Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey

The effectiveness of custom hard-shell 3D-printed foot orthoses in a cohort of patients who did not respond to treatment with custom ethylene-vinyl-acetate (EVA) foot orthoses

BACKGROUND

Patients who do not achieve positive outcomes with custom ethylene-vinyl-acetate (EVA) foot orthoses will often be escalated to other services for treatment, which may include surgery.

OBJECTIVE

This study aimed to explore the effectiveness of custom hard-shell 3D-printed foot orthoses for patients who did not respond to treatment with custom EVA foot orthoses and were being considered for treatment escalation.

DESIGN

An eight-week clinical evaluation and a two-year review of relevant medical records.

METHOD

Thirty-six consecutive patients with a range of musculoskeletal lower limb pathology who remained symptomatic after 12-weeks use of custom EVA foot orthoses were fitted with custom hard-shell 3D-printed foot orthoses. The Foot Health Status Questionnaire was used to assess patients at baseline and eight-week follow-up in conjunction with the Client Satisfaction with Device module of the Orthotics and Prosthetics User Survey. Patients were categorised as responders or non-responders based on their change in pain scores. A review of relevant medical records two years after receiving their orthoses determined if patients required further treatment for their initial condition.

RESULTS

Across the full cohort there were significant improvements in pain, function and foot health. At follow-up, responders reported significantly improved pain, function and foot health compared with non-responders. Twenty-six patients (12 responders, 14 non-responders) required no further treatment for their original condition after two years.

CONCLUSIONS

Custom hard-shell 3D-printed foot orthoses have the potential to improve pain, function, foot health, and provide satisfaction in patients with lower limb musculoskeletal conditions which do not improve with custom EVA foot orthoses.

Virtual Assessment of Functional Mobility in Lower Extremity Prosthesis Clients: An Exploratory Study

Objective

To investigate the relationship between patient perception of lower extremity function and a home-based virtual clinician assessment of mobility in lower limb prosthesis clients.

Design

Descriptive observational study using a clinician-administered functional mobility survey and timed Up and Go test to assess lower extremity function under supervision.

Setting

Health Insurance Portability and Accountability Act-compliant online virtual platform.

Participants

Twelve lower limb loss clients currently using prostheses, aged ≥19 years, not pregnant, and with no stroke, seizure disorder, or cancer.

Interventions

Not applicable.

Main Outcome Measures

Main outcomes were mobility survey scores and mean timed Up and Go duration.

Results

Most participants reported significant ease of completing basic indoor ambulation and toileting tasks (66%-75%) and significant difficulty in running or prolonged ambulation activities (83%) requiring use of lower limb prosthesis. Timed Up and Go test was faster (11.0±2.9 s) than the reference range for transtibial prosthesis users and negatively associated with self-reported lower extremity functional status (r=-.70, P=.02).

Conclusions

Self-reported movement with lower limb prostheses at home and evaluation of mobility via a virtual platform is a feasible assessment modality that may reduce the frequency of therapy visits, defray some rehabilitation costs, and minimize the travel burden to distant prosthetic clinics.

Prosthetic device and service satisfaction, quality of life, and functional performance in lower limb prosthesis clients

OBJECTIVE

The aim of this study was to characterize the relationship between prosthetic device and service satisfaction, health-related quality of life (HRQOL), and functional movement in a diverse population of lower limb prosthesis users.

METHODS

An online survey was conducted on individuals with lower limb amputation between September and October 2021. Sample validated questionnaires assessing demographic and clinical features, satisfaction, functional outcomes, and quality of life were analyzed using path analysis.

RESULTS

Participants were 1736 individuals with lower limb amputation. Overall, 44% of participants reported dissatisfaction with prosthetic device, whereas 37% were dissatisfied with prosthetic service. Low functional mobility was reported by 58% of participants and 61% reported low HRQOL. Lower extremity functional status (β = 0.55), HRQOL (β = 0.08), Activities-specific Balance Scale (β = 0.22), and modified fall efficacy scale (β = -0.07) are significantly associated with prosthetic device satisfaction ( P < 0.0005, R 2 = 0.47). Satisfaction with provider service was significantly associated with lower extremity functional status (β = 0.44) and balance confidence (β = 0.18) ( P < 0.0005, R 2 = 0.34).

CONCLUSION AND CLINICAL RELEVANCE

Civilians, veterans, and service members reported low functional mobility, low quality of life, and moderate levels of dissatisfaction with their lower extremity prosthetic device and provider service. Improvements in mobility, balance, quality of life, and fall efficacy may enhance device satisfaction. Functional mobility and balance improvements may increase ratings of provider service. This study provides feedback that may improve clinical decisions on lower limb prosthesis patient care.

Factors influencing satisfaction with prosthetic and orthotic services - a national cross-sectional study in Sweden

PURPOSE

To evaluate client satisfaction with prosthetic and orthotic services in Sweden, determine if satisfaction differs between clients using different devices and identify factors which influence client satisfaction.

MATERIALS AND METHODS

A cross-sectional design was used to survey 7318 clients. The survey included items related to demographics, quality of life, device comfort, device use, the extent to which clients' needs were met and satisfaction with services. Ethics approval was provided by the Swedish Ethical Review Authority.

RESULTS

A total of 2925 surveys were returned reflecting a response rate of 41%. Mean OPUS-CSS point score was 61.9(SD 16.8) with differences observed between device categories (p < 0.001). Factors that were identified as most positively influencing client satisfaction were, being a limb prosthesis user and being under 65 years. When analysing scores for individual OPUS items breast prosthesis users scored higher than users of other devices. Clients were most satisfied with the level of respect they were shown by staff (mean = 2.72/3) and less satisfied with coordination of services with other therapists/doctors(mean = 1.88/3).

CONCLUSIONS

Prosthetic and orthotic users are reasonably satisfied with the services they receive. Attention should be directed towards understanding why prosthetic users are more satisfied than orthotic users and why clients under 65 years report higher satisfaction scores.

Validity and reliability of the Dutch translation of the OPUS' client satisfaction with device module in chronic users of hand orthoses

BACKGROUND

Orthosis satisfaction is an important outcome in assessing quality of care. However, no measurement specifically assessing orthosis satisfaction is available in the Dutch language. Therefore, the aim of this study was to translate the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey (OPUS) into Dutch, and to assess its content validity, structural validity and reliability in persons with chronic hand conditions.

METHODS

The CSD was translated and cross-cultural adapted according to respective guidelines. To determine content validity, 10 chronic hand orthotic users and two professionals judged the relevance, comprehensibility, and comprehensiveness of the Dutch CSD (D-CSD). Thereafter, in a cross-sectional study, 76 persons were asked to complete the D-CSD twice, with a 2-week interval. Dimensionality of the D-CSD was examined by principal component analysis (PCA), and factor model fit was assessed by confirmatory factor analysis (CFA). Reliability was assessed as internal consistency and test-retest reliability, including the 95% limits of agreement (LoA), the standard error of measurement (SEM) and smallest detectable change (SDC).

RESULTS

The D-CSD items and response options were deemed relevant and comprehensible. After adding an item on cleaning the orthosis, content validity was judged sufficient. PCA indicated a one-factor model, which was confirmed by CFA. We found good internal consistency (Cronbach's alpha = 0.82; 95%CI 0.75-0.87), and moderate to good test-retest reliability (ICC = 0.81; 95%CI 0.71-0.87). There was no difference between the mean D-CSD score at test (26.8 points) and retest (25.9 points) (mean (SD) difference: 0.86 points (4.00); 95%CI -0.06-1.79; p = 0.07). The 95% LoA were -6.99 to 8.71, and the SEM and SDC were 2.88 and 7.98 points, respectively.

CONCLUSIONS

Based on sufficient content and structural validity, and good reliability, we consider the D-CSD a useful tool to evaluate orthosis satisfaction in persons with chronic hand conditions on group level. Because of a relatively high SDC, sensitivity to detect changes over time on individual level is limited.

STUDY REGISTRATION NUMBER

NCT05320211.

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.

Test-retest reliability of the Arabic translation of the Lower Extremity Functional Status of the Orthotics and Prosthetics Users' Survey

BACKGROUND

The number of amputations secondary to diverse factors in Arabic countries is expected to rise in the coming years. Therefore, there is a need for high-quality service that can be monitored by the use of standardized patient-reported outcome measures of amputee patients' functional status. This study aimed to translate the Lower Extremity Functional status Orthotics and Prosthetics Users' Survey (OPUS-LEFS) to Arabic and test its reliability in a sample of Arabic-speaking people with amputation.

METHODS

Standard forward and backward translation, followed by an examination by a team of experts, and then preliminary testing were conducted on the final translation. The OPUS-LEFS was cross-culturally validated, and its test-retest reliability was examined in patients with lower extremity amputations (N = 67).

RESULTS

No issues were observed concerning the patients' understanding or the meaning of the items on the Arabic translation of the OPUS-LEFS. The intraclass correlation coefficient was 0.99 (95% confidence interval [CI]: 0.985 to 0.995), and the mean difference was -0.278 (95% CI: -5.83 to 5.28), indicating excellent test-retest reliability.

CONCLUSIONS

The study's results suggest that the Arabic translation of the OPUS-LEFS is a reliable tool that can be recommended for future use as an outcome measure for patients from Arabic-speaking nations with little knowledge of the English language.

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 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.

Satisfaction with ankle foot orthoses in individuals with Charcot-Marie-Tooth disease

BACKGROUND

Ankle foot orthoses (AFOs) are commonly prescribed to individuals with Charcot-Marie-Tooth disease (CMT). The aim of this study was to evaluate patient reported satisfaction with orthotic devices and services in individuals with CMT to provide preliminary data for advancing AFO development and improving clinical care.

METHODS

The Orthotics and Prosthetics Users Survey was distributed via e-mail through the Inherited Neuropathy Consortium (INC) Contact Registry and includes 11 device-specific questions and 10 service-related questions. Participants were also asked open-ended questions about their experiences with AFOs.

RESULTS

Three hundred and fourteen individuals completed the survey. Over one-third of participants provided negative responses, including dislike of AFO appearance, discomfort, abrasions or irritations, and pain. Ratings of orthotic services were generally positive.

CONCLUSIONS

Lower scores related to discomfort, abrasions and pain identified areas for AFO improvement. Continued research in these areas will be beneficial to informing and advancing AFO development and improving clinical care.

Prosthesis satisfaction in a national sample of Veterans with upper limb amputation

BACKGROUND

Many persons with upper limb amputation reject prostheses, and many are not satisfied with their devices. Research is needed to understand modifiable factors related to device satisfaction. Myoelectric devices with multiple degrees of freedom are now available; however, no studies have examined whether they lead to greater device satisfaction. Prosthetic training contributes to more skillful prosthesis use and greater likelihood of long-term use; however, the relationship between training and device satisfaction is unclear.

OBJECTIVES

(1) To describe and compare satisfaction by prosthesis and terminal device type and (2) to identify factors associated with satisfaction.

STUDY DESIGN

Cross-sectional study.

METHODS

Participants were 449 persons with unilateral upper limb amputation who used a prosthesis. Participants described their prostheses, prosthetic training, device repairs, visits to a prosthetist, and rated device satisfaction using two standardized measures (Trinity Amputation and Prosthesis Experience Scales Satisfaction scale and Orthotics and Prosthetics Users' Survey - Client Satisfaction with Devices scale). Multivariate generalized linear regression models examined the relationship between prosthesis and terminal device type and satisfaction, controlling for covariates that were meaningful in bivariate analyses.

RESULTS

There were no differences in satisfaction by prosthesis type or terminal device degrees of freedom. Satisfaction was associated with receipt of training to use the initial prosthesis, amputation level, age, and race.

CONCLUSION

No differences in satisfaction by device or terminal device type were observed. Worse satisfaction was associated with more proximal amputation level, younger age, and black race. The association between receipt of initial prosthetic training and device satisfaction points to the critical role of occupational or physical therapy in the early stages of prosthetic care.

CLINICAL RELEVANCE

Prosthetic satisfaction did not vary by device or terminal device degrees of freedom. Proximal amputation level, younger age, and black race were associated with lower prosthetic satisfaction. Receipt of initial prosthetic training was associated with greater device satisfaction, pointing to the critical role and lasting impact of early training.

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.

Learning of Artificial Sensation Through Long-Term Home Use of a Sensory-Enabled Prosthesis

Upper limb prostheses are specialized tools, and skilled operation is learned by amputees over time. Recently, neural prostheses using implanted peripheral nerve interfaces have enabled advances in artificial somatosensory feedback that can improve prosthesis outcomes. However, the effect of sensory learning on artificial somatosensation has not been studied, despite its known influence on intact somatosensation and analogous neuroprostheses. Sensory learning involves changes in the perception and interpretation of sensory feedback and may further influence functional and psychosocial outcomes. In this mixed methods case study, we examined how passive learning over 115 days of home use of a neural-connected, sensory-enabled prosthetic hand influenced perception of artificial sensory feedback in a participant with transradial amputation. We examined perceptual changes both within individual days of use and across the duration of the study. At both time scales, the reported percept locations became significantly more aligned with prosthesis sensor locations, and the phantom limb became significantly more extended toward the prosthesis position. Similarly, the participant’s ratings of intensity, naturalness, and contact touch significantly increased, while his ratings of vibration and movement significantly decreased across-days for tactile channels. These sensory changes likely resulted from engagement of cortical plasticity mechanisms as the participant learned to use the artificial sensory feedback. We also assessed psychosocial and functional outcomes through surveys and interviews, and found that self-efficacy, perceived function, prosthesis embodiment, social touch, body image, and prosthesis efficiency improved significantly. These outcomes typically improved within the first month of home use, demonstrating rapid benefits of artificial sensation. Participant interviews indicated that the naturalness of the experience and engagement with the prosthesis increased throughout the study, suggesting that artificial somatosensation may decrease prosthesis abandonment. Our data showed that prosthesis embodiment was intricately related to naturalness and phantom limb perception, and that learning the artificial sensation may have modified the body schema. As another indicator of successfully learning to use artificial sensation, the participant reported the emergence of stereognosis later in the study. This study provides the first evidence that artificial somatosensation can undergo similar learning processes as intact sensation and highlights the importance of sensory restoration in prostheses.

Perceptions of ability among adults with upper limb absence: impacts of learning, identity, and community

Aims: The purpose of this research was to examine the lived experiences of adults with upper limb absence, specifically the interplay of device use, ability, and quality of life through semi-structured interviews. We sought to draw insight from these experiences to improve the practice and perceptions of adults with upper limb absence, prosthetists, and technology designers.Methods: Semi-structured interviews were conducted and interpreted with phenomenological analysis for fourteen individuals with acquired or congenital limb absence. Through an interpretive phenomenological analysis approach, researchers employed an inductive approach to coding and identification of central themes.Results: Participants shared high perceptions of ability and function, regardless of prosthesis or assistive technology use. Life experiences related to three dimensions strongly influenced perceptions of ability: (1) learning to live with upper limb absence, (2) developing their identity, and (3) connecting with their community. The diversity of experiences across participants highlighted the limitations of identifying "normative" pathways of recovery or device use, emphasizing the need for flexible and adaptable systems that can creatively support personal goals and needs.Conclusions: Integration of novel platforms for professional practice, supportive communities, and technology innovation can support the evolving needs and care of individuals with upper limb absence.Implications for rehabilitationIn this study, perceptions of ability were largely independent of prosthetic use and each individual developed a unique toolkit of devices and strategies to support function in daily life.Clinicians can support perceptions of ability by promoting opportunities for community development and life-long learning.Informal communities, such as online networks, can provide novel device designs, resources for learning, and societal awareness to empower individuals with limb absence.

A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic

BACKGROUND

Waiting is common in health care, delays intervention, and has negative effects on satisfaction with services.

OBJECTIVES

To evaluate effects of a modified walk-in system, where patients were invited consecutively from the waiting list to attend the clinic on a walk-in basis, on waiting times, services, and work environment.

STUDY DESIGN

Parallel-group trial.

METHODS

In all, 1286 consecutive patients in need of shoe insoles were randomized to waiting lists for modified walk-in ( n = 655) or a scheduled appointment ( n = 631). Seven staff members also participated.

RESULTS

The median indirect waiting time to first appointment was 40 days shorter for modified walk-in (135 days) than for scheduled appointment (175 days; p < 0.001); 17% of those randomized to modified walk-in did not attend the clinic compared to 6% for scheduled appointment ( p < 0.001). Mean direct waiting time in the waiting room was 9.9 min longer for modified walk-in than for scheduled appointment ( p < 0.001). Patients attending modified walk-in or a scheduled appointment reported similar levels of satisfaction with services. Staff reported more support from co-workers with modified walk-in than with scheduled appointment ( p = 0.041).

CONCLUSION

The modified walk-in can reduce indirect waiting times without any substantial worsening of direct waiting times, service quality, or work environment. Studies are needed to investigate why many patients drop out from modified walk-in. Clinical relevance A modified walk-in system can cut the queues and create more timely interventions by reducing indirect waiting times. This system can therefore be recommended in secondary-care prosthetic and orthotic clinics to reduce patients' suffering from their health condition.

Home Use of a Neural-connected Sensory Prosthesis Provides the Functional and Psychosocial Experience of Having a Hand Again

The loss of a hand has many psychosocial repercussions. While advanced multi-articulated prostheses can improve function, without sensation, they cannot restore the full experience and connection of a hand. Direct nerve interfaces can restore naturalistic sensation to amputees. Our sensory restoration system produced tactile and proprioceptive sensations on the hand via neural stimulation through chronically implanted electrodes. In this study, upper limb amputees used a sensory-enabled prosthesis in their homes and communities, autonomously and unconstrained to specific tasks. These real-life conditions enabled us to study the impact of sensation on prosthetic usage, functional performance, and psychosocial experience. We found that sensory feedback fundamentally altered the way participants used their prosthesis, transforming it from a sporadically-used tool into a readily and frequently-used hand. Functional performance with sensation improved following extended daily use. Restored sensation improved a wide range of psychosocial factors, including self-efficacy, prosthetic embodiment, self-image, social interaction, and quality of life. This study demonstrates that daily use of a sensory-enabled prosthesis restores the holistic experience of having a hand and more fully reconnects amputees with the world.

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.

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.