User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke

Bulley, Catherine; Shiels, J.; Wilkie, K.; Salisbury, Lisa

doi:10.1016/j.physio.2010.11.001

Cited by 59 publications

(31 citation statements)

References 18 publications

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“…These studies, 13,72,76 utilising different research techniques and with varying patient populations, found that orthoses that did not fit properly, which were considered uncomfortable, heavy, cumbersome and unsightly, and which drew attention to disability, were less acceptable to patients, results which match findings from our own study. Phillips et al 13 combined nominal group technique and interviews in her study of people with CMT disease to identify perceived barriers and benefits to the use of AFOs.…”

Section: Findings In the Context Of Other Studiessupporting

confidence: 72%

“…Three studies 13,72,76 have considered the views of patients towards the use of AFOs. These studies, 13,72,76 utilising different research techniques and with varying patient populations, found that orthoses that did not fit properly, which were considered uncomfortable, heavy, cumbersome and unsightly, and which drew attention to disability, were less acceptable to patients, results which match findings from our own study.…”

Section: Findings In the Context Of Other Studiesmentioning

confidence: 99%

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Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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BackgroundPatients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee–ankle–foot orthoses (KAFOs).ObjectivesTo assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.MethodsQualitative study of views of orthoses users – a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review – 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis – a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.ResultsQualitative study – a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients’ prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review – a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis – in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553.ConclusionsVarious types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.LimitationsThe population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.Future workFuture work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.Study registrationThis study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Findings In the Context Of Other Studiessupporting

confidence: 72%

Section: Findings In the Context Of Other Studiesmentioning

confidence: 99%

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

O’Connor

McCaughan

McDaid

et al. 2016

Health Technol Assess

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“…Bulley et al [15] from a qualitative study based on focus group interviews, reported reasons for dissatisfaction as: 'uncomfortable, remarks of the participants to check the internal validity [26].…”

Section: Introductionmentioning

confidence: 99%

Use of and Satisfaction with Ankle Foot Orthoses

EJM¹

2015

Clin Res Foot Ankle

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Objective: The aim of this study was to obtain insight in specific elements influencing the use, non-use, satisfaction, and dissatisfaction of ankle foot orthoses (AFOs) and the presence of underexposed problems with respect to AFOs. Methods:A questionnaire was composed to obtain information from AFO users to investigate the variables associated with satisfaction and the relation between these variables. A specific feature of this study was the systematic analysis of the remarks made by the respondents about their AFO. Quantitative data analyses were used for analysing the satisfaction and qualitative analyses were used analysing the remarks of the respondents. A total of 211 users completed the questionnaire.Results: Our survey showed that 1 out of 15 AFOs were not used at all. About three quarters of the AFO users were satisfied and about one quarter was dissatisfied. Females and users living alone reported relatively high levels of dissatisfaction, especially in the field of dimensions, comfort, weight, safety and effectiveness. Dissatisfaction with respect to off-the-shelf AFOs for the item durability was higher than that for custom-made AFOs. In the delivery and maintenance process the items 'maintenance', 'professionalism' and 'delivery follow-up' were judged to be unsatisfactory. A large number of comments were made by the respondents to improve the device or process, mainly by the satisfied AFO users. These comments show that even satisfied users experience many problems and that a lot of problems of AFO users are 'underexposed'. Conclusion:To improve user satisfaction, the user practice has to be identified as an important sub-process of the whole orthopaedic chain especially in the diagnosis and prescription, delivery tuning and maintenance, and evaluation phase.

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“…It starts from the moment a problem is reported, defines the design phase and concludes with the evaluation of the medical device and its use that has been supplied. Therefore, the key question is: Why there still remain -despite the use of ICF and PDMD -a substantial level of non-use of devices and a significant level of dissatisfaction among AFO users [6,14,15,17,[29][30][31]? In our opinion, the answer has to be found in the general character of the ICF and the PMDM that they neither facilitate a systematic and detailed analysis of the activities of users nor support a systematic mapping of the environments in which users are living.…”

Section: Identifying Needs Of Customersmentioning

confidence: 99%

“…Wessel et al [16] showed that satisfaction is positively influenced by the design of the AFO, or in other words, the look and feel of the product and its aesthetics. The functionality of the AFO, the received care, and the involvement of the AFO user in the design process also influence satisfaction positively [17].…”

Section: Introductionmentioning

confidence: 99%

Mapping user activities and user environments during the client intake and examination phase: An exploratory study from the perspective of ankle foot orthosis users

Holtkamp

Verkerk

Hoof

et al. 2017

TAD

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Abstract.BACKGROUND: Non-use of and dissatisfaction with ankle foot orthoses (AFOs) occurs frequently. The objective of this study is to gain insight in the conversation during the intake and examination phase, from the clients' perspective, at two levels: 1) the attention for the activities and the context in which these activities take place, and 2) the quality of the conversation. METHODOLOGY: Semi-structured interviews were performed with 12 AFO users within a two-week period following intake and examination. In these interviews, and subsequent data analysis, extra attention was paid to the needs and wishes of the user, the desired activities and the environments in which these activities take place. RESULTS AND CONCLUSION: Activities and environments were seldom inquired about or discussed during the intake and examination phase. Also, activities were not placed in the context of their specific environment. As a result, profundity lacks. Consequently, orthotists based their designs on a 'reduced reality' because important and valuable contextual information that might benefit prescription and design of assistive devices was missed. A model is presented for mapping user activities and user environments in a systematic way. The term 'user practices' is introduced to emphasise the concept of activities within a specific environment.

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User experiences, preferences and choices relating to functional electrical stimulation and ankle foot orthoses for foot-drop after stroke

Cited by 59 publications

References 18 publications

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis

Use of and Satisfaction with Ankle Foot Orthoses

Mapping user activities and user environments during the client intake and examination phase: An exploratory study from the perspective of ankle foot orthosis users

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