Orthotic Research Initiative for Outcomes aNalysis (ORION I): predictors of PROMIS PF for stroke survivors seeking orthotic intervention

Abstract

Purpose: Ankle-foot orthoses (AFOs) are used to improve physical performance measures of physical function (PF) post-stroke; however, the perception of improved PF of this population has not been described. The purpose of this study was to identify the predictors of self-reported PF of individuals seeking orthotic intervention post-stroke. Materials and Methods: A retrospective analysis of 237 patients at a nationwide orthotic services provider in the United States was conducted to characterize PF using the Patient-Reported Outcome Measures Information SystemV R . A backward stepwise multiple regression was conducted to identify demographic characteristics predictive of self-reported PF. Results: The mean T-score of PF of the sample was 30.8 (66.5), two standard deviations below the US general population mean, indicating significant impairment. The regression model explained approximately 15% (R ¼ 0.411) of the variance in PF of the sample. Self-reported PF was worse for individuals requiring more supportive assistive devices (b ¼ 0.270, p ¼ 0.001), those with more recent ankle problems (b ¼ À0.167, p ¼ 0.035), and those with greater living assistance (b ¼ À0.139, p ¼ 0.089). Conclusions: These results improve understanding of the factors that contribute to impaired self-reported PF of stroke survivors in need of AFO intervention. ä IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFOs) are often used to improve physical performance measures of physical performance (PF) during stroke rehabilitation. Our data indicate that the self-reported PF of AFO users is severely impaired. Level of assistance, time since ankle and foot problems began, and living assistance status are important clinical characteristics to consider when planning AFO intervention for this population.

Development and initial validation of the Orthotic Patient-Reported Outcomes—Mobility (OPRO-M): An item bank for evaluating mobility of people who use lower-limb orthoses

“…PROMIS-PF scores are centered on responses from a general population and may be challenging to interpret when assessing mobility of LLO users. DiBello et al reported that people who received an AFO post-stroke had a mean PROMIS-PF T-score of 30.8—nearly two standard deviations below the general population mean [ 11 ]. It is challenging to accurately measure and evaluate changes in mobility with PROMIS-PF when LLO users are so near the floor of the scale (i.e., a T-score of 30.8 places someone within the bottom 3% of the US general population).…”

Development of a candidate item bank for measuring mobility of lower limb orthosis users

“…Another study used PROMIS-PF to assess 237 AFO users affected by stroke and reported a mean T-score that was two standard deviations below the U.S. general population. 30 Although these studies illustrate potential applications for PROMIS-PF in LLO-related research, the general population-based scoring system may limit its utility as a clinical assessment tool. Thus, although LEFS, OPUS-LEFS, and PROMIS-PF may be applicable to LLO users, their clinical utility may be limited by a general population focus and/or forms that do not allow for customization to specific types of users.…”

“…Weber et al 29 tested PROMIS‐PF in a sample of 98 LLO users and reported initial evidence of known groups construct validity. Another study used PROMIS‐PF to assess 237 AFO users affected by stroke and reported a mean T‐score that was two standard deviations below the U.S. general population 30 . Although these studies illustrate potential applications for PROMIS‐PF in LLO‐related research, the general population‐based scoring system may limit its utility as a clinical assessment tool.…”