Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey


  • Bart Raijmakers Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
  • Roelofine A. Berendsen-de Gooijer
  • Hilde E. Ploeger
  • Fieke S. Koopman
  • Frans Nollet
  • Merel-Anne Brehm



poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation


Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.
Design: Cross-sectional survey study.
Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.
Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.
Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).
Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Knee-ankle-foot orthoses for knee instability are commonly prescribed in polio survivors to enhance safe ambulation. This survey investigated the use of knee-ankle-foot orthoses in daily life and differences in factors of usability between users and discontinued users. Seventy-six percent of polio survivors used their custom-made knee-ankle-foot orthosis in daily life. Important usability factors that were related to continued use of knee-ankle-foot orthoses were low perceived walking ability status without orthosis, previous orthosis experience, high perceived effectiveness and satisfaction when standing and walking with a knee-ankle-foot orthoses. When prescribing a custom-made knee-ankle-foot orthoses it is important to consider these factors and discuss goals of use and expected benefits of the knee-ankle-foot orthoses with the patient, especially in relation to perceived walking limitations and activities in daily life.


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How to Cite

Raijmakers, B., Berendsen-de Gooijer, R. A., Ploeger, H. E., Koopman, F. S., Nollet, F., & Brehm, M.-A. (2022). Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey. Journal of Rehabilitation Medicine, 54, jrm00261.



Original Report