Abstract
Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities. The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs). An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively. Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were "restriction of mobility" (n=6), followed by "emotional strain" (n=5) and "impaired gait pattern" (n=4). Corresponding results for potential patient benefits were seen in "improved quality-of-life" (n=8) as well as "improved gait pattern" (n=8) followed by "high reliability of the orthosis" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users. Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.
Highlights
Orthotic devices, in particular knee-ankle-foot-orthoses (KAFOs) are well accepted for treating knee instability in neuromuscular disease and central nervous system conditions
Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis
Patients with muscular knee instability following neuromuscular or central nervous system injuries or conditions who use KAFOs/stance control orthoses (SCOs) are suffering from restricted mobility, emotional strain and impaired gait patterns
Summary
In particular knee-ankle-foot-orthoses (KAFOs) are well accepted for treating knee instability in neuromuscular disease and central nervous system conditions. Knee instability conditions can cause several problems, including pain, falls, range of mobility issues and limited engagement in daily activities, which could be alleviated with the use of better orthotic devices.[1,2]. A KAFO is usually prescribed when other types of bracing like ankle-foot-orthoses (AFO) cannot adequately control knee instability because of weakness (e.g., quadriceps weakness) or ligament laxity.[3] Patients suffering from knee instability due to neuromuscular disease (e.g., after acute poliomyelitis, incomplete spinal cord injury, or femoral nerve lesions), benefit from KAFOs with locked or posterior off-set orthotic knee joints by preventing the paretic or paralyzed leg from collapsing and to aid in safe ambulation.[2,4] a locked knee precludes knee flexion during swing and, requires compensatory mechanisms to achieve sufficient toe clearance.[2]. Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities
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