Abstract
Purpose state: Orthotic wearing time may be an important confounder in efficacy studies of treatment in children with spastic cerebral palsy (SCP). Most studies measure parent-reported wearing time (WTparent) with questionnaires, but it is questionable whether this yields valid results. This study aims to compare WTparent with objectively measured wearing time (WTobj) in children with SCP receiving orthotic treatment.Method: Eight children with SCP participated in this observational study. For one year, they received knee-ankle-foot orthosis (KAFO) treatment. WTparent was measured using questionnaires. WTobj was measured using temperature sensor-data-loggers that were attached to the KAFOs. The 2.5th and 97.5th percentiles and median of differences between methods (per participant) were used to calculate limits of agreement and systematic differences.Results: There was no systematic difference between WTparent and WTobj (0.1 h per week), but high inter-individual variation of the difference was found, as reflected by large limits of agreement (lower limit/2.5th percentile: −1.7 h/week; upper limit/97.5th percentile: 11.1 h/week).Conclusions: Parent-reported wearing time (WTparent) of a KAFO differs largely from objectively measured wearing time (WTobj) using temperature sensors. Therefore, parent-reported wearing time (WTparent) of KAFOs should be interpreted with utmost care.Implications for RehabilitationLow wearing time of orthoses may be a cause of inefficacy of orthotic treatment and incorrect reported wearing time may bias results of efficacy studies.Results of this study show that parent-reported wearing time is not in agreement with objectively measured wearing time.Parent-reported wearing time of KAFOs should be interpreted with utmost care.Objective methods are recommended for measuring orthotic wearing time.
Highlights
According to the International Society for Prosthetics and Orthotics consensus document1;2, orthotic treatment is applied in efforts to prevent deformities and muscle shortening in children with spastic cerebral palsy (SCP)
We aim to compare parentreported wearing time in children with SCP, collected using questionnaires, and objective wearing time, measured using temperature sensor-data-loggers attached to the knee-ankle-foot orthosis (KAFO)
Temperature sensor data were available for 8 participants of the Splint study (mean age: 8.7±1.9 years; gender: 6 males, 2 females; GMFCS: level I (n=2), level II (n=4), III (n=2))
Summary
According to the International Society for Prosthetics and Orthotics consensus document1;2, orthotic treatment is applied in efforts to prevent deformities and muscle shortening in children with spastic cerebral palsy (SCP). Two recent studies[4,5,6], investigating the efficacy of ankle-foot orthoses (AFO) and knee-ankle-foot orthoses (KAFO) straining the calf muscles, used questionnaires filled in by the participant’s parents to assess wearing time. It is questionable whether such parent-reported wearing time is a valid measure. Several objective methods are available, such as data acquisition using temperature sensors[7,8,9,10] or using force transducers9;11 attached to the orthoses These methods yielded reliable and valid wearing time estimates[7,8,9,10,11]. This study aims to compare parent-reported wearing time (WTparent) with objectively measured wearing time (WTobj) in children with SCP receiving orthotic treatment
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