Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review

Perspectives on and use of assistive technology by persons with MS: a scoping review

Assistive technology (AT) provides persons with Multiple Sclerosis (PwMS) ability to engage in daily activities, however acquiring AT can be challenging. Understanding current state of knowledge about perspectives and use of AT by PwMS may support critical thinking about AT acquisition process. The aim of this scoping review was to map what is known about AT use by PwMS, to identify gaps in knowledge to guide future research and practice for AT matching. A scoping review of qualitative research on perspectives and use of AT by PwMS searched four databases (Medline, CINAHL, PsychNet, and Engineering Village). Papers included focused on non-institutional settings, addressed participant's feelings/perceptions/experiences, and were in English. Initial search October 2021, updated 2022 and 2023. Two reviewers conducted screening, review, and extraction, with a third resolving disagreements. Data extraction guided by the Canadian Model of Occupational Performance and Engagement, categorised AT use by productivity, self-care, and/or leisure occupations. Covidence® was used for extraction. Findings were exported into a spreadsheet to facilitate thematic analysis. Search identified 22 peer-reviewed journals and 11 consumer publications (n = 33). Most common AT was mobility devices. Primary purposes were self-care and leisure. Common use included functional mobility, transportation, personal care, household management, recreation, and socialisation. Perceptions focused on AT need, adjusting to AT, influencing factors, performance and engagement improvements, and seeking acquisition advice. Lack of research on experiences and use of AT beyond mobility equipment, and for engagement of daily activities. Evidence provides some insights for future directions and implications to support AT acquisition for PwMS.

Functional and perceptive differences between conventional and advanced ankle foot orthoses in community ambulators post-limb trauma: the injuries managed with advanced bracing of the lower extremity (IM ABLE) study

Introduction

Many military service members and civilians suffer from lower extremity trauma. Despite recent advancements in lower limb bracing technology, it remains unclear whether these newer advanced braces offer improved comfort and functionality compared to conventional options. The IDEO (Intrepid Dynamic Exoskeletal Orthosis), a type of "advanced" orthosis was developed to assist in maintaining high functional performance in patients who have experienced high-energy lower extremity trauma and underwent limb salvage surgeries.

Methods

A cross-sector multi-site initiative was completed to study the efficacy of advanced ankle foot orthoses (AFO) for lower limb trauma and injury compared to a conventional AFO. Following fitting, training, and accommodation, the subjects were assessed in each AFO system for mobility, self-reported function, safety and pain, and preference.

Results

They preferred the advanced over the conventional AFO and the mobility and exertion perception improved with the advanced AFO with no difference in pain or overall health status scores.

Discussion

Thus, an advanced AFO is an option for trauma affecting the lower limb. Long-term studies are required to better understand the accommodation and learning process of using an advanced AFO.

Passive Articulated and Non-Articulated Ankle-Foot Orthoses for Gait Rehabilitation: A Narrative Review

The aim of this work was to study the different types of passive articulated and non-articulated ankle-foot orthoses for gait rehabilitation in terms of working principles, control mechanisms, features, and limitations, along with the recent clinical trials on AFOs. An additional aim was to categorize them to help engineers and orthotists to develop novel designs based on this research. Based on selected keywords and their composition, a search was performed on the ISI Web of Knowledge, Google Scholar, Scopus, and PubMed databases from 1990 to 2022. Forty-two studies met the eligibility criteria, which highlighted the commonly used types and recent development of passive articulated and non-articulated ankle-foot orthoses for foot drop. Orthotists and engineers may benefit from the information obtained from this review article by enhancing their understanding of the challenges in developing an AFO that meets all the requirements in terms of ease of use, freedom of movement, and high performance at a relatively low cost.

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

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 System®. 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 (±6.5), two standard deviations below the US general population mean, indicating significant impairment. The regression model explained approximately 15% (R = 0.411) of the variance in PF of the sample. Self-reported PF was worse for individuals requiring more supportive assistive devices (β = 0.270, p = 0.001), those with more recent ankle problems (β = -0.167, p = 0.035), and those with greater living assistance (β = -0.139, p = 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.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.