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Feng J, Weiss J, Thompson A, Meeker JE. Passive Dynamic Ankle Foot Orthoses Use in Civilian Patients with Arthritic Conditions of the Foot and Ankle. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231157734. [PMID: 36937807 PMCID: PMC10014983 DOI: 10.1177/24730114231157734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background Nonsurgical interventions such as bracing with ankle foot orthoses (AFOs) aim to assist, restore, and redirect weightbearing forces to address difficulty with mobilization. We identified a custom carbon fiber passive dynamic ankle foot orthosis (PDAFO) that was designed to meet the needs of military combat veterans. We sought to evaluate the off-loading properties of one model of PDAFO (ExoSym) in a civilian population. Methods Civilian patients 18 years or older were prescribed a PDAFO by a single surgeon. Pedobarographic data were obtained using the Tekscan F-Scan system. With the insole, participants were instructed to walk at a self-selected pace along a 20 m walkway under 3 conditions: (1) insole placed in between the brace and foot (over); (2) insole placed between the brace and insole of the shoe (under); (3) without the brace, the insole was placed in between the foot and insole of the shoe in both limbs (without).For assessment, forefoot and heel areas were evaluated with respect to maximal force, force*time integral (FTI), maximal contact area, maximal contact pressure, pressure*time integral (PTI), center of force (COF) excursion. Results Six patients with arthritic foot and ankle conditions completed pedobarographic assessment for analysis. The brace reduced forefoot maximal force and contact pressures by 66% and 49%, respectively (538 ± 236 to 185 ± 130 N [P < .001], and 99 ± 38 to 50 ± 24 P < .002). Additionally, participants were observed to load the forefoot portion of the brace with double the maximum contact pressures compared to the unbraced foot (204 ± 57 to 99 ± 38 kPa, P < .001). Conclusion The results of this study showed that the PDAFO unloaded substantial force and pressure experienced by the forefoot. Participants loaded the brace to a greater extent than when going unbraced. ADAFO can provide measurable pressure relief for patients with arthritic conditions. Level of Evidence Level IV, case series.
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Affiliation(s)
- Jing Feng
- Motion Analysis Center, Shriners
Hospitals for Children, Portland, OR, USA
| | - Jason Weiss
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Austin Thompson
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - James E. Meeker
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Ploeger HE, Bus SA, Brehm MA, Nollet F. Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey. Eur J Phys Rehabil Med 2020; 56:575-584. [DOI: 10.23736/s1973-9087.20.06020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miller Renfrew L, Rafferty D, Lord A, Hunter R, Paul L. Determining validity of the PALite and ODFS PACE activity logger for measuring step count in healthy adults. Gait Posture 2020; 80:315-317. [PMID: 32593100 DOI: 10.1016/j.gaitpost.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determining adherence with orthoses is important for clinicians prescribing devices. Measuring orthotic use often relies on patient recall which has poor agreement with objective measures. Measuring step count whilst wearing an orthosis could help objectively quantifying adherence. The Odstock Drop Foot Stimulator (ODFS) Pace, used in foot drop, has an integral activity logger which provides data on step count. The PALite, an accelerometer, measures step count and can be fixed to an ankle foot orthoses (AFO). Both have the potential to provide objective measures of adherence; however, their validity for this purpose has not been determined. RESEARCH QUESTION To determine the validity of the PALite and ODFS Pace activity logger in measuring total step count, by exploring their level of agreement. METHODS A convenience sample of sixteen healthy volunteers, aged 18-65, were recruited from Glasgow Caledonian University (GCU). Participants walked continuously for 5 min on a treadmill at three walking speeds; normal (1.3ms-1), slow (0.4 ms-1) and fast (1.7-2.0 ms-1), wearing both the PALite and ODFS Pace. All walks were video recorded, viewed by 2 raters, and observed step count was determined by a click counter. Step count from both devices was validated against observed step count using video recording. The level of agreement between the three methods was established. RESULTS There was no significant difference between the 3 methods of measuring step count at any walking speed (normal, p = 0.913; slow, p = 0.938; fast, p = 0.566). Good levels of agreement for both devices with observed step count at all 3 walking speeds, with mean percentage differences being between -1.2 and 2.1 % (maximum upper and lower levels of agreement = 19.5 and -18.8 %) was detected. SIGNIFICANCE Clinicians could consider both devices to objectively measure step count with people who are prescribed foot drop orthoses, thus quantifying orthotic use.
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Affiliation(s)
| | - D Rafferty
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - A Lord
- MS Service, NHS Ayrshire and Arran, Scotland, UK
| | - R Hunter
- MS Service, NHS Ayrshire and Arran, Scotland, UK
| | - L Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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McCaughan D, Booth A, Jackson C, Lalor S, Ramdharry G, O'Connor RJ, Phillips M, Bowers R, McDaid C. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives. BMJ Open 2019; 9:e029313. [PMID: 31628124 PMCID: PMC6803152 DOI: 10.1136/bmjopen-2019-029313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users' perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes. DESIGN Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using 'Framework'. SETTING AND PARTICIPANTS A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36-80 years). RESULTS Patients' medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively. CONCLUSIONS Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects. TRIAL REGISTRATION NUMBER This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228.
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Affiliation(s)
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Lalor
- Orthotics, Queen Mary's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
- Orthotics/Prosthetics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Gita Ramdharry
- Faculty of Allied Health, Midwifery and Social Care, Kingston University/St George's University of London, London, UK
- Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Roy Bowers
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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5
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Swinnen E, Lefeber N, Werbrouck A, Gesthuizen Y, Ceulemans L, Christiaens S, De Wael L, Buyl R, Ilsbroukx S, Van Nieuwenhoven J, Michielsen M, Lafosse C, Kerckhofs E. Male and female opinions about orthotic devices of the lower limb: A multicentre, observational study in patients with central neurological movement disorders. NeuroRehabilitation 2018; 42:121-130. [PMID: 29400677 DOI: 10.3233/nre-172214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Because user-satisfaction and acceptance may partly determine the grade of compliance to an orthotic device (OD), the aim of this multicentre observational study was to inquire the reasons for acceptance and the user-satisfaction of an OD of the lower limb in male and female central neurological movement disorders (CNMD) patients. METHODS Persons with CNMD having at least one prescribed OD of the lower limb were included. Two questionnaires were used: the MIRAD-ACCORT-II (reasons for acceptance) and a modified version of the D-QUEST 2.0 (user-satisfaction). Descriptive analyses were performed and to analyse the differences between the males' and females' answers Chi2- and Mann-Whitney U tests were used. RESULTS Twenty-six stroke and 23 multiple sclerosis patients participated (53% males). "Comfort", "safety", "effectiveness" and "ease of use" were reported as most important aspects. 86% of the patients were (very) satisfied about their OD. Only for the aspect safety, compared to males, significant more females reported that if the OD is not safe enough they will not use it. CONCLUSION For both, males and females, aspects related to comfort and functionality were reported as much more important than the esthetical aspects, and in general they are quite satisfied with the OD and the process of providing the OD. Orthopaedic technicians and health care providers can take these aspects into account when developing, constructing and providing OD's.
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Affiliation(s)
- Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Amber Werbrouck
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yelena Gesthuizen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Ceulemans
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Sofie Christiaens
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lise De Wael
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Marc Michielsen
- Sint Ursula Rehabilitation Center, Jessa Hospital, Herk-de-Stad, Belgium
| | | | - Eric Kerckhofs
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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6
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O'Connor J, McCaughan D, McDaid C, Booth A, Fayter D, Rodriguez-Lopez R, Bowers R, Dyson L, Iglesias CP, Lalor S, O'Connor RJ, Phillips M, Ramdharry G. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis. Health Technol Assess 2018; 20:1-262. [PMID: 27477023 DOI: 10.3310/hta20550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). OBJECTIVES To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. METHODS Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. RESULTS Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review - a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis - in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553. CONCLUSIONS Various types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users. LIMITATIONS The population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs. FUTURE WORK Future work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joanne O'Connor
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Alison Booth
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Roy Bowers
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Lisa Dyson
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Lalor
- Queen Mary's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rory J O'Connor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Gita Ramdharry
- Kingston University and St George's University of London, London, UK
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Swinnen E, Lafosse C, Van Nieuwenhoven J, Ilsbroukx S, Beckwée D, Kerckhofs E. Neurological patients and their lower limb orthotics: An observational pilot study about acceptance and satisfaction. Prosthet Orthot Int 2017; 41:41-50. [PMID: 26246356 DOI: 10.1177/0309364615592696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although an orthotic device of the lower limb improves the functionality of neurological patients, anecdotally clinical experience suggests that the compliance is rather limited. OBJECTIVES The aim was to determine the satisfaction and acceptance of a lower limb orthotic device. STUDY DESIGN A qualitative observational pilot study with a mix-method design. METHODS Adult neurological patients who had a prescribed lower limb orthotic device were included. One published and clinically used questionnaire about satisfaction (D-Quest) and one ad hoc constructed questionnaire about acceptance of the orthotic device (MIRAD-ACCORT questionnaire) were used for data collection. RESULTS In total, 33 patients participated (28 ankle-foot orthotic device, 3 knee-ankle-foot orthotic device and 2 other types). In general, they were satisfied about their orthotic device and the services. Less than one-fourth of the patients had some negative comments about the 'visual aspects' and the 'ability to hide' of their orthotic device. These, however, had a lower priority when compared with functionality, which was reported as a main advantage and is a reason for continuing the use of their orthotic device. CONCLUSION Patients were satisfied in relation to their lower limb orthotic device. With regard to acceptance, it can be concluded that factors associated with functionality and comfort are more important than the aesthetic and psychological aspects of the orthotic device. Clinical relevance Patients were satisfied with their lower limb orthotic device. Some patients had some negative comments about the 'aesthetics aspects' and the 'ability to hide' their orthotic device. However, improvements in functionality were mostly reported as a main advantage and a reason for continuing the use of their orthotic device.
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Affiliation(s)
- Eva Swinnen
- 1 Vrije Universiteit Brussel, Brussels, Belgium.,2 Erasmus University College, Brussels, Belgium.,3 Center for Neuroscience, Brussels, Belgium
| | | | | | | | | | - Eric Kerckhofs
- 1 Vrije Universiteit Brussel, Brussels, Belgium.,3 Center for Neuroscience, Brussels, Belgium
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8
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Abstract
Fifty-five older subjects, who had been prescribed a lower leg brace (below knee orthosis - BKO) were interviewed to assess patient satisfaction and compliance. Over 80% of subjects were still using their brace: the majority (81 %) found them comfortable and a similar proportion said they were beneficial to their walking. Nearly half of the subjects (45%) were unable to put on their brace independently. Many of these individuals were very disabled, usually as a result of a stroke. Inability to apply the orthosis was related to disability, but not to patient age nor to the type of brace. Difficulties encountered by users included discomfort caused by the orthosis, problems with clothing and footwear and difficulties getting the orthosis modified or repaired. Improvements in brace design and service provision would help to minimize these problems.
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Affiliation(s)
- HC Hanger
- Department of Medicine for the Elderly, St James's University Hospital, Leeds
| | - GP Mulley
- Department of Medicine for the Elderly, St James's University Hospital, Leeds
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Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review. J Bodyw Mov Ther 2015; 19:759-70. [PMID: 26592234 DOI: 10.1016/j.jbmt.2015.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/02/2015] [Accepted: 06/12/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Alongside the positive effects of use of orthotic devices for the lower extremities (ODLE) and orthopedic shoes, complaints and criticism by users possibly lead to non-compliance. OBJECTIVE The purpose is to determine the compliance of patients wearing an ODLE or orthopedic shoes and to describe the main reasons for using and not using. METHODS Different online databases were searched for articles about patients' compliance with regard to an ODLE or orthopedic shoes. A methodological quality control was conducted. RESULTS Ten studies (1576 patients) were included. The data revealed between 6 and 80% not users. Several reasons for not using the orthotic device were described (e.g. pain, discomfort and cosmetically unacceptable). CONCLUSIONS The high percentage of patients who are not wearing the prescribed orthotic devices leads to a high financial loss for society and a waste of therapeutic effort. These results should be taken into account during the design, construction and selection process of orthotic devices.
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10
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Chen CL, Teng YL, Lou SZ, Lin CH, Chen FF, Yeung KT. User satisfaction with orthotic devices and service in taiwan. PLoS One 2014; 9:e110661. [PMID: 25338026 PMCID: PMC4206442 DOI: 10.1371/journal.pone.0110661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/24/2014] [Indexed: 11/21/2022] Open
Abstract
User satisfaction is afforded considerable importance as an outcome measurement in evidence-based healthcare and the client-centered approach. Several studies have investigated user satisfaction with orthoses. Few studies have investigated user satisfaction with orthoses in Taiwan. Therefore, the purpose of this study was to investigate the user satisfaction with orthotic devices and service using the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology. We conducted a cross-sectional study of 280 subjects who had used orthoses and received services. The results showed that the mean satisfaction score was 3.74 for the devices and 3.56 for service. Concerning the participants, 69.1% and 59.6% were quite satisfied or very satisfied with their devices and service, respectively. The satisfaction score of orthotic service was lower than that of the devices. Regarding demographic characteristics, participants living in different areas differed only in service score (p = 0.002). The participants living in eastern area and offshore islands were the least satisfied with the orthotic service. For clinical characteristics, there was a significant difference in satisfaction scores among severity of disability (all p = 0.015), types of orthoses (all p = 0.001), and duration of usage (all p = 0.001). The participants with mild disability, wearing the pressure garment and using the orthosis for less than one year, were the most satisfied with their orthotic devices and service. There is a need for improved orthotic devices and services, especially with respect to the comfort of the devices and the provision of subsidy funding.
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Affiliation(s)
- Chiung-Ling Chen
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Teng
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shu-Zon Lou
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chung-Hui Lin
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Fen-Fen Chen
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kwok-Tak Yeung
- School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan
- Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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11
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Tyson SF, Sadeghi-Demneh E, Nester CJ. A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke. Clin Rehabil 2013; 27:879-91. [PMID: 23798747 DOI: 10.1177/0269215513486497] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke. DATA SOURCES The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data. REVIEW METHODS Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model. RESULTS Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001-0.0002); knee kinematics in stance phase (P < 0.0001-0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18-0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only. CONCLUSIONS An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.
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Affiliation(s)
- S F Tyson
- Stroke and Vascular Research Centre and School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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12
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Assessing Satisfaction With Orthotic Devices and Services: A Systematic Literature Review. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jpo.0b013e318217a0fe] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Objective design criteria for orthotic components is lacking. This paucity of data results in prescription guidelines based on assumptions or practitioners' past experience, and the potential for incorrectly designed components. The purpose of this study was to directly measure loads on the knee joint of a knee-ankle-foot orthosis. STUDY DESIGN Case series. CASE DESCRIPTION AND METHODS Three subjects who had been prescribed a knee-ankle-foot orthosis for quadriceps weakness underwent gait analysis and orthotic upright load data collection. A load sensor to measure the three force and three moment components was used in place of the lateral knee joint while the subjects walked in three knee flexion positions. FINDINGS AND OUTCOMES Forces were highest in compression and moments were greatest in the sagittal plane. The kinetics did not increase solely with patient weight. There was substantial variability between subjects. CONCLUSIONS This data will help guide orthotic component design and prescription guidelines. Knowledge of loading conditions will lead to more optimal orthotic intervention for patients and increased patient satisfaction. CLINICAL RELEVANCE This study is one of the first to directly measure loads on the upright of a KAFO. These data provide objective targets for engineering design. The data from this small case series can also be used to establish guidelines for patient device selection.
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Affiliation(s)
- K A Bernhardt
- Motion Analysis Laboratory, Mayo Clinic, Rochester, MN 55905, USA
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14
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van Netten JJ, Jannink MJA, Hijmans JM, Geertzen JHB, Postema K. Patients' expectations and actual use of custom-made orthopaedic shoes. Clin Rehabil 2010; 24:919-27. [PMID: 20576666 DOI: 10.1177/0269215510367991] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the association between patients' expectations and the actual use of custom-made orthopaedic shoes. DESIGN A prospective cohort study with internal comparison. SETTING Twelve orthopaedic shoe companies. PATIENTS During six months, consecutive patients who were provided with their first ever pair of orthopaedic shoes and aged 16 years or older were recruited. A total of 339 patients with different pathologies were included (response 67%). Mean (SD) age of the patients was 63 (15) years, and 129 patients (38%) were male. MAIN MEASURES A practical and reproducible questionnaire, measuring: frequency of use of orthopaedic shoes, patients' expectations and experiences of aspects of the usability of orthopaedic shoes, and communication about patients' expectations. RESULTS Patients' expectations were not associated with the use of orthopaedic shoes (P-values range: 0.106 to 0.607), but the difference between expectations and experiences was (P-values range: <0.001 to 0.012). The expectations of patients who frequently used their orthopaedic shoes were in concordance with their experiences, whereas the expectations of patients who did not use their orthopaedic shoes were much higher than their experiences. There was no communication of patients' expectations with the medical specialist or orthopaedic shoe technician in 34% and 25% of the patients respectively. CONCLUSIONS In relation to the actual use of orthopaedic shoes, it is crucial that patients' expectations are not much higher than their experiences.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen and Graduate School for Health Research, University of Groningen, Groningen, The Netherlands.
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15
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Abstract
Stance control knee orthoses (SCOs) have become very popular recently. However, there is little information regarding opinions of actual orthosis users. The purpose of this study was to quantify the users' opinions of a SCO, and see whether factors found important for knee orthoses in past studies hold true for a stance control orthosis as well. A standardized survey was employed as part of a larger field trial study of the Dynamic Knee Brace System, a SCO developed by the authors. The Dynamic Knee Brace System scored well in areas of effectiveness, operability, and dependability, but areas in need of improvement included weight, cosmesis, and donning and doffing. These findings match well with previous knee orthosis studies. This study shows that wearing a stance control knee orthosis can be a positive experience for an orthosis user.
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Affiliation(s)
- Kathie A Bernhardt
- Motion Analysis Laboratory, Mayo Clinic, Rochester, Minnesota 55905, USA
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16
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Abstract
During peacetime, the military physiatrist uses orthotics in much the same way as the civilian physiatrist. In wartime, the focus shifts to a return-to-duty scope of care, and orthotic use is limited. This article discussed orthotic use in the wartime and military training/deployment setting with special emphasis on those orthoses that help soldiers successfully return to duty. Efficacy data are lacking on many commonly used orthotic devices, especially in the area of prevention and pain control. A good knowledge of the patient's functional and biomechanical limitations, use of a team-based approach to orthosis prescription, and consideration of efficacy studies and future trends will provide the best opportunity for a successful orthotic outcome.
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Affiliation(s)
- Steven E Braverman
- Physical Medicine and Rehabilitation Service, Moncrief Army Community Hospital, Fort Jackson, South Carolina, USA
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17
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Abstract
Studies show that patient dissatisfaction with prescribed footwear results in low usage and that the cause is the system that provides it. The aim of this study was to compare referrer and patient perceptions of a multidisciplinary footwear clinic (MDFC) and a traditional surgical appliance clinic (SAC). Referring consultants completed a questionnaire for every referral (28 referred to the MDFC and 27 to the SAC) during a six-month period. Structured interviews were designed to gather the data. The results showed that referrers to both groups indicated that they lacked the time and knowledge to give advice about retail footwear. The entire MDFC group but only 18 (66.6%) of patients in the SAC group had the opportunity for discussion about footwear before the prescription took place. Some 17 (62.9%) in the SAC group reported problems with the footwear but only 11 (40.7%) of this group were informed what to do if problems occurred. Both groups demonstrated an association between the patient's attitude, their perception of improvement in their feet and overall satisfaction. These factors seemed to have an impact on the usage of the prescription footwear with 13 (48.1%) of the SAC group using other footwear compared with 2 (7.2%) in the MDFC group. This study adds to the suggestions made in other studies that there is a need to review the SAC system and identifies key areas that influence patient satisfaction.
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Affiliation(s)
- A Williams
- Department of Podiatry, Salford Royal Hospitals NHS Trust, Stott Lane, Salford, England, UK.
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18
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Korpela R, Seppänen RL, Koivikko M. Rehabilitation service evaluation: a follow-up of the extent of use of technical aids for disabled children. Disabil Rehabil 1993; 15:143-50. [PMID: 8374159 DOI: 10.3109/09638289309166005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The increased awareness of the benefits of rehabilitation technology will lead to an increased demand for services and may lead to discrepancies between needs and resources available. The present study was a regional follow-up of the use of 1278 technical aids. In this study the satisfaction with aids was high and quite near the optimum, but unsatisfactory areas were also identified. A better follow-up of the use of technical aids should be part of rehabilitation practice. Careful assessment of functional and psychosocial needs, goal attainment and environmental factors, and a good system of selection with available alternatives and proper instructions are the basic considerations for satisfactory technical aids.
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Affiliation(s)
- R Korpela
- Department of Paediatric Neurology, Tampere University Hospital, Finland
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19
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Korpela R, Seppänen RL, Koivikko M. Technical aids for daily activities: a regional survey of 204 disabled children. Dev Med Child Neurol 1992; 34:985-98. [PMID: 1426689 DOI: 10.1111/j.1469-8749.1992.tb11404.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Home-care of even severely disabled children is strongly favoured today. However, the role of technical aids for daily activities has not been emphasised in the assessment of the needs of families with disabled children. This study evaluated the extent of help needed for daily living among 204 disabled children and the uses and role of and need for technical aids for eating, dressing, toileting and bathing. The children needed much help. Severely disabled children and their parents benefited most from the use of aids. The structured interview unexpectedly revealed many problems, including a considerable need for extra aids for dressing, bathing and toileting. The parents were ready to accept technical aids, but needed more information on their possibilities, benefits and therapeutic aspects. The authors conclude that the need for technical aids for daily activities is not readily recognised during outpatient or hospital visits.
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Affiliation(s)
- R Korpela
- Department of Paediatric Neurology, Tampere University Hospital, Finland
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20
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21
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Lord M, Foulston J, Smith PJ. Technical evaluation of a CAD system for orthopaedic shoe-upper design. Proc Inst Mech Eng H 1991; 205:109-15. [PMID: 1840716 DOI: 10.1243/pime_proc_1991_205_276_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Computer aided design is now employed routinely in the volume shoe trade. New styles are developed on a three-dimensional image of the last followed by automated pattern generation and engineering. It is suggested that such systems could be useful in the orthopaedic footwear industry although the different requirements for these bespoke products need careful consideration. A clinical trial has been conducted on the Shoemaster (Clarks Shoes) upper design system both to assess its technical capabilities and to consider its role in improvement of service and cosmetic appearance. This particular system works throughout on a three-dimensional representation of the shoe last, which offers particular advantages for integration with shape capture and reproduction. The report concentrates on the technical evaluation to assess (a) its ability to work with unusual last shapes dictated by medical requirements and (b) its potential for integration into a complete computer system for design of both shoe lasts and shoe uppers. The trial indicates that this particular system is promising in both respects.
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Affiliation(s)
- M Lord
- Department of Medical Engineering and Physics, King's College School of Medicine and Dentistry, London
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22
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Pratt DJ. Three-dimensional electrogoniometric study of selected knee orthoses. Clin Biomech (Bristol, Avon) 1991; 6:67-72. [PMID: 23915477 DOI: 10.1016/0268-0033(91)90001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/1990] [Accepted: 11/10/1990] [Indexed: 02/07/2023]
Abstract
In an attempt to provide quantitative data on the functional performance of six selected knee orthoses a 9-D electrogoniometric study was initiated. Using a TRIAX electrogoniometer the orthoses were compared in a group of ten subjects during normal level walking. The orthoses were Cinch, Fastwrap, Drop-lok, Lerman Multi-ligamentous, Donjoy 4pt, and Flex 10. It was found that the simple orthoses provided little support and may severely restrict knee flexion even without any hinges being locked. The more rigid orthoses were superior although providing surprisingly little control of knee adduction and internal rotation unless the joints were locked. The results suggest that further work in this area is required with more comprehensive measurements of knee motion (translational and rotational) during activities other than walking.
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Affiliation(s)
- D J Pratt
- Orthotic and Disability Research Centre, Derbyshire Royal Infirmary, UK
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23
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Kohn JG, Mortola P, LeBlanc M. Clinical trials and quality control: checkpoints in the provision of assistive technology. Assist Technol 1990; 3:67-74. [PMID: 10147560 DOI: 10.1080/10400435.1991.10132184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Clinical trials and quality control measures are characterized by evaluation of assistive technology by users, and feedback to providers for the purpose of improving devices or service delivery. These processes recognize that consumer satisfaction is an important measure of device and service delivery effectiveness. In this article, types of clinical trials are reviewed, and both prospective and retrospective methods of quality control are presented. The authors take the position that rehabilitation engineering centers providing customized devices and adapted technology should implement quality control measures in order to improve services to their clients.
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Affiliation(s)
- J G Kohn
- Rehabilitation Engineering Center, Children's Hospital at Stanford, Palo Alto, California
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24
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25
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Collinson PO, Fink RS, Ramhamadany EM, Greenwood TW, Chandler HA, Brooks GR. Desktop laboratory technology in general practice. BMJ (CLINICAL RESEARCH ED.) 1989; 299:976. [PMID: 2508958 PMCID: PMC1837796 DOI: 10.1136/bmj.299.6705.976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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26
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Craig JOMC, Highman JH. Radiology about to go digital. West J Med 1989. [DOI: 10.1136/bmj.299.6705.975-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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