The Objective Measurement of Brace-Use Adherence in the Treatment of Idiopathic Clubfoot

Sangiorgio, Sophia N.; Ho, Nathan C.; Morgan, Rebecca D; Ebramzadeh, Edward; Zionts, Lewis E.

doi:10.2106/jbjs.16.00170

Cited by 39 publications

(53 citation statements)

References 32 publications

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“…However, as only 5 of the 12 measurements were taken with temperature sensors and the rest was based on questionnaires, the results are somewhat biased. A similar discrepancy between self-reported and objective measurement has also been observed in other fields of treatment, such as clubfoot and scoliosis therapy [17, 31].…”

Section: Discussionsupporting

confidence: 64%

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Schwarze

Horoba

Block

et al. 2019

Rehabilitation Research and Practice

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Objective. To date there is only limited knowledge about the wearing time of orthoses. Ankle-foot orthoses (AFOs) have not been studied with this research question. Additional influences of the orthotic design as well as weekdays and the weekend are also unknown. Design. Monocentric, clinically prospective intervention study. Patients. Inclusion of 10 patients with bilateral spastic cerebral palsy. Methods. Equipment of all subjects with a dynamic ankle-foot orthosis (DAFO) and modular shank supply (MSS, dynamic elastic shank adaptation or ground reaction AFO). Integration of temperature sensors for recording the wearing time for a period of 3 months. Results. The actual wearing time was below the recommendations on actually worn days as well as the average of the entire study period. In addition, the actual usage in terms of days and hours was well below the recommendations. The wearing time showed differences between weekdays and weekend. Differences between DAFO and MSS were not detectable. Conclusion. The actual usage behavior of ankle-foot orthoses differs from the recommendations of the prescriber. This applies to both DAFOs and modular use with shank supplies. Environmental factors may have a significant impact on wearing times on weekdays and the weekend.

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Section: Discussionsupporting

confidence: 64%

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Schwarze

Horoba

Block

et al. 2019

Rehabilitation Research and Practice

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show abstract

“…Another consideration that may impact on long term conservative footwear management is compliance with the intervention [48]; this was not accounted for or was inconsistently measured in the studies potentially introducing confounding bias [49,50]. The medical conditions with the highest number of studies were pes planus (five studies) and cerebral palsy (four studies).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of therapeutic footwear for children: A systematic review

Hill

Healy

Chockalingam

2020

Journal of Foot and Ankle Research

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Background: It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children. Methods: A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers. Results: Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled "corrective and "functional" based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited. Conclusion: Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.

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“…When using self-report, patients may find it difficult to accurately remember their adherence level, and studies on orthotic devices for other medical conditions have shown that self-report overestimates adherence. 46 , 47 However, using objective methods, such as temperature and activity monitors, is not without challenges.…”

Section: Methods To Measure Adherencementioning

confidence: 99%

Methodological considerations of investigating adherence to using offloading devices among people with diabetes

Jarl¹

2018

PPA

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Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to measure adherence have defined adherence as the number of steps taken with the device, which excludes weight-bearing activities where no steps are taken. Conceptual frameworks are not made explicit in the current quantitative research. It is concluded that future studies should use a longitudinal design with observational studies to identify patient groups prone to nonadherence and factors that influence adherence and experimental studies to evaluate interventions to improve adherence, focusing on these patient groups and factors. Furthermore, adherence should be defined in terms of relative adherence to using offloading devices during all weight-bearing activities, and objective measurement of adherence (using accelerometers and temperature monitors) should be used whenever possible. Clearly defined conceptual frameworks should guide the choice of factors to include in the study and the analysis of their interactions. By implementing these recommendations, research could provide a stronger evidence base in the future, supporting interventions to increase adherence and thereby improve outcomes for people with diabetic foot complications.

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The Objective Measurement of Brace-Use Adherence in the Treatment of Idiopathic Clubfoot

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 39 publications

References 32 publications

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Wearing Time of Ankle-Foot Orthoses with Modular Shank Supply in Cerebral Palsy: A Descriptive Analysis in a Clinically Prospective Approach

Effectiveness of therapeutic footwear for children: A systematic review

Methodological considerations of investigating adherence to using offloading devices among people with diabetes

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