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

Abstract

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.

Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders

“…Considering that our study compared specialist care AFOs to a variety of UC orthoses as provided in clinical practice, rather than walking with shoes as in previous studies, the improvements found can be considered meaningful. For specialist care KAFOs, the effects on perceived stability and satisfaction are in line with earlier improvements found for specialist care carbon composite KAFOs [ 23 , 49 ]. When compared to objectively measured walking ability in a gait laboratory, perceived effects such as safety while walking on irregular surfaces may be more representative of walking in daily life and therefore of greater importance to patients.…”

“…Furthermore, these improvements may have contributed to the shift in functional ambulation level, which increased with a specialist care orthosis from 8% to 19% full community walkers, although the increased use of walking aids at follow-up should be considered in this shift. Mean satisfaction scores with the specialist care orthosis were comparable with previous studies using the D-QUEST [ 26 , 49 , 50 ].…”

Long-term locked knee ankle foot orthosis use: A perspective overview of iatrogenic biomechanical and physiological perils

“…Although the benefits of swing phase knee motion provided by SC-KAFO are evident, the L-KAFO remains the most prevalent orthotic intervention for patient in need of a KAFO (7)(8)(9). L-KAFO must be prescribed in the presence of hip or knee flexion contractures >10 degrees, leg length discrepancy >15 cm, genu varum/valgum >10 degrees, body weight >125 kg, hip musculature strength <grade 3 (fair), the need for ischial weightbearing, cognitive and psychological disorders, and those with bilateral motor impairment or flail lower limbs (8,9). However, most patients devoid of these limitations are not prescribed SC-KAFO primarily due to cost and the need for training, predisposing the wearer to iatrogenic consequences associated with long-term use.…”

Assessing pain—the invisible, long-haul polio symptom

“…Total knee and hip replacements address overused, weakened lower extremities. [10][11][12][13][14][15] There is no cure for polio, but it can be prevented with safe and effective vaccination. Inactivated poliovirus vaccine (IPV) given by I.M.…”