Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders

A microprocessor stance and swing control orthosis improves balance, risk of falling, mobility, function, and quality of life of individuals dependent on a knee-ankle-foot orthosis for ambulation

INTRODUCTION

The C-Brace microprocessor stance and swing control orthosis was designed to overcome safety and functional limitations of traditional knee-ankle-foot orthoses (KAFOs) for individuals with lower limb paresis. However, a systematic comparison to established KAFO types has not been performed in a bigger sample.

METHODS

International multicenter, randomized, controlled, cross-over clinical trial. Legacy KAFO users at risk of falling were randomized to KAFO/C-Brace or C-Brace/KAFO use for three months with each orthosis. Primary outcome was balance assessed with the Berg Balance Scale (BBS). Secondary outcomes were falls, mobility, function, and quality of life.

RESULTS

Intention-to-treat analysis with 102 participants. With the C-Brace, the BBS improved by 3.3 ± 6.3 points (p < 0.0001). Significantly fewer participants presented BBS scores <40 indicative of increased fall risk (16 vs. 36, p = 0.018). Mean falls reduced from 4.0 ± 16.8 to 1.1 ± 3.3 (p = 0.002). Outcomes for function, mobility, and quality of life showed significant improvements with the C-Brace.

DISCUSSION

The improvements in fall risk and mobility can be attributed to the stumble recovery and controlled knee flexion during weight bearing of the C-Brace and have a positive impact on the quality of life of users.

CONCLUSION

The C-Brace represents an option for KAFO users with increased fall risk and reduced mobility.

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

BACKGROUND

Orthoses are often prescribed to improve mobility of people with chronic health conditions that affect lower limb function. Patient-reported survey instruments can be used to measure aspects of mobility that cannot be easily assessed in clinical or research settings. A population-specific item bank could be designed to measure aspects of mobility that are most important to lower limb orthosis users and used to evaluate the effects of orthoses.

OBJECTIVE

To develop items for a new survey instrument to measure mobility of lower limb orthosis users.

DESIGN

Survey items were developed using a qualitative item review process.

SETTING

Focus groups were held by video conferencing. Cognitive interviews were conducted by telephone.

PARTICIPANTS

Focus group and cognitive interview participants were adults with at least 6 months of experience using a lower limb orthosis that extended from the foot to a level above the ankle.

METHODS

Research methods included focus groups with lower limb orthosis users, an item generation and reduction process that involved a stakeholder advisory panel, and cognitive interviews with target respondents.

RESULTS

A total of 1180 extant items were identified in a literature review. Focus group participants (n = 29) provided feedback that informed the suitability of a construct definition and conceptual model. An advisory panel contributed to the selection of 118 candidate items for measuring orthotic mobility. Feedback from cognitive interview participants (n = 30) informed removal or revision of problematic items, resulting in a candidate bank of 100 mobility items.

CONCLUSIONS

The rigorous qualitative methods applied here resulted in a large set of candidate items that spanned a range of situations relevant to moving with a lower limb orthosis. Next steps include administration of the candidate items to a large sample of lower limb orthosis users and calibration of the item bank.

Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders

BACKGROUND

Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary expert setting may improve treatment outcomes.

AIM

To examine the effectiveness of specialist care orthoses compared to usual care orthoses on personal goal attainment and walking ability.

DESIGN

Cohort study.

POPULATION

Adults with NMD who experienced walking problems due to calf and/or quadriceps muscle weakness and were provided with a specialist care lower limb orthosis between October 2011 and January 2021.

METHODS

Three months after provision, the specialist care orthosis was compared to the usual care orthosis worn at baseline in terms of personal goal attainment (Goal Attainment Scaling (GAS)), comfortable walking speed (m/s), net energy cost (J/kg/m) (both assessed during a 6-minute walk test), perceived walking ability and satisfaction.

RESULTS

Sixty-four adults with NMD were eligible for analysis. The specialist care orthoses comprised 19 dorsiflexion-restricting ankle-foot orthoses (AFOs), 22 stance-control knee-ankle-foot orthoses (KAFOs) and 23 locked KAFOs. Overall, 61% of subjects showed a clinically relevant improvement in GAS score. Perceived safety, stability, intensity, fear of falling and satisfaction while walking all improved (p≤0.002), and subjects were satisfied with their specialist care orthosis and the services provided. Although no effects on walking speed or net energy cost were found in combined orthosis groups, specialist care AFOs significantly reduced net energy cost (by 9.5%) compared to usual care orthoses (from mean (SD) 3.81 (0.97) to 3.45 (0.80) J/kg/m, p = 0.004).

CONCLUSION

Guideline-based orthotic care within a multidisciplinary expertise setting could improve treatment outcomes in adults with NMD compared to usual orthotic care by improvements in goal attainment and walking ability. A randomized controlled trial is now warranted to confirm these results.

Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review

OBJECTIVE

The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings.

METHODS

Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance.

RESULTS

Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics.

CONCLUSIONS

Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.

Experts' Perceived Patient Burden and Outcomes of Knee-ankle-foot-orthoses (Kafos) Vs. Microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot Orthoses (Mp-sscos)

BACKGROUND

Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities.

OBJECTIVES

The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs).

METHODOLOGY

An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively.

FINDINGS

Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were "restriction of mobility" (n=6), followed by "emotional strain" (n=5) and "impaired gait pattern" (n=4). Corresponding results for potential patient benefits were seen in "improved quality-of-life" (n=8) as well as "improved gait pattern" (n=8) followed by "high reliability of the orthosis" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users.

CONCLUSION

Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.

Stance-Control Knee-Ankle-Foot Orthoses for People With Knee Instability: A Health Technology Assessment

BACKGROUND

Knee instability can arise from various causes and conditions such as neuromuscular disease, central nervous system conditions, and trauma. For people with knee instability, knee orthosis devices are prescribed to help with standing, walking, and performing tasks. We conducted a health technology assessment of stance-control knee-ankle-foot orthoses (SCKAFOs) for people with knee instability, which included an evaluation of the effectiveness, safety, and budget impact of publicly funding SCKAFOs, as well as patient preferences and values.

METHODS

We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Risk of Bias in Nonrandomized Studies (RoBANS) tool and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and also analyzed the budget impact of publicly funding SCKAFOs in people with knee instabilities in Ontario. We did not conduct a primary economic evaluation as there was limited comparative clinical evidence to inform an economic model. Our reference case budget impact analysis was done from the perspective of the Ontario Ministry of Health; it compared the total costs of a basic mechanical SCKAFO and locked KAFO (LKAFO) for people with knee instability. We also performed scenario analyses varying the following parameters: the price of all classes of SCKAFO (mechanical, electronic, and microprocessor), and the uptake of SCKAFO. To contextualize the potential value of SCKAFO, we spoke with people with knee instability.

RESULTS

We included four studies in the clinical evidence review. We are uncertain if SCKAFOs improve walking ability, energy consumption, or activities of daily living compared with LKAFOs (GRADE: Very low). Our economic evidence review identified one costing analysis that suggested that the costs of orthotic devices such as LKAFOs and SCKAFOs are highly variable according to the cost of materials, professional time, and customization required by the individual patient. The budget impact of publicly funding mechanical SCKAFOs in Ontario over the next 5 years (at a full device cost of $10,784) ranged from an additional $0.50 million in year 1 (at an uptake rate of 30% in the target population [429 eligible people]) to $0.83 million in year 5 (at an uptake rate of 50%), with a total budget impact of $3.34 million over 5 years. We found that the greatest increase in budget impact in the scenario analysis came from the microprocessor SCKAFO device, which had an additional cost of $10.07 million in year 1, increasing to $16.78 million in year 5. When we decreased the cost of a mechanical SCKAFO device (to $7,384), this reduced the 5-year budget impact to $0.89 million (vs. $3.34 million in the reference case). The people with knee instability with whom we spoke reported that they preferred a device that would provide a more typical gait, but starting with this type of device would be easier than switching from an existing LKAFO.

CONCLUSIONS

We are uncertain if SCKAFOs improve walking ability, reduce energy consumption, or improve activities of daily living compared with LKAFOs. We estimate that the additional cost to provide public funding for a mechanical SCKAFO in people with knee instability would range from about $0.50 million in year 1 to $0.83 million in year 5, yielding a total budget impact of $3.34 million over 5 years. Depending on the class of SCKAFO and the uptake rate for the device, the budget impact may vary. People who met the criteria for the use of a SCKAFO did have a strong preference for it over an LKAFO.

Functioning in adult patients with idiopathic inflammatory myopathy: Exploring the role of environmental factors using focus groups

Objective

Health-related quality of life is impaired in idiopathic inflammatory myopathies. This study aimed to identify the main areas of the health-related quality of life environment domain that are affected in patients with myositis.

Methods

A qualitative study was performed using focus groups and applying the International Classification of Functioning, Disability, and Health. Participants were recruited from a cohort of 323 adult inflammatory myopathy patients consulting at a reference center for idiopathic inflammatory myopathy in Spain, selected by the maximum variation strategy, and placed in focus groups with 5 to 7 patients per group. The number of focus groups required was determined by data saturation.

Results

Twenty-five patients distributed in 4 focus groups were interviewed. The verbatim provided 54 categories directly related with environmental factors. Those associated with products or substances for personal consumption (e110), health professionals (e355), health services, systems and policies (e580), products and technology for personal use in daily living (e115), and immediate family (e310) were the ones most frequently reported.

Conclusion

The results of this study led to identification of several environmental factors that affect the health-related quality of life of patients with myositis. Remedial interventions should be designed to address some of these factors.

The immediate effects of sensorimotor foot orthoses on foot kinematics in healthy adults

BACKGROUND

Sensorimotor foot orthoses is an alternative concept, which in addition to mechanical effects, are designed to change muscle activation by altering sensory input to the plantar surface of the foot. However, there is little evidence of how these affect the kinematics of the foot during gait.

RESEARCH QUESTION

The aim of the study was to explore the immediate effect of calcaneal medial heel bars and retrocapital bars on foot kinematics during the stance phase of gait.

METHODS

Kinematic data were collected from 32 healthy individuals using an eight camera motion capture system and a six-degrees-of-freedom multi-segment foot model in three different orthotic conditions; calcaneal medial heel bar, retrocapital bar, and no orthosis. Vector field statistical analysis was performed to explore the effect of the orthotic conditions over the kinematic time series curves during stance phase. Peak median and interquartile ranges were also reported during the different phases of stance.

RESULTS

The calcaneal medial bar significantly decreased rearfoot eversion for the majority of the stance phase and compensatory increased midfoot eversion during the entire stance phase compared to the no orthosis condition. The retrocapital bar rotated the foot externally significantly abducting the rearfoot for the entire stance phase and the midfoot for the majority of stance phase.

SIGNIFICANCE

The calcaneal medial heel bar and retrocapital bar significantly altered the foot kinematics in a way that may benefit patients with abnormal pronation and intoeing gait.

Specialised orthotic care to improve functioning in adults with neuromuscular disorders: protocol of a prospective randomised open-label blinded end-point study

INTRODUCTION

People suffering from leg muscle weakness caused by neuromuscular disorders (NMDs) are often provided with leg orthoses to reduce walking problems such as increased walking effort, diminished walking speed, reduced balance and falls. However, evidence for the effectiveness of leg orthoses to improve walking in this patient group is limited and there is an absence of standardised practice in orthotic prescription. In 2012 a Dutch multidisciplinary guideline was developed aimed to standardise the orthotic treatment process in NMD. Although application of the guideline in expert centres (specialised orthotic care) seems beneficial regarding clinical effectiveness, larger studies are necessary to confirm results and investigate cost-effectiveness. Therefore, this study aims to examine the effectiveness and cost-effectiveness of specialised orthotic care compared with usual orthotic care in adults with slowly progressive NMD.

METHODS AND ANALYSIS

A prospective randomised open-label blinded end-point study will be performed, in which 70 adults with slowly progressive NMD are randomly assigned to specialised orthotic care (intervention) or usual orthotic care (control). Outcome measures are assessed at baseline and at 3 and 6 months follow-up. The primary endpoints are gross walking energy cost (J/kg/m) assessed during a 6 min walk test and achievement of personal goals, measured with the Goal Attainment Scale. Secondary endpoints include walking speed, gait biomechanics, stability, physical functioning, falls and fear of falling, perceived fatigue and satisfaction. For the economic evaluation, societal costs and health-related quality of life will be assessed using cost questionnaires and the 5-Level version of EuroQol 5 Dimension, retrospectively.

ETHICS AND DISSEMINATION

The study is registered in the Dutch trial register (NL 7511) and the protocol has been approved by the Medical Ethics Committee of the Academic Medical Center in Amsterdam. Results will be presented at national and international scientific conferences and disseminated through peer-reviewed journals and media aimed at a broad audience including patients.

Orthotic care needs in a cohort of neurological rehabilitation inpatients

AIM

Orthotic management is frequently part of the rehabilitation of various neurological conditions in adults such as stroke, peripheral neuropathies, spinal cord injuries and multiple sclerosis. Despite this, there are limited data available on the implementation of orthotic care in practice. The primary aim of this study is to establish the proportion of inpatients in a mixed neurorehabilitation cohort which receive orthotic assessment and treatment. The secondary aim was to document the overall care pathway.

METHODS

Existing data were reviewed retrospectively. Data gathered included patient demographics such as age, gender and diagnosis, type of orthoses prescribed, number of orthotic treatment sessions required and outcome measures used. The paper was prepared in accordance with the STROBE statement for observational studies.

RESULTS

During a 6 month period, 54 patients were admitted as inpatients. Of these, 25 (46%) were referred to the orthotic service for assessment, with 23 (43%) receiving a lower limb orthosis and 19 (35%) subsequently being discharged using either an ankle-foot orthosis or knee-ankle-foot orthosis. The conditions most commonly seen were stroke (40%), incomplete spinal cord injuries (28%) and peripheral neuropathies (16%). Significant improvements were recorded at discharge using the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Various aspects of the orthotic care process are described.

CONCLUSIONS

This study suggests that orthotic treatment is needed with high frequency in a mixed inpatient neurorehabilitation cohort. In terms of service planning, these data support existing the recommendation that neurological rehabilitation centres should have good access to orthotic services.Implications for rehabilitationCustom orthoses such as AFOs and KAFOs are frequently needed by neurological rehabilitation inpatients.Orthoses may facilitate standing and walking at an earlier stage during rehabilitation.Those responsible for neurological rehabilitation services should ensure appropriate access to orthotic services.

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.

Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review

OBJECTIVES

To assess whether a core outcome set is required for studies evaluating the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities.

DESIGN

Survey of outcome measures used in primary studies identified by a systematic review.

DATA SOURCES

ASSIA, CENTRAL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index, CINAHL, DARE, Embase, HMIC, MEDLINE, MEDLINE In-Process, PsycINFO, Science Citation Index, Social Care Online, Social Policy & Practice, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform and the UK Clinical Trials Gateway were searched up to February 2017.

ELIGIBILITY CRITERIA

Studies evaluating pharmacological or non-pharmacological interventions for children (≤18 years old) with a neurodisability and experiencing non-respiratory sleep disturbance.

DATA EXTRACTION AND SYNTHESIS

Outcome measures were listed from each study and categorised into domains.

RESULTS

Thirty-nine studies assessed five core outcome areas: child sleep, other child outcomes, parent outcomes, adverse events and process measures. There were 54 different measures of child sleep across five domains: global measures; sleep initiation; maintenance; scheduling; and other outcomes. Fifteen non-pharmacological (58%) and four pharmacological studies (31%) reported child outcomes other than sleep using 29 different measures.One pharmacological and 14 non-pharmacological (54%) studies reported parent outcomes (17 different measures). Eleven melatonin studies (85%) recorded adverse events, with variation in how data were collected and reported. One non-pharmacological study reported an explicit method of collecting on adverse events. Several process measures were reported, related to adherence, feasibility of delivery, acceptability and experiences of receiving the intervention.

CONCLUSIONS

There is a lack of consistency between studies in the outcome measures used to assess the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities. A minimum core outcome set, with international consensus, should be developed in consultation with parents, children and young people, and those involved in supporting families.

PROSPERO REGISTRATION NUMBER

CRD42016034067.

Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke

[Purpose] The purpose of this study was to evaluate the early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke. [Participants and Methods] Timed static standing balance in four standing conditions (feet apart with eyes open, feet apart with eyes closed, feet together with eyes open, and tandem stance with eyes open) was assessed in 29 inpatients (mean age: 67.3 ± 13.3 years) with subacute stroke with and without a knee-ankle-foot orthosis on the paretic lower limb. [Results] In the group of participants who were unable to stand without a knee-ankle-foot orthosis, the proportion of participants who were able to stand with a knee-ankle-foot orthosis was significantly increased in the following conditions: feet apart with eyes open and feet apart with eyes closed. In the group of participants who were able to stand without a knee-ankle-foot orthosis, the mean duration of time for which the participants with a knee-ankle-foot orthosis were able to stand was significantly longer than that for those without a knee-ankle-foot orthosis for all standing conditions. [Conclusion] A knee-ankle-foot orthosis may be a useful assistive device to support static standing balance for people with subacute stroke.

Report: NIA workshop on translating genetic variants associated with longevity into drug targets

To date, candidate gene and genome-wide association studies (GWAS) have led to the discovery of longevity-associated variants (LAVs) in genes such as FOXO3A and APOE. Unfortunately, translating variants into drug targets is challenging for any trait, and longevity is no exception. Interdisciplinary and integrative multi-omics approaches are needed to understand how LAVs affect longevity-related phenotypes at the molecular physiologic level in order to leverage their discovery to identify new drug targets. The NIA convened a workshop in August 2017 on emerging and novel in silico (i.e., bioinformatics and computational) approaches to the translation of LAVs into drug targets. The goal of the workshop was to identify ways of enabling, enhancing, and facilitating interactions among researchers from different disciplines whose research considers either the identification of LAVs or the mechanistic or causal pathway(s) and protective factors they influence for discovering drug targets. Discussions among the workshop participants resulted in the identification of critical needs for enabling the translation of LAVs into drug targets in several areas. These included (1) the initiation and better use of cohorts with multi-omics profiling on the participants; (2) the generation of longitudinal information on multiple individuals; (3) the collection of data from non-human species (both long and short-lived) for comparative biology studies; (4) the refinement of computational tools for integrative analyses; (5) the development of novel computational and statistical inference techniques for assessing the potential of a drug target; (6) the identification of available drugs that could modulate a target in a way that could potentially provide protection against age-related diseases and/or enhance longevity; and (7) the development or enhancement of databases and repositories of relevant information, such as the Longevity Genomics website ( https://www.longevitygenomics.org ), to enhance and help motivate future interdisciplinary studies. Integrative approaches that examine the influence of LAVs on molecular physiologic phenotypes that might be amenable to pharmacological modulation are necessary for translating LAVs into drugs to enhance health and life span.

The regularity of orthosis use and the reasons for disuse in stroke patients

This is a Retrospective descriptive study. Orthoses and walking aids are used frequently in stroke rehabilitation to facilitate ambulation. The aim was to describe the regularity of orthosis use and the reasons for disuse in stroke after discharge from inpatient rehabilitation. The study included 64 (43 men, 21 women) subacute stroke patients who had been discharged from our clinic in the last 6 months. Demographic and clinical findings, proposed orthoses and walking aids, frequency of usage for the proposed orthoses, reasons for disuse, and the ambulation levels were recorded. A total of 54 (84.4%) patients had an ankle-foot orthosis and 10 (15.6%) patients had a knee-ankle-foot orthosis. The orthosis frequency of use was every day in 38 (59.4%) patients and one to seven times a week in seven (10.9%) patients, whereas 19 (29.7%) did not use them. The reasons for orthosis disuse were finding them unnecessary in seven (27%) patients, usage difficulties in six (23%) patients, pressure sensation in five (19.2%) patients, the belief that they did not make life easier in five (19.2%) patients, lack of a suitable environment in one (3.8%) patient, orthosis wear in one (3.8%) patient, and systemic disease in one (3.8%) patient. Age, sex, residence, the disease duration, and recommended orthosis duration (how long the prescribed orthosis was used), recommended orthosis, range of motion limitation in the lower extremities, presence of spasticity, type of orthosis, and the ambulation level were not statistically significantly associated with the frequency of orthosis use (P>0.05). The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage (P<0.008). Orthosis use had been discontinued by 29% of the patients. The most common reasons reported for discontinuing orthosis use were that the patients found it unnecessary, usage difficulty, pressure sensation, not making life easier, lack of a suitable environment, and orthosis wear. The only significant clinical factor for the frequency of orthosis use was the lower extremity Brunnstrom neurophysiological recovery stage.