A Survey of Clinical Practice Patterns of Physical Therapists for the Use of Ankle-Foot Orthoses or Functional Electrical Stimulation Poststroke

Abstract

ABSTRACT Objective The aims of this study were (1) to understand the practice patterns and decision-making factors of physical therapists (PTs) when choosing ankle-foot orthoses (AFOs) or functional electrical stimulation (FES) for patients with mobility deficits secondary to poststroke hemiplegia and (2) to explore perceived gaps in knowledge to inform development of a clinical practice guideline (CPG). Methods A mixed-methods web-based survey collected quantitative and qualitative data from practicing PTs. Descriptive analysis of quantitative data and thematic content analysis of the qualitative data were completed. Results The 103 PTs were practicing clinicians with a doctoral degree and specialized board certification. A higher level of confidence with AFOs compared with FES was reported, along with increased inclusion of AFOs compared with FES for assessments and treatments. The PTs considered outcomes across the International Classification of Functioning, Disability and Health (ICF) when choosing devices, noting barriers in access and reimbursement as influential factors in clinical decision making. Fewer than 50% participated in continuing education on AFO or FES. Perceived knowledge gaps and educational needs included assessment and intervention strategies to support clinical decision making. The PTs considered themselves influential in the decision-making process and more than 95% of the respondents replied that a CPG on AFO and FES poststroke would impact clinical practice. Conclusion Themes related to education, clinical decision-making, access, and reimbursement were identified. A CPG may provide valuable information to address gaps in knowledge to improve clinical practice and decision-making. Clinical Relevance This research aims to inform the development of a CPG to address needs and gaps in knowledge identified by practicing clinicians. The information gained will inform knowledge translation strategies to promote best practices when implementing AFO and FES to improve activity and participation levels of individuals poststroke.