factors influencing satisfaction with prosthetic and orthotic services - a national cross-sectional study in Sweden

PURPOSE

To evaluate client satisfaction with prosthetic and orthotic services in Sweden, determine if satisfaction differs between clients using different devices and identify factors which influence client satisfaction.

MATERIALS AND METHODS

A cross-sectional design was used to survey 7318 clients. The survey included items related to demographics, quality of life, device comfort, device use, the extent to which clients' needs were met and satisfaction with services. Ethics approval was provided by the Swedish Ethical Review Authority.

RESULTS

A total of 2925 surveys were returned reflecting a response rate of 41%. Mean OPUS-CSS point score was 61.9(SD 16.8) with differences observed between device categories (p < 0.001). Factors that were identified as most positively influencing client satisfaction were, being a limb prosthesis user and being under 65 years. When analysing scores for individual OPUS items breast prosthesis users scored higher than users of other devices. Clients were most satisfied with the level of respect they were shown by staff (mean = 2.72/3) and less satisfied with coordination of services with other therapists/doctors(mean = 1.88/3).

CONCLUSIONS

Prosthetic and orthotic users are reasonably satisfied with the services they receive. Attention should be directed towards understanding why prosthetic users are more satisfied than orthotic users and why clients under 65 years report higher satisfaction scores.

A comparison of the perceptions of wearing an ankle foot orthosis by individuals with peripheral artery disease according to their baseline-level of physical activity

INTRODUCTION

Peripheral artery disease (PAD) is a prevalent cardiovascular disease that limits an individual's ability to walk. One potential way to improve physical activity for patients with PAD is an ankle foot orthosis (AFO). Previous research has found that various factors may influence an individual's willingness to wear AFOs. However, one factor that has been understudied is an individual's baseline physical activity level prior to wearing AFOs. Therefore, the purpose of this study was to compare the perceptions of wearing AFOs for 3 months among individuals with PAD according to their baseline level of physical activity.

METHODS

Accelerometer-derived physical activity prior to AFO prescription was used to classify participants into either a higher or lower activity group. Semi-structured interviews were conducted at 1.5 and 3-months after wearing the AFOs to assess participants' perceptions of using the orthosis. Data were analyzed by a directed content analysis approach, then the percentage of respondents for each theme were calculated and compared between higher and lower activity groups.

FINDINGS

Several differences were found. Participants in the higher activity group more often reported positive impacts from wearing the AFOs. Additionally, participants who were in the lower activity group more often reported the AFOs caused physical pain while participants in the higher activity group more often reported the device was uncomfortable during daily activities.

CONCLUSION

Baseline physical activity levels may help to better understand barriers to wear and needed support to increase adherence to an AFO wear prescription, especially for patients with PAD with limited activity.

Exploring telehealth interventions to monitor rehabilitation in patients with peripheral artery disease

Peripheral artery disease is a manifestation of systemic atherosclerosis, and these patients often have claudication pain in the legs during activity. This leads to generally adopting an inactive lifestyle; hence, even small changes in physical activity could reduce the risk of an adverse cardiovascular event. For patients with peripheral artery disease compliance with non-invasive interventions like assistive devices and long-term exercise therapy is important for improved health outcomes. Benefits to patients can only be measured if patients with peripheral artery disease adhere to the intervention and barriers are identified with improved solutions. The effect of mobile health including pedometers and smartphone technological applications in motivating the patient to continue adhering to the intervention and persist in physical activity is a new venture to be explored.