Ambulatory KAFOs: A Physical Therapist???s Perspective

Edelstein, Joan E.

doi:10.1097/00008526-200606001-00006

Cited by 4 publications

(3 citation statements)

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“…Low satisfaction in terms of ease of use can imply problems with donning and doffing of the KAFO, which has been reported previously as a negative aspect of KAFO use in polio survivors ( 15 ) and individuals with inclusion body myositis ( 29 ). Performing activities such as going up and down stairs, cycling or operating the KAFO may also result in low satisfaction with ease of use ( 28 , 30 ). It is important that these aspects receive specific attention when delivering a KAFO ( 11 ) in order to enhance compliance in using the KAFO ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Raijmakers

Gooijer²,

Ploeger³

et al. 2022

JRM

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Objective: To investigate the use of custom-made knee-ankle-foot-orthoses in daily life and differences in usability factors of knee-ankle-foot-orthoses between users and discontinued users. Design: Cross-sectional survey study. Subjects: A total of 163 polio survivors provided with a knee-ankle-foot-orthosis at an outpatient clinic of a university hospital. Methods: Use and usability of knee-ankle-foot-orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard. Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot-orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot-orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot-orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot-orthosis-related aspects (p < 0.001). Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot-orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot-orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot-orthosis in polio survivors.

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Section: Discussionmentioning

confidence: 99%

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Raijmakers

Gooijer²,

Ploeger³

et al. 2022

JRM

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“…18 The importance of appropriate training with the orthosis and associated assistive devices has been previously emphasised. 19 It has been suggested that rejection might, in some instances, be due solely to lack of appropriate gait training. 2 The need for training for orthosis users in the care of the orthosis and care of the skin to avoid adverse effects has also been recommended.…”

Section: Patient Perspectivementioning

confidence: 99%

“…2 The need for training for orthosis users in the care of the orthosis and care of the skin to avoid adverse effects has also been recommended. 19 Other problems that have been cited include auditory distraction, memory of old leather and steel orthoses for patients with poliomyelitis, and damage to clothing. 20 If a patient has unrealistic and unfilled expectations then this may lead to abandoning the orthosis.…”

Section: Patient Perspectivementioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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BackgroundPatients 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).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative 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.ResultsQualitative 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.ConclusionsVarious 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.LimitationsThe 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 workFuture 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 registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Principles of Lower Extremity Orthoses

Lusardi¹

2013

Orthotics and Prosthetics in Rehabilitation

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Ambulatory KAFOs: A Physical Therapist???s Perspective

Cited by 4 publications

References 0 publications

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Principles of Lower Extremity Orthoses

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