Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Oct 17;9(10):e029313.
doi: 10.1136/bmjopen-2019-029313.

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

Dorothy McCaughan  1 , Alison Booth  2 , Cath Jackson  1 , Simon Lalor  3   4 , Gita Ramdharry  5   6 , Rory J O'Connor  7 , Margaret Phillips  8 , Roy Bowers  9 , Catriona McDaid  1
Affiliations
Multicenter Study

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

Dorothy McCaughan et al. BMJ Open. .

Abstract

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.

Keywords: central nervous system conditions; knee instability; neuromuscular conditions; orthoses; patient perspectives; qualitative study.

PubMed Disclaimer

Conflict of interest statement

Competing interests: During this study, SL was an employee of Opcare, a company that provides orthotic and prosthetic services to the UK NHS. This company does not manufacture orthotic devices, although a sister company ORTHO C FAB does.

Figures

Figure 1
Figure 1
Data analysis using framework approach.
Figure 2
Figure 2
Study participants’ perceptions of positive and negative aspects of their orthoses.
Figure 3
Figure 3
Study participants’ perceptions of positive and negative aspects of footwear.
See this image and copyright information in PMC

References

    1. Ramdharry GM, Pollard AJ, Marsden JF, et al. . Comparing gait performance of people with Charcot-Marie-Tooth disease who do and do not wear ankle foot orthoses. Physiother Res Int 2012;17:191–9. 10.1002/pri.531 - DOI - PubMed
    1. Swinnen E, Lafosse C, Van Nieuwenhoven J, et al. . Neurological patients and their lower limb orthotics: an observational pilot study about acceptance and satisfaction. Prosthet Orthot Int 2017;41:41–50. 10.1177/0309364615592696 - DOI - PubMed
    1. Vinci P, Gargiulo P. Poor compliance with ankle-foot-orthoses in Charcot-Marie-Tooth disease. Eur J Phys Rehabil Med 2008;44:27–31. - PubMed
    1. Chisholm AE, Perry SD. Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Disabil Rehabil 2012;7:437–49. 10.3109/17483107.2012.680940 - DOI - PubMed
    1. Michael JW. KAFOs for Ambulation: An Orthotist's Perspective. JPO Journal of Prosthetics and Orthotics 2006;18:P187–91. 10.1097/00008526-200606001-00007 - DOI

Publication types

MeSH terms

Associated data