Assessing Satisfaction With Orthotic Devices and Services: A Systematic Literature Review

A Systematic Review of the Optimal Management of Pediatric Distal Radius Displacement Fractures: Open Reduction and Internal Fixation Versus Cast Placement

Distal radius fractures are among the most common pediatric injuries, affecting thousands of children each year. These fractures often require clinical intervention to reduce displacement and ensure the proper healing of the growth plate and wrist bone. The primary objective of this comprehensive analysis is to compare the effectiveness of open reduction and internal fixation (ORIF) versus cast placement in the treatment of pediatric distal radius fractures, with the aim of identifying the optimal treatment approach. Therefore, a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on pediatric distal radius displacement fractures using extensive database searches from 2000 to 2024 for specific keywords, ensuring transparency and reproducibility. Our findings indicate that higher displacement necessitates ORIF to minimize long-term complications and ensure better functional outcomes for pediatric patients. Rare studies comparing ORIF and cast placement are analyzed, emphasizing the advantages and limitations of each approach. The document concludes that the choice between ORIF and casting depends on factors such as fracture severity, patient's age, and specific characteristics of the injury to ensure optimal outcomes in pediatric distal radius fracture management. In conclusion, our data suggests that ORIF and cast placement each have pros and cons for pediatric distal radius fractures, with the best treatment depending on fracture specifics and patient factors, but neither method is clearly superior for long-term outcomes.

Validity, reliability, and Rasch analysis of the orthotics and prosthetics users' survey: Turkish version of the lower-extremity functional status

BACKGROUND

It is well known that questionnaires and scales are easy to use, cheap, and provide fast results. In the clinical setting, it will be easier and more comfortable to evaluate lower-extremity functions in both prosthesis and orthosis users with a single questionnaire.

OBJECTIVES

To study the Turkish version of the orthotics and prosthetics users' survey lower-extremity functional status (OPUS-LEFS) and investigate its reliability and validity in the Turkish prosthesis and orthosis users.

STUDY DESIGN

After forward and backward translation process, test-retest, internal consistency, validity, dimensionality, and Rasch analysis were done for 139 participants.

METHODS

Participants with a lower-limb prosthesis or orthosis were recruited in this study. Test and retest of the survey was done 1-3 days apart. For convergent validity, Nottingham Health Profile was used. Pearson correlation coefficient was used to analyze test-retest reliability; Cronbach's alpha for internal consistency, Spearman's correlation coefficient for validity, exploratory factor analysis by means of Kaiser-Meyer-Olkin and Bartlett's value of sphericity for dimensionality, and Rasch analysis were used.

RESULTS

Test-retest reliability of OPUS-LEFS showed very strong correlation (0.994) and for internal consistency with Cronbach's alpha value 0.71 of the Turkish version of OPUS-LEFS. Analyses showed that OPUS-LEFS is valid ( p < 0.001) and significant ( p < 0.001).

CONCLUSIONS

The Turkish version of the OPUS-LEFS has been shown to be a valid and reliable tool in evaluating both orthosis and prosthesis users with a self-administered questionnaire for LEFS.

Novel 3D-printed foot orthoses with variable hardness: A comfort comparison to traditional orthoses

Custom foot orthoses are used to treat a variety of foot pathologies. However, orthotic production requires significant hands-on fabrication time and expertise to produce orthoses that are both comfortable and effective. This paper introduces a novel 3D printed orthosis and fabrication method that utilizes custom architectures to produce variable-hardness regions. These novel orthoses are compared to traditionally fabricated orthoses during a 2-week user comfort study. Twenty (n = 20) male volunteers underwent orthotic fitting for both traditional and 3D-printed foot orthoses prior to engaging in treadmill walking trials and 2 weeks of wear. Each participant undertook a regional comfort, acceptance, and comparison analysis of the orthoses at three time points throughout the study (0, 1, and 2 weeks). Both the 3D-printed and the traditionally fabricated foot orthoses demonstrated statistically significant increases in comfort when compared to the factory fabricated shoe insert. Additionally, the two orthosis groups were not significantly different from each other in comfort rankings both regionally and overall at any time point. The similar comfort achieved by the 3D-printed orthosis to the traditionally fabricated orthosis after 7 days and 14 days emphasizes the potential of the future use of the more reproducible and adaptable 3D-printed orthosis manufacturing methodology.

Evaluation of User's Satisfaction With Orthotic and Prosthetic Devices and Services in Orthotics and Prosthetics Center of Iran University of Medical Sciences

BACKGROUND

The number of patients receiving orthotics and prosthetic services is increasing globally. A way to investigate patients' insight about services provided to them is to evaluate their satisfaction with the received services. Furthermore, incorporating patients' preferences into practice is an inseparable part of evidence-based practice. Applying such information in practice can contribute to the enhancement of the quality of services, the effectiveness of therapeutic interventions, and finally, the economic growth of service centers.

OBJECTIVES

To evaluate patients' satisfaction with the orthotic and prosthetic devices and services provided by the orthotics and prosthetics clinic of Iran University of Medical Sciences.

METHODOLOGY

In this study, 173 people referring to the orthotics and prosthetics clinic of Iran University of Medical Sciences were recruited, and their satisfaction level was examined using the Orthotics and Prosthetics Users' Survey questionnaire (OPUS) through a phone interview.

FINDINGS

Concerning the devices, the mean value of total satisfaction score was 74:00±19.80 and the highest score belonged to no wear or rupture of the clothes with their devices (mean value = 4.76±0.84). In terms of services, the mean value of total satisfaction score was 72.12 ± 15.90 with the highest score belonging to the politeness of the clinic staff (mean value = 4.92±0.57). When the time point from receiving service was taken into account, the patients who received the service for less than a year showed higher satisfaction level with the service (p=0.024). Although satisfaction with the device was slightly higher among the participants who used the devices for more than a year, no significant difference was observed between the two groups in terms of device satisfaction.

CONCLUSIONS

The overall satisfaction level from the devices and services was relatively high. However, the satisfaction level with the costs and coordination of the staff with the physicians showed a decline.

Reliability and validity of the Turkish version of the satisfaction module of the Orthotics and Prosthetics Users' Survey

BACKGROUND

Evaluation of prosthesis and orthosis (P&O) devices and service satisfaction in patients using P&O are important to understand the patient perspective and improve the quality of devices and the services.

OBJECTIVE

The aim of this study was to translate the original Orthotics and Prosthetics Users' Survey (OPUS) satisfaction module into Turkish and examine its psychometric properties in lower limb P&O users.

STUDY DESIGN

Cross-sectional study.

METHODS

The Turkish versions of the OPUS-Client Satisfaction with Device (CSD) and Service (CSS) modules were applied to 157 individuals using a lower limb prosthesis or orthosis. The retest of the survey was applied 5-7 days later. Intraclass correlation coefficient was used to determine test-retest reliability, and Cronbach alpha was used to determine internal consistency. Criterion validity was evaluated using the Nottingham Health Profile. Exploratory factor analysis was used to examine the factor structure of the Turkish version of the OPUS satisfaction module.

RESULTS

The test-retest correlation (intraclass correlation coefficient = 0.92 for CSD and 0.91 for CSS) and internal consistency (Cronbach's alpha = 0.84 for CSD and 0.95 for CSS) were high. A statistically significant correlation was found between the OPUS CSD and CSS modules and the Nottingham Health Profile (r = -0.325 for CSD module, r = -0.381 for CSS module, P < 0.001). The factor analysis revealed one-factor structure for both modules.

CONCLUSIONS

This study demonstrated the reliability and validity of the Turkish version of the OPUS satisfaction module, and it provides a useful starting point for future studies on this survey.

Psychometric evaluation of the Arabic version of the Quebec user evaluation of satisfaction with assistive technology (A-QUEST 2.0) in prosthesis users

BACKGROUND

The evaluation of patient satisfaction and perceptions plays a vital role in determining the quality of prosthesis users' devices and the competency of healthcare services.

AIM

To evaluate the psychometric properties of the Arabic Quebec User Evaluation of Satisfaction with Assistive Technology (A-QUEST 2.0) with prosthetics users.

DESIGN

A methodological study.

SETTING

Saudi Arabia, Turkey.

POPULATION

A convenience sample of outpatient prosthesis users (N.=183).

METHODS

The A-QUEST 2.0 includes two subscales respectively evaluating the user's satisfaction with the device and the services provided. The data for each subscale were investigated using Rasch analysis to evaluate the item fit, reliability indices, item difficulty, local item dependency, and differential item functioning (DIF).

RESULTS

Both subscales met the Rasch criteria for the functioning of rating scale categories. All items showed an acceptable fit to the Rasch model. The person separation indices for the Device and Services subscales were 2.21 (Cronbach's α=0.90) and 1.72 (Cronbach's α=0.85), respectively. Therefore, the two subscales are sensitive enough to distinguish between at least three different levels of satisfaction. The unidimensionality of each subscale was confirmed, and none of the items displayed differential item functioning across age, gender, location of amputation, country, and duration of use.

CONCLUSIONS

Overall, the findings indicate the psychometric evaluation of A-QUEST 2.0 is effective with prosthesis users across different clinical contexts and cultures. Thus, the A-QUEST 2.0 allows for a comprehensive understanding of users' perceptions of prosthesis characteristics, particularly among subjects with lower limb amputations caused by traumatic injuries.

CLINICAL REHABILITATION IMPACT

Our paper provides clinicians dealing with Arabic patients a validated outcome measure for satisfaction with prosthesis. Besides providing information in the development of new products and service delivery. Further studies are necessary to improve the measure's metric quality in different contexts and for different prosthesis devices.

Psychometric properties of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users' Survey (OPUS): a scoping review

Patient's satisfaction with device is an important clinical outcome in prosthetics and orthotics. The Client Satisfaction with Device (CSD) - one of the five modules of the Orthotics and Prosthetics Users' Survey (OPUS) - has been defined as the only outcome measure specifically developed to measure user satisfaction with a prosthesis or an orthosis. The aim of this study was to provide a comprehensive review of the psychometric properties of the CSD, summarizing the present evidence on this measure, and verifying if the scoring system is consistent in the literature. A systematic literature search was conducted utilizing PRISMA guidelines. Articles were searched in PubMed and Scopus databases using search terms relating to the psychometric properties of the CSD. Thirteen articles assessing the psychometric properties of the CSD met the inclusion criteria for this review. The CSD has been translated and validated in several languages. However, these versions are not consistent across the studies since they include different number of items, with different number of response options, and scoring systems. The CSD - where used in its eight-item version, rated with a four-point rating scale - can be judged as a tool with acceptable psychometric properties for assessing satisfaction with devices in prosthesis and orthosis users. This CSD version seems the best one for optimizing coverage and psychometric quality with the fewest number of items. Further studies are warranted to assess the degree of suitability of this scale in specific populations of users of prostheses or orthoses and to analyze its psychometric properties in further cultural contexts.

Effectiveness, Safety, and Acceptance of an Interim Orthosis in Patients with Diabetes in the Immediate Postoperative Chopart Surgery

Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, P = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, P = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, P = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.

A survey of client experiences with orthotics using the QUEST 2.0

INTRODUCTION

Hand orthoses are designed to relieve pain, immobilize a body part and protect the injury site, prevent or correct deformity, and promote healing in the body. Practitioners who prescribe and create orthoses are reliant on patient adherence to achieve desired outcomes in treatment. Understanding client preferences may promote better orthotic intervention outcomes.

PURPOSE OF THE STUDY

The purpose of this cross-sectional study was to determine the level of client satisfaction with device characteristics and service provision of custom-fabricated hand orthotics using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) version 2.0 questionnaire.

METHODS

After approval from an institutional review board, participants for this study were obtained through a convenience sample from a hand rehabilitation clinic. Seventy-two participants were administered the QUEST 2.0 to evaluate their satisfaction regarding various aspects of their orthotic devices. The 12 satisfaction categories in the QUEST are dimensions, weight, adjustments, safety, durability, easy to use, comfort, effectiveness, service delivery, repairs/services, professional service, and follow-up service. Each question was scored on a 5-point Likert scale and then recorded in the following 3 sections: device, service, and total score. The mean and standard deviation were calculated for each of the 12 items to determine the primary determinants of orthotic satisfaction.

RESULTS

The top 3 categories for a participant's orthotic device characteristics were comfort (81%), effectiveness (75%), and ease of use (74%). The participants' mean score for the device section was 4.53. The mean service score was 4.71. The total mean score was 4.61.

CONCLUSION

Therapists who are fabricating prescribed orthotic devices for individuals should consider comfort, effectiveness, and ease of use as they fabricate and adjust the device for their client. Identifying the client's desired aspects of the device can help the therapist create a better therapeutic relationship with the client and may improve their overall experience receiving orthotic intervention.

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives

OBJECTIVES

Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users' perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes.

DESIGN

Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using 'Framework'.

SETTING AND PARTICIPANTS

A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36-80 years).

RESULTS

Patients' medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively.

CONCLUSIONS

Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects.

TRIAL REGISTRATION NUMBER

This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228.

Orthosis Comfort Score: Establishing initial evidence of reliability and validity in ankle foot orthosis users

BACKGROUND

Comfort of an orthosis is an important characteristic that is likely to dictate use of and satisfaction with a device. However, instruments to assess only orthosis user comfort do not exist. The Prosthetic Socket Fit Comfort Score, developed previously for prosthesis users, may be adapted to serve this purpose.

OBJECTIVES

This study's purpose was to assess the validity and reliability of the Orthosis Comfort Score, a self-report instrument adapted from the Prosthetic Socket Fit Comfort Score.

STUDY DESIGN

This is a prospective, observational study designed to establish initial evidence of validity and reliability for an outcome measure that assesses comfort.

METHODS

Ankle foot orthosis users completed the Orthosis Comfort Score and two validated patient satisfaction questionnaires. An orthotist documented an assessment of fit. Post-visit Orthosis Comfort Scores were documented after the appointment and 2-4 weeks later. Orthosis Comfort Scores were compared to the patient satisfaction questionnaires, assessment of fit and orthosis use (hours per week).

RESULTS

There were 46 study participants. Orthosis Comfort Scores had a moderate positive correlation with their orthotist's assessment of fit, very strong positive correlations with patient satisfaction questionnaires and fair positive correlation with orthosis use (all correlations p < 0.05).

CONCLUSION

This study demonstrates initial evidence for the validity and reliability of the Orthosis Comfort Score in ankle foot orthosis users.

CLINICAL RELEVANCE

The Orthosis Comfort Score is a simple patient-reported outcome measure that can be readily incorporated into clinical practice or research study to obtain a rapid assessment of comfort. It can be used to facilitate communication about device fit, evaluate comfort over time and/or assess changes in comfort with a new device.

Male and female opinions about orthotic devices of the lower limb: A multicentre, observational study in patients with central neurological movement disorders

BACKGROUND AND OBJECTIVE

Because user-satisfaction and acceptance may partly determine the grade of compliance to an orthotic device (OD), the aim of this multicentre observational study was to inquire the reasons for acceptance and the user-satisfaction of an OD of the lower limb in male and female central neurological movement disorders (CNMD) patients.

METHODS

Persons with CNMD having at least one prescribed OD of the lower limb were included. Two questionnaires were used: the MIRAD-ACCORT-II (reasons for acceptance) and a modified version of the D-QUEST 2.0 (user-satisfaction). Descriptive analyses were performed and to analyse the differences between the males' and females' answers Chi2- and Mann-Whitney U tests were used.

RESULTS

Twenty-six stroke and 23 multiple sclerosis patients participated (53% males). "Comfort", "safety", "effectiveness" and "ease of use" were reported as most important aspects. 86% of the patients were (very) satisfied about their OD. Only for the aspect safety, compared to males, significant more females reported that if the OD is not safe enough they will not use it.

CONCLUSION

For both, males and females, aspects related to comfort and functionality were reported as much more important than the esthetical aspects, and in general they are quite satisfied with the OD and the process of providing the OD. Orthopaedic technicians and health care providers can take these aspects into account when developing, constructing and providing OD's.

What is the opinion of patients with multiple sclerosis and their healthcare professionals about lower limb orthoses? A qualitative study using focus group discussions

OBJECTIVE

The aim of this study was to collect patients' and healthcare professionals' opinions about lower limb orthoses (LL-orthoses): 1) the positive and negative aspects; 2) the differences in wearing them according to location; and 3) their recommendations for future modifications.

METHODS

Four focus group discussions were performed, with in total twenty patients with MS with a prescribed LL-orthosis and seven healthcare professionals. Audiotaped discussions were transcribed and qualitatively processed (NVivo11).

RESULTS

Healthcare professionals and patients state that a LL-orthosis improves gait and reduces the risk of falling. Some negative aspects were indicated like stigmatization, difficulties to put on and off the LL-orthosis and the aesthetic aspects. Several patients mentioned that they did not get enough or no correct information about the adaptability and use of the orthoses. Opinions regarding differences in wearing according to location (e.g. in and outside the rehabilitation center) were diverse. Recommendations for future changes were e.g. more refined and firmer orthoses.

CONCLUSIONS

The opinions collected are interesting for taking into account in the process of construction and delivering of LL-orthoses. Future research should focus on the opinions concerning different types of LL-orthosis in relation with the severity of the limitations of the patients.

Enhancing quality of prosthetic services with process and outcome information

BACKGROUND

Prosthetic clinics in the United States must attain accreditation in order to receive reimbursement from Medicare. The accreditation process requires clinics to establish and implement performance management plans and quality improvement activities. This report describes the experience of seven prosthetic clinics in collecting patient-reported outcome data and using it to improve quality of services.

OBJECTIVES

To describe the experience of prosthetic clinics implementing outcome monitoring and quality improvement activities as part of routine patient care.

STUDY DESIGN

Qualitative, ethnographic design.

METHODS

Clinics incorporated the Orthotics Prosthetics Users' Survey into routine care for patients aged 18 years and older who received a new lower limb prosthesis or socket. Orthotics Prosthetics Users' Survey measures lower extremity functional status, quality of life, and satisfaction with device and services. Clinics selected Orthotics Prosthetics Users' Survey-derived indicators on which to implement quality improvement action plans.

RESULTS

Seven clinics participated, but only three were able to sustain data collection. Two clinics initiated quality improvement activities focused on improving declining satisfaction or functional scores.

CONCLUSIONS

Quality improvement activities based on patient-reported outcomes require a high degree of organizational commitment and support. External facilitation can support clinics' quality improvement activities. Clinical relevance This project illustrates the challenges of sustaining quality improvement activities using patient-reported outcome data in prosthetic clinics.

Neurological patients and their lower limb orthotics: An observational pilot study about acceptance and satisfaction

BACKGROUND

Although an orthotic device of the lower limb improves the functionality of neurological patients, anecdotally clinical experience suggests that the compliance is rather limited.

OBJECTIVES

The aim was to determine the satisfaction and acceptance of a lower limb orthotic device.

STUDY DESIGN

A qualitative observational pilot study with a mix-method design.

METHODS

Adult neurological patients who had a prescribed lower limb orthotic device were included. One published and clinically used questionnaire about satisfaction (D-Quest) and one ad hoc constructed questionnaire about acceptance of the orthotic device (MIRAD-ACCORT questionnaire) were used for data collection.

RESULTS

In total, 33 patients participated (28 ankle-foot orthotic device, 3 knee-ankle-foot orthotic device and 2 other types). In general, they were satisfied about their orthotic device and the services. Less than one-fourth of the patients had some negative comments about the 'visual aspects' and the 'ability to hide' of their orthotic device. These, however, had a lower priority when compared with functionality, which was reported as a main advantage and is a reason for continuing the use of their orthotic device.

CONCLUSION

Patients were satisfied in relation to their lower limb orthotic device. With regard to acceptance, it can be concluded that factors associated with functionality and comfort are more important than the aesthetic and psychological aspects of the orthotic device. Clinical relevance Patients were satisfied with their lower limb orthotic device. Some patients had some negative comments about the 'aesthetics aspects' and the 'ability to hide' their orthotic device. However, improvements in functionality were mostly reported as a main advantage and a reason for continuing the use of their orthotic device.

A systematic review of questionnaires to assess patient satisfaction with limb orthoses

BACKGROUND

Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties.

OBJECTIVES

To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties.

STUDY DESIGN

Systematic review.

METHODS

A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed.

RESULTS

A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort.

CONCLUSION

Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users' Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted.

CLINICAL RELEVANCE

Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.

User satisfaction with orthotic devices and service in taiwan

User satisfaction is afforded considerable importance as an outcome measurement in evidence-based healthcare and the client-centered approach. Several studies have investigated user satisfaction with orthoses. Few studies have investigated user satisfaction with orthoses in Taiwan. Therefore, the purpose of this study was to investigate the user satisfaction with orthotic devices and service using the Taiwanese version of Quebec User Evaluation of Satisfaction with Assistive Technology. We conducted a cross-sectional study of 280 subjects who had used orthoses and received services. The results showed that the mean satisfaction score was 3.74 for the devices and 3.56 for service. Concerning the participants, 69.1% and 59.6% were quite satisfied or very satisfied with their devices and service, respectively. The satisfaction score of orthotic service was lower than that of the devices. Regarding demographic characteristics, participants living in different areas differed only in service score (p = 0.002). The participants living in eastern area and offshore islands were the least satisfied with the orthotic service. For clinical characteristics, there was a significant difference in satisfaction scores among severity of disability (all p = 0.015), types of orthoses (all p = 0.001), and duration of usage (all p = 0.001). The participants with mild disability, wearing the pressure garment and using the orthosis for less than one year, were the most satisfied with their orthotic devices and service. There is a need for improved orthotic devices and services, especially with respect to the comfort of the devices and the provision of subsidy funding.

Validation of the Arabic version of the client satisfaction with device module of the orthotics and prosthetics users survey

BACKGROUND AND OBJECTIVES

Assessing patient satisfaction with orthosis (PSwO) is a key point for clinical practice to increase a patient's adherence to therapeutic programs and reduce orthotic-related costs. The Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey (OPUS) is one of the most widely-used questionnaires for assessing PSwO, but its validated version in the Arabic language is lacking. The objective of this study is to generate and psychometrically validate an Arabic version of the CSD (CSD-Ar).

DESIGN AND SETTINGS

This is a cross-sectional study, conducted during February to June 2013 at 2 inpatient and outpatient rehabilitation departments in Riyadh, Saudi Arabia.

PATIENTS AND METHODS

Translation of CSD-Ar was carried out according to the guideline recommendations of Linacre. A convenience sample of 100 orthotic-user patients with various conditions (59% men, mean age 36 years) completed the CSD-Ar. Data were analyzed using exploratory factor analysis followed by Rasch analysis.

RESULTS

Factor analysis confirmed the unidimensionality of the CSD-Ar. Rasch criteria for the functioning of rating scale categories were fulfilled. All items showed an adequate fit to the Rasch model. The person separation reliability was .75 and Cronbach alpha .83. There was a borderline local dependency between items 1 ("My device fits well") and 3 ("My device is comfortable throughout the day").

CONCLUSION

The internal construct validity of the CSD-Ar in Arab patients with various types of orthotics has been confirmed. This study provides a useful starting point for the use of this outcome measure in Arabic-speaking countries.