Barriers and facilitators to lower extremity orthotic compliance in the pediatric population: A scoping review of the literature

Abstract

Despite the purported benefits of lower extremity orthotics in the literature, pediatric compliance rates remain low. This scoping review synthesized the available literature regarding barriers and facilitators to lower extremity orthotic compliance in the pediatric population using the framework of the International Classification of Functioning, Disability and Health: Children and Youth (ICF). A comprehensive search of MEDLINE, EMBASE, and CINAHL was conducted on May 11, 2021, and of PsycInfo on May 12, 2021. Article reference lists and gray literature were also searched. A total of 81 articles were included. Factors described in at least four articles were labeled as universal barriers or facilitators. In the International Classification of Functioning, Disability and Health: Children and Youth domain of Body Functions/Body Structures, universal barriers were present in the global mental functions, experience of self and time, sensory functions, function of joints and bones, and structures related to the skin subcategories, with no universal facilitators identified. For the Activity Limitations/Participation Restrictions domain, one universal facilitator was identified in the mobility subcategory. In the Environmental Contextual Factors domain, universal barriers were found in the attitudes of immediate and extended family and societal attitude subcategories, with both universal barriers and facilitators found in support & relationships: immediate and extended family, support and relationships: health professionals, services, systems, and policies, and products and technology. The reviewed literature strongly emphasizes the importance of proper orthotic fit and comfort, and the child’s experience of self, for lower extremity orthotic compliance, along with multiple environmental factors.

Dinamik Ayak-Ayakbileği Ortezi Kullanan Spastik Serebral Palsili Çocukların Memnuniyet Düzeylerinin Araştırılması

“…It can be said that this is one of the points that should be emphasized as a result of our study. Especially in orthotic approaches to be applied in adolescents with CP, it may be important to pay attention to visuality, to offer shoe options that can be used with the orthosis, in order to increase the satisfaction of orthosis usage (Marcotte et al 2023).…”

Factors Affecting Patient Compliance with Upper Limb Bracing Following Physical Therapy

“…The upper limb is one of the most important parts of the body that possesses the functional ability to perform daily activities, self-care duties, hobbies and sports. Upper limb rehabilitation following acute injury will help the patient restore the mobility and strength of the upper limb so that they can perform their activities of daily living independently [2][3] .…”

Development and Initial Evaluation of a Soft Ankle Support for Children With Ankle Impairments

“…Adults also identified comfort, effectiveness, and safety as the most important aspects of orthoses 9. In a scoping review of barriers and facilitators to lower extremity (LE) orthosis compliance in pediatrics, Marcotte et al10 identified a variety of commonly reported barriers to adherence, including skin irritation, discomfort/pain, sleep disturbances, and restriction of LE movement; social stigma, including feeling embarrassed and/or self-conscious about the device, was also a barrier to adherence. Specifically, children with cerebral palsy report on AFOs positively regarding function (eg, fewer falls, improved walking and balance) but negatively regarding aesthetics (ie, they dislike AFO cosmesis) 11.…”