Defining and grouping children’s therapeutic footwear and criteria for their prescription: an international expert Delphi consensus study

Abstract

ObjectivesThis study aimed to achieve an expert consensus on how to define and group footwear interventions for children, with a further focus on the design characteristics and prescription of off-the-shelf stability footwear for children with mobility impairment.SettingA group of multinational professionals, from clinicians to those involved in the footwear industry, were recruited to ensure a spectrum of opinions.ParticipantsThirty panellists were contacted, of which 24 consented to participate and six withdrew before round 1, a further two withdrew after round 1. Sixteen panellists completed the consensus exercise.Primary and secondary outcome measuresA Delphi consensus method was employed with round 1 split into three sections: (1) terms and definitions, (2) specifics of off-the-shelf stability footwear design and (3) criteria for clinical prescription of off-the-shelf stability footwear. The panel was asked to rate their level of agreement with statements and to provide further insights through open-ended questions. The opinions of the experts were analysed to assess consensus set at 75% agreement or to modify or form new statements presented through the subsequent two rounds.ResultsTherapeutic footwear was the agreed term to represent children’s footwear interventions, with grouping and subgrouping of therapeutic footwear being dependent on their intended clinical outcomes (accommodative, corrective or functional). Both the heel counter and topline as well as the stiffness and width of the sole were identified as potentially influencing mediolateral stability in children’s gait. A consensus was achieved in the prescription criteria and outcome measures for off-the-shelf stability therapeutic footwear for cerebral palsy, mobile symptomatic pes planus, Duchenne muscular dystrophy, spina bifida and Down’s syndrome.ConclusionsThrough a structured synthesis of expert opinion, this study has established a standardisation of terminology and groupings along with prescription criteria for the first time. Reported findings have implications for communication between stakeholders, evidence-based clinical intervention and standardised outcome measures to assess effectiveness.

Parents, health professionals and footwear stakeholders' beliefs on the importance of different features of young children's footwear: a qualitative study

“…As such, many footwear recommendations may be subject to trend rather than based on sound concepts. Foundational children's footwear research data fields have recently been formed through a consensus‐based taxonomy of children's footwear styles and features, establishing recommendations on defining therapeutic footwear, footwear design characteristics and prescription variables [15, 16]. The next steps for children's footwear research must involve developing a consistent suite of outcome measures to add to these foundation data fields.…”

“…Researchers have recently also explored how young children describe comfort [14], when young children wear footwear with different features, and how these features are described [15]. Children's footwear research has also focused on which footwear features may be therapeutically important if a child has a foot, leg or gait problem [16]. This small but building pool of evidence of the impact of footwear's on functional abilities mean understanding the different beliefs of stakeholders about footwear flexibility and key features are critical for research translation.…”

Evidence-based rehabilitation medicine: definition, foundation, practice and development

“…EBNRM primarily focuses on the rehabilitation of patients with TBI [ 99 ], while EBENRM centers on the application of footwear [ 100 ], [ 101 ], [ 102 ], prosthetic limbs [ 103 ], arch support [ 104 ], and power wheelchairs [ 105 ]. EBTCRM primarily emphasizes traditional Chinese exercise therapy [ 106 ] and acupuncture [ 107 , 108 ].…”

Young children’s footwear taxonomy: An international Delphi survey of parents, health and footwear industry professionals

“…The purchase of children’s footwear is a common source of angst for parents and caregivers [ 5 ], with ill-fitting and poor choice of footwear often cited as the basis of foot-related issues as adults [ 6 ]. This angst can be heightened when children present with disability or developmental concerns, where specific footwear features may assist in achieving, improving or maintaining ambulation [ 7 – 10 ]. The lack of consistency in descriptors of footwear types and features can stymie both health professionals and parents as it is typically dependant on the individual retail centre to interpret prescribed or recommended inclusions.…”