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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(10):e029313BO

Abstract

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.

Authors+Show Affiliations

York Trials Unit, University of York, York, UK.Department of Health Sciences, University of York, York, UK.York Trials Unit, University of York, York, UK.Orthotics, Queen Mary's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK. Orthotics/Prosthetics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.Faculty of Allied Health, Midwifery and Social Care, Kingston University/St George's University of London, London, UK. Queen Square Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.Rehabilitation, Derby Hospitals/ Nottingham University, Derby, UK.Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.York Trials Unit, University of York, York, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31628124

Citation

McCaughan, Dorothy, 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, vol. 9, no. 10, 2019, pp. e029313.
McCaughan D, Booth A, Jackson C, 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(10):e029313.
McCaughan, D., Booth, A., Jackson, C., Lalor, S., Ramdharry, G., O'Connor, R. J., ... McDaid, C. (2019). Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives. BMJ Open, 9(10), pp. e029313. doi:10.1136/bmjopen-2019-029313.
McCaughan D, 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 Oct 17;9(10):e029313. PubMed PMID: 31628124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives. AU - McCaughan,Dorothy, AU - Booth,Alison, AU - Jackson,Cath, AU - Lalor,Simon, AU - Ramdharry,Gita, AU - O'Connor,Rory J, AU - Phillips,Margaret, AU - Bowers,Roy, AU - McDaid,Catriona, Y1 - 2019/10/17/ PY - 2019/10/20/entrez PY - 2019/10/20/pubmed PY - 2019/10/20/medline KW - central nervous system conditions KW - knee instability KW - neuromuscular conditions KW - orthoses KW - patient perspectives KW - qualitative study SP - e029313 EP - e029313 JF - BMJ open JO - BMJ Open VL - 9 IS - 10 N2 - 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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31628124/Orthotic_management_of_instability_of_the_knee_related_to_neuromuscular_and_central_nervous_system_disorders:_qualitative_interview_study_of_patient_perspectives L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=31628124 DB - PRIME DP - Unbound Medicine ER -