Patient compliance and effect of orthopaedic shoes

Does user perception affect adherence when wearing biomechanically optimised ankle foot orthosis - footwear combinations: A pilot study

STUDY DESIGN

Pilot study.

BACKGROUND

Ankle foot orthoses (AFOs) and footwear combination (FC) is a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. Biomechanically optimising the AFO-FC often requires large adaptations to the sole of the user's footwear. There is currently a dearth of literature regarding the user's perception of wearing biomechanically optimised AFOs and adapted footwear and whether their perception affects their adherence to orthotic treatment.

OBJECTIVE

This study aimed to investigate perception and adherence to wearing an AFO and FC the participants were asked to wear as part of their orthotic prescription. In particular, whether the visibly modified footwear affected the user's adherence to the orthotic treatment.

METHODS

Questionnaire devised for the purpose of this study.

RESULTS

All five participants responded to the questionnaire; reporting a high number of positive responses in relation to function, including; an improvement in the way they walked, improved balance and fewer falls. Conversely, there was a high level of negative responses regarding aesthetics, with all participants reporting they did not like the cosmesis of their AFO-FCs. They were conscious that the modification to their footwear was noticeable and therefore different from their peers, yet they adhered to the treatment and in some cases increased the wearing time.

CONCLUSIONS

This pilot set of questions indicated that cosmesis is an important factor for children who wear AFOs and adapted footwear. It can be concluded that the impact of the adapted AFO-FC on the participants' function outweighed their opinion on the cosmesis of the device.

CLINICAL RELEVANCE

It is vital to understand how orthotic prescriptions affect user adherence. Orthotic prescriptions which are not utilised by the user result in a failed treatment intervention, regardless of the scientific application underpinning them.

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.

Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review

BACKGROUND

Alongside the positive effects of use of orthotic devices for the lower extremities (ODLE) and orthopedic shoes, complaints and criticism by users possibly lead to non-compliance.

OBJECTIVE

The purpose is to determine the compliance of patients wearing an ODLE or orthopedic shoes and to describe the main reasons for using and not using.

METHODS

Different online databases were searched for articles about patients' compliance with regard to an ODLE or orthopedic shoes. A methodological quality control was conducted.

RESULTS

Ten studies (1576 patients) were included. The data revealed between 6 and 80% not users. Several reasons for not using the orthotic device were described (e.g. pain, discomfort and cosmetically unacceptable).

CONCLUSIONS

The high percentage of patients who are not wearing the prescribed orthotic devices leads to a high financial loss for society and a waste of therapeutic effort. These results should be taken into account during the design, construction and selection process of orthotic devices.

Effect of rocker shoes on pain, disability and activity limitation in patients with rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients.

OBJECTIVES

The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis.

STUDY DESIGN

Clinical trial.

METHODS

Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient's foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment.

RESULTS

With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials.

CONCLUSION

Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels.

CLINICAL RELEVANCE

The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.

Patients' expectations and actual use of custom-made orthopaedic shoes

OBJECTIVE

To investigate the association between patients' expectations and the actual use of custom-made orthopaedic shoes.

DESIGN

A prospective cohort study with internal comparison.

SETTING

Twelve orthopaedic shoe companies.

PATIENTS

During six months, consecutive patients who were provided with their first ever pair of orthopaedic shoes and aged 16 years or older were recruited. A total of 339 patients with different pathologies were included (response 67%). Mean (SD) age of the patients was 63 (15) years, and 129 patients (38%) were male.

MAIN MEASURES

A practical and reproducible questionnaire, measuring: frequency of use of orthopaedic shoes, patients' expectations and experiences of aspects of the usability of orthopaedic shoes, and communication about patients' expectations.

RESULTS

Patients' expectations were not associated with the use of orthopaedic shoes (P-values range: 0.106 to 0.607), but the difference between expectations and experiences was (P-values range: <0.001 to 0.012). The expectations of patients who frequently used their orthopaedic shoes were in concordance with their experiences, whereas the expectations of patients who did not use their orthopaedic shoes were much higher than their experiences. There was no communication of patients' expectations with the medical specialist or orthopaedic shoe technician in 34% and 25% of the patients respectively.

CONCLUSIONS

In relation to the actual use of orthopaedic shoes, it is crucial that patients' expectations are not much higher than their experiences.

Form may be as important as function in orthotic acceptance: a case report

Orthotic prescription offers interesting insights into patient compliance with what a physician or therapist recommends. For example, when a deficit is severe, an orthotic device or gait aid as large and intrusive as a cane or ankle-foot orthosis is usually well accepted. However, an orthosis, even if beneficial, may be discarded if it is not essential to performing daily activities, is uncomfortable, or if the patient feels it highlights his/her disability. Nevertheless, it is sometimes possible to alter the appearance or form of an appliance from an orthosis that is appropriate but resisted by a patient to an orthosis that maintains its function but is embraced. This report presents the case of a patient who required a thumb orthosis to maintain her thumb interphalangeal joint in extension after a stroke but found that it interfered with her self-image and her ability to perform her job.