Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives
Objectives Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit devi...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2019-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/10/e029313.full |
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| author | Gita Ramdharry Alison Booth Catriona McDaid Dorothy McCaughan Cath Jackson Simon Lalor Rory J O'Connor Margaret Phillips Roy Bowers |
| author_facet | Gita Ramdharry Alison Booth Catriona McDaid Dorothy McCaughan Cath Jackson Simon Lalor Rory J O'Connor Margaret Phillips Roy Bowers |
| author_sort | Gita Ramdharry |
| collection | DOAJ |
| description | Objectives Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes.Design Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using ‘Framework’.Setting and participants A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36–80 years).Results Patients’ medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively.Conclusions Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects.Trial registration number This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228. |
| format | Article |
| id | doaj-art-c5034a70dfb743b49f28350bf3eee88e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-c5034a70dfb743b49f28350bf3eee88e2024-12-13T03:15:10ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2019-029313Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectivesGita Ramdharry0Alison Booth1Catriona McDaid2Dorothy McCaughan3Cath Jackson4Simon Lalor5Rory J O'Connor6Margaret Phillips7Roy Bowers87 Department of Neuromuscular Diseases, University College London, London, UK1 Department of Health Sciences, University of York, York, UKYork Trials Unit, University of York, York, UKDepartment of Health Sciences, University of York, York, UKValid Research, Wetherby, UK3 Orthotics, Queen Mary’s Hospital, St George’s University Hospitals NHS Foundation Trust, London, UKAcademic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK8 Rehabilitation, Derby Hospitals/ Nottingham University, Derby, UK9 Department of Biomedical Engineering, University of Strathclyde, Glasgow, UKObjectives Adults with knee instability related to neuromuscular disorders or central nervous conditions often experience mobility problems and rely on orthoses to improve function and mobility. Patient views of device effectiveness and acceptability are underexplored. Our study aimed to elicit device users’ perspectives regarding fitting, acceptability, effectiveness and use of orthoses, and identify important treatment outcomes.Design Qualitative descriptive study using in-depth semistructured interviews. Interview transcriptions were coded and thematically analysed, using ‘Framework’.Setting and participants A purposive sample of 24 adult users of orthotic devices. Nineteen patients were recruited across three National Health Service sites, and five people through charities/patient support groups in England. Half of the participants had been diagnosed with poliomyelitis, and the remainder with multiple sclerosis, Charcot-Marie-Tooth disease, spinal injury or spina bifida, and stroke. The median age of participants was 64.5 years (range 36–80 years).Results Patients’ medical condition impacted significantly on daily life. Participants relied on orthotic devices to enable engagement in daily activities. Patient goals for mobility were linked to individual circumstances. Desired treatment outcomes included reduction in pain, trips and falls, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses and associated with reported use. Obtaining suitable footwear alongside orthotic devices was a significant concern. Time pressures during device fitting were viewed negatively.Conclusions Orthotic devices for knee instability play a crucial role in promoting, maintaining and enhancing physical and psychological health and well-being, enabling patients to work, engage in family life and enjoy social activities. Future research should consider how best to measure the impact of orthotic devices on patient quality of life and daily functioning outside the clinic setting, as well as device use and any adverse effects.Trial registration number This qualitative study was retrospectively registered as Current Controlled Trials ISRCTN65240228.https://bmjopen.bmj.com/content/9/10/e029313.full |
| spellingShingle | Gita Ramdharry Alison Booth Catriona McDaid Dorothy McCaughan Cath Jackson Simon Lalor Rory J O'Connor Margaret Phillips Roy Bowers Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives BMJ Open |
| title | Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives |
| title_full | Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives |
| title_fullStr | Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives |
| title_full_unstemmed | Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives |
| title_short | Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives |
| title_sort | orthotic management of instability of the knee related to neuromuscular and central nervous system disorders qualitative interview study of patient perspectives |
| url | https://bmjopen.bmj.com/content/9/10/e029313.full |
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