Use and Usability Of Custom-Made Knee-Ankle-Foot Orthoses In Polio Survivors with Knee Instability: A Cross-Sectional Survey
Keywords: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.
Nollet F, Beelen A, Prins MH, de Visser M, Sargeant AJ, Lankhorst GJ, et al. Disability and functional assessment in former polio patients with and without postpolio syndrome. Arch Phys Med Rehabil 1999; 80: 136-143.
Bickerstaffe A, Beelen A, Nollet F. Circumstances and consequences of falls in polio survivors. J Rehabil Med 2010; 42: 908-915.
Perry J, Clark D. Biomechanical abnormalities of post-polio patients and the implications for orthotic management. NeuroRehabilitation 1997; 8: 119-138. DOI: https://doi.org/10.1016/S1053-8135(96)00216-8
Brehm MA, Nollet F, Harlaar J. Energy demands of walking in persons with postpoliomyelitis syndrome: relationship with muscle strength and reproducibility. Arch Phys Med Rehabil 2006; 87: 136-140.
Lygren H, Jones K, Grenstad T, Dreyer V, Farbu E, Rekand T. Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post-polio symptoms. Physiother Res Int 2007; 12: 39-49.
Ivanyi B, Nollet F, Redekop WK, de Haan R, Wohlgemuht M, van Wijngaarden JK, et al. Late onset polio sequelae: disabilities and handicaps in a population-based cohort of the 1956 poliomyelitis outbreak in The Netherlands. Arch Phys Med Rehabil 1999; 80: 687-690.
Bickerstaffe A, Beelen A, Nollet F. Change in physical mobility over 10 years in post-polio syndrome. Neuromuscul Disord 2015; 25: 225-230.
Jensen MP, Alschuler KN, Smith AE, Verrall AM, Goetz MC, Molton IR. Pain and fatigue in persons with postpolio syndrome: independent effects on functioning. Arch Phys Med Rehabil 2011; 92: 1796-1801.
Hachisuka K, Makino K, Wada F, Saeki S, Yoshimoto N. Oxygen consumption, oxygen cost and physiological cost index in polio survivors: a comparison of walking without orthosis, with an ordinary or a carbon-fibre reinforced plastic knee-ankle-foot orthosis. J Rehabil Med 2007; 39: 646-650.
Hsu JD, Michael JW, Fisk JR. AAOS atlas of orthoses and assistive devices. 4th edn. F. Nollet CTN, editor. Philadelphia: Mosby; 2008.
Brehm M, Nollet F. Beenorthesen bij neuromusculaire aandoeningen. [Leg orthoses in neuromuscular disorders]. Amsterdam: Reed Business; 2014 (in Dutch).
Ploeger HE, Bus SA, Brehm MA, Nollet F. Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey. Eur J Phys Rehabil Med 2020; 56: 575-584.
Waring WP, Maynard F, Grady W, Grady R, Boyles C. Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population. Arch Phys Med Rehabil 1989; 70: 371-375.
International Organization for Standardization (ISO). Guidance on usability, 9241-11:1998(E). Geneva: ISO.
McCaughan D, Booth A, Jackson C, Lalor S, Ramdharry G, O'Connor RJ, et al. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives. BMJ Open 2019; 9: e029313.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349.
Otto Bock HealthCare GmbH. E-MAG Active - Information for Practitioners. [Date accessed Apr 1, 2021] Available from: https://media.ottobock.com/_web-site/orthotics/e-mag/files/e_mag_active_information_for_specialist_dealers.pdf.
Basko Healthcare - Swing Phase Lock 2 [Available from: https://basko.com/en-en/Products/Orthotic-components/Lower-extremity/Details/Swing-Phase-Lock-2-Orthotic-Knee-Joint?s=spl.
Brehm MA, Ploeger HE, Nollet F. Self-reported functional ambulation is related to physical mobility status in polio survivors; a cross-sectional observational study. Ann Phys Rehabil Med 2020: 101428.
Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998; 51: 1055-1068.
Wessels RD, De Witte LP. Reliability and validity of the Dutch version of QUEST 2.0 with users of various types of assistive devices. Disabil Rehabil 2003; 25: 267-272.
Swinnen E, Lafosse C, Van Nieuwenhoven J, Ilsbroukx S, Beckwee D, Kerckhofs E. Neurological patients and their lower limb orthotics: an observational pilot study about acceptance and satisfaction. Prosthet Orthot Int 2017; 41: 41-50.
Ramdharry GM, Pollard AJ, Marsden JF, Reilly MM. Comparing gait performance of people with Charcot-Marie-Tooth disease who do and do not wear ankle foot orthoses. Physiother Res Internat 2012; 17: 191-199.
Hebert JS. Ambulatory KAFOs: a physiatry perspective. JPO J Prosthet Orthot 2006; 18: P169-P174.
Andrysek J, Klejman S, Kooy J. Examination of knee joint moments on the function of knee-ankle-foot orthoses during walking. J Appl Biomech 2013; 29: 474-480.
Bernhardt KA, Kaufman KR. Loads on the uprights of a knee-ankle-foot orthosis. Prosthet Orthot Int 2011; 35: 106-112.
Yakimovich T, Lemaire ED, Kofman J. Preliminary kinematic evaluation of a new stance-control knee-ankle-foot orthosis. Clin Biomech (Bristol, Avon) 2006; 21: 1081-1089.
Brehm MA, Beelen A, Doorenbosch CA, Harlaar J, Nollet F. Effect of carbon-composite knee-ankle-foot orthoses on walking efficiency and gait in former polio patients. J Rehabil Med 2007; 39: 651-657.
Bernhardt KA, Irby SE, Kaufman KR. Consumer opinions of a stance control knee orthosis. Prosthet Orthot Int 2006; 30: 246-256.
Edelstein JE. Ambulatory KAFOs: a physical therapist's perspective. J Prosthet Orthot 2006; 18: 183-186.
How to Cite
Copyright (c) 2022 Bart Raijmakers, Roelofine A. Berendsen-de Gooijer, Hilde E. Ploeger, Fieke S. Koopman, Frans Nollet, Merel-Anne Brehm
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.