Relationship between use of ankle-foot orthoses and quality of life and psychological well being : a research plan

An ankle-foot orthosis (AFO) is an externally applied device that encompasses the joints of the ankle and foot, used to modify the structural and functional characteristics of the neuromuscular and skeletal systems(ISO,1989,a&b). AFOs are prescribed for people who have a loss of function affecting their mobility, experienced in wide range of conditions such as stroke, poliomyelitis, cerebral palsy, spina bifida and osteoarthritis

Use of the ICF to investigate impairment, activity limitation and participation restriction in people using ankle-foot orthoses to manage mobility disabilities

This study investigated differences in impairment, activity limitation, participation restrictions and psychological distress between participants using ankle-foot orthoses (AFOs) as recommended, participants who did not use AFOs as recommended and participants who did not know recommendations for use.  Adults (n = 157) fitted with an AFO by an NHS Orthotic Service in Scotland completed a postal questionnaire that measured impairment, activity limitations participation restrictions and psychological distress using scales from the RAND 36-Item Health Survey 1.0 and the Hospital Anxiety and Depression Scale (HADS).  41% of participants used their AFOs as recommended, 32% did not use their AFOs as recommended and 27% did not know the recommendations for use. Participants using AFOs as recommended reported lower levels of impairment and activity limitations, indicated by higher energy levels (p = 0.005), higher physical functioning (p = 0.005), lower role-limitations due to emotional problems (p = 0.001) and lower levels of anxiety (p = 0.003) compared to people not using AFOs as recommended.  Health professionals need to ensure whether patients understand the recommendations for use of their AFO. Additionally, the results of the study support the value of evaluating patients' psychological well-being to gain a better understanding of AFO use. Implications for Rehabilitation Participants who reported using AFOs as recommended had significantly lower levels of impairment, activity limitations and anxiety compared to those who did not use their AFO as recommended. In this study, 27% of participants did not know recommendations for use of AFOs. Health professionals should give consideration as to how information, regarding wearing instructions and use of AFOs, is provided to people who are prescribed AFOs. Psychological outcomes in orthotics are rarely assessed. However, this study demonstrates there is a value in measuring psychological outcomes in orthotic management

A collaboration between the University of Strathclyde and Prosthetic & Orthotic Practice Educators for improved practice educator training

Introduction, One of the most important experiences of learning for AHP students is clinical placement, in which students apply theory to practice. In order for practice educators to support student learning on placement, it is important for HEIs to provide relevant training to practice educators. The BSc(Hons) Prosthetics and Orthotics Programme, Department of Biomedical Engineering, University of Strathclyde (UoS) provides a 3 hour training session to prosthetic and orthotic practice educators and also offers board specific training sessions on request. Following Covid, these sessions have run successfully online, over Zoom. Content of the training is usually reviewed and revised by the practice education co-ordinators annually, and informal feedback is invited. Feedback collated during the NHS Education for Scotland (NES) Prosthetics and Orthotics (P&O) scoping review, and NES Allied Health Professional (AHP) Practice Educators survey, demonstrated that Practice Educator (PE) training provided by the University of Strathclyde (UoS) was one of the most important factors for clinicians when supporting student practice-based learning (PrBL). In response to this, P&O practice educators and NCPO agreed to collaborate on a project to review and improve the content of P&O specific PE training. AIM: To seek views on content, materials and methods used in PE training, and following feedback, implement changes which will improve the current uni-professional training. Methods: NES / UoS P&O PE survey specifically around P&O PE Training – 32 respondents with recruitment of n=11 volunteers – describe participants (P/O) Of the 11, 5 representatives participated in review from NES / UoS / P and O workforce – describe (P/O) - describe experience Based on the findings and feedback of the survey - revision of UoS PE training materials took place with addition of new resources – done over MSTeams with the use of Jamboard. Revised UoS P&O PE Training piloted in January 2023 and re-evaluated using MSForms Results/Discussion, Bar charts – summary of change I terms of percentage helpful and v. helpful Chart for the new materials Summary paragraph Comments from pilot evaluation Discussion and Conclusion This project met its aim of improving the content of the P&O specific PE training, as evidenced by the evaluation of the pilot training. The main benefits to the revised training were improved awareness of resources for Practice Educators, clearer signposting of support for students, increased relevance of case studies. In addition, the collaboration benefited the HEI in providing a greater understanding of some of the challenges faced by PEs. In addition, Practice Educators gained valuable insights into the HEI’s decision-making and considerations when providing PE training. Both parties reflected that the collaboration has been beneficial, with practice educators reporting increased engagement and interest in PE, and the HEI valuing the role of PEs, beyond supporting students. This project has resulted in improved relationships and communication for those involved, and was a worthwhile process, which we would recommend to others involved in PE training

Use of the theory of planned behaviour to predict adherence to ankle-foot orthoses (AFOs) in people with stroke free paper presentation

Ankle-foot Orthoses (AFOs) can be used to effectively manage impairments to gait, following a stroke. However, non-adherence to orthoses is an inefficient use of resources, and poor adherence is also associated with poorer outcomes in physical and mental health. Use of a theoretical model of behaviour to understand adherence to AFOs is important because interventions based on theory are more likely to be successful in changing behaviour. One such model, is the Theory of Planned Behaviour (TPB)

Understanding adherence to ankle-foot orthoses, an application of the theory of planned behaviour

Ankle-foot orthoses (AFOs) are used to manage mobility disability in a wide range of conditions such as stroke, multiple sclerosis, arthritis, and trauma. However, sub-optimal adherence has been identified as a major concern. Poor adherence to AFOs may result in diminished physical and mental health outcomes, and is also an inefficient use of scarce resource. In addition, little is known about the extent of use of AFOs in the longer term. Therefore, this thesis set out to initially understand the prevalence of adherence to AFOs, and the relationship between adherence to AFOs and health and functioning outcomes.;The International Classification of Functioning Disability and Health (ICF, WHO, 2001) was used as a framework to define health outcomes. The first investigation was a cross-sectional survey, conducted with 157 participants from NHS Greater Glasgow and Clyde, who had been prescribed an AFO for a range of conditions. The adherence rate to use of AFOs as recommended was 56%. This study demonstrated that AFO use as recommended was associated with better physical and mental health outcomes.;Therefore, an understanding of potentially modifiable factors, which can improve adherence to AFOs, offers an alternative method of optimising outcomes of AFO use.;The Medical Research Council's framework for complex interventions (Craig et al., 2013) identifies the need for theory-driven research to inform interventions. Consequently, this thesis used a theoretical approach to attempt to understand adherence to orthoses. Firstly, the Theory of Planned Behaviour (TPB, Ajzen, 1991) was identified as a potentially appropriate model. Then, a meta-analysis was conducted, which drew on the wider health adherence literature, to review the efficacy of the TPB in understanding health adherence behaviours in conditions, which may give rise to an orthotic intervention.;This found that the TPB accounted for 28.3% of the variance in intentions and 14% of the variance in adherence behaviours. Attitudes and Perceived Behavioural Control (PBC) were significant predictors of intention, and intention was a significant predictor of behaviour. In line with the TPB, intention mediated the effects of attitude and PBC on behaviour. This suggested the TPB might offer a useful model to investigate adherence to AFOs.;This thesis then applied the TPB to modelling AFO use in people with stroke. Stroke was selected as the focus of this investigation, as it is the leading cause of acquired adult disability worldwide (McGrath, Canavan, & O'Donnell, 2018), and, in the first study, was identified as the most common condition for which an AFO is prescribed. In addition, Scotland has a high incidence of stroke, compared to other UK nations, and improving the treatment and care of stroke is a clinical priority (Scottish Government, 2014a).;In order to conduct a TPB investigation, firstly, a beliefs elicitation study was conducted with 13 participants who had been prescribed an AFO by NHS Lanarkshire following stroke. This study enabled elicitation of attitudinal, normative and control beliefs, in line with the TPB model.;Participants reported more advantages compared to disadvantages of using AFOs, suggesting that they had a generally positive attitude towards AFO use. The most commonly stated advantages were 'increased mobility' and 'supports the position of the leg or foot'. The most common disadvantage detailed was 'discomfort', followed by 'problems with footwear size' and 'problems with footwear style'. Participants also identified a far greater number of people who would approve of AFO use, compared to people who would disapprove of AFO use suggesting that support for use of AFOs from a wide range of normative groups is high.;Family and health professionals were the most frequently elicited supporting normative referents. However, participants identified far fewer enabling factors compared to factors which made AFO use difficult, suggesting that perceived control of AFO use may be low in people with stroke. The main barriers to AFO use highlighted by participants were: obstacles in the environment, needing help to put the AFO on and off, the AFO causing pain or discomfort, and low mood or tiredness.;Then, the efficacy of the TPB model in explaining adherence to use of AFOs in people with stroke was investigated. Attitude, subjective norm and PBC were measured at Time 1 and behaviour was measured one month later, at Time 2, using a prospective questionnaire design in 49 participants from NHS Lanarkshire. In this investigation, 63% of people used their AFO as recommended. The TPB accounted for 57% variance in intentions and 43% variance in use of AFOs as recommended. The significant amount of variance accounted for indicates the TPB is a useful model for understanding adherence to AFOs in people with stroke.;Attitude was the only significant predictor of intention, and intention was the only significant predictor of behaviour. These findings were broadly in line with the meta-analysis conducted, albeit, with a greater amount of variance explained. The higher level of variance found in the TPB study could potentially be explained by careful design of the questionnaire, and use of an elicitation investigation using participants with the same inclusion criteria, which ensured compatibility of measures.;The relationship between the underlying beliefs, the direct TPB constructs, and intention and behaviour, were analysed, enabling potential targets of a future intervention to be identified. Attitudinal beliefs, normative beliefs and control beliefs were significantly correlated with the direct constructs, demonstrating that the beliefs measured provided a good understanding of the cognitive foundations of attitude, subjective norms and PBC. Analysis of correlations between belief-based measures, intention, and behaviour enabled the identification of beliefs that could be targeted in a future intervention to increase adherence to AFO use.;These were positive attitudinal beliefs that AFOs can increase mobility, improve balance, and help a person to improve during rehabilitation, and also negative beliefs that AFOs may cause pain or discomfort, are heavy, and are effortful to use.;This thesis is the first body of work, which has applied a psychological model of behaviour to understanding AFO use in stroke, and therefore makes a significant contribution to the emerging cross-disciplinary field of psychology and physical rehabilitation for mobility disabilities. In addition, this work provides evidence of the efficacy of the TPB as a theoretical model for investigating other health behaviours, and specifically adherence behaviours in stroke.;Finally, this investigation has identified potential beliefs, which could be utilised in a future intervention to increase adherence to use of AFOs, by targeting the significant underlying attitudinal beliefs. More research is required to corroborate these findings, and important areas for future research have also been highlighted: there is the need for a stronger evidence base for recommendations for use of AFOs, and researchers should consider a broader range of outcome measures, which are more reflective of the patient experience of using an AFO in a real-world setting.Ankle-foot orthoses (AFOs) are used to manage mobility disability in a wide range of conditions such as stroke, multiple sclerosis, arthritis, and trauma. However, sub-optimal adherence has been identified as a major concern. Poor adherence to AFOs may result in diminished physical and mental health outcomes, and is also an inefficient use of scarce resource. In addition, little is known about the extent of use of AFOs in the longer term. Therefore, this thesis set out to initially understand the prevalence of adherence to AFOs, and the relationship between adherence to AFOs and health and functioning outcomes.;The International Classification of Functioning Disability and Health (ICF, WHO, 2001) was used as a framework to define health outcomes. The first investigation was a cross-sectional survey, conducted with 157 participants from NHS Greater Glasgow and Clyde, who had been prescribed an AFO for a range of conditions. The adherence rate to use of AFOs as recommended was 56%. This study demonstrated that AFO use as recommended was associated with better physical and mental health outcomes.;Therefore, an understanding of potentially modifiable factors, which can improve adherence to AFOs, offers an alternative method of optimising outcomes of AFO use.;The Medical Research Council's framework for complex interventions (Craig et al., 2013) identifies the need for theory-driven research to inform interventions. Consequently, this thesis used a theoretical approach to attempt to understand adherence to orthoses. Firstly, the Theory of Planned Behaviour (TPB, Ajzen, 1991) was identified as a potentially appropriate model. Then, a meta-analysis was conducted, which drew on the wider health adherence literature, to review the efficacy of the TPB in understanding health adherence behaviours in conditions, which may give rise to an orthotic intervention.;This found that the TPB accounted for 28.3% of the variance in intentions and 14% of the variance in adherence behaviours. Attitudes and Perceived Behavioural Control (PBC) were significant predictors of intention, and intention was a significant predictor of behaviour. In line with the TPB, intention mediated the effects of attitude and PBC on behaviour. This suggested the TPB might offer a useful model to investigate adherence to AFOs.;This thesis then applied the TPB to modelling AFO use in people with stroke. Stroke was selected as the focus of this investigation, as it is the leading cause of acquired adult disability worldwide (McGrath, Canavan, & O'Donnell, 2018), and, in the first study, was identified as the most common condition for which an AFO is prescribed. In addition, Scotland has a high incidence of stroke, compared to other UK nations, and improving the treatment and care of stroke is a clinical priority (Scottish Government, 2014a).;In order to conduct a TPB investigation, firstly, a beliefs elicitation study was conducted with 13 participants who had been prescribed an AFO by NHS Lanarkshire following stroke. This study enabled elicitation of attitudinal, normative and control beliefs, in line with the TPB model.;Participants reported more advantages compared to disadvantages of using AFOs, suggesting that they had a generally positive attitude towards AFO use. The most commonly stated advantages were 'increased mobility' and 'supports the position of the leg or foot'. The most common disadvantage detailed was 'discomfort', followed by 'problems with footwear size' and 'problems with footwear style'. Participants also identified a far greater number of people who would approve of AFO use, compared to people who would disapprove of AFO use suggesting that support for use of AFOs from a wide range of normative groups is high.;Family and health professionals were the most frequently elicited supporting normative referents. However, participants identified far fewer enabling factors compared to factors which made AFO use difficult, suggesting that perceived control of AFO use may be low in people with stroke. The main barriers to AFO use highlighted by participants were: obstacles in the environment, needing help to put the AFO on and off, the AFO causing pain or discomfort, and low mood or tiredness.;Then, the efficacy of the TPB model in explaining adherence to use of AFOs in people with stroke was investigated. Attitude, subjective norm and PBC were measured at Time 1 and behaviour was measured one month later, at Time 2, using a prospective questionnaire design in 49 participants from NHS Lanarkshire. In this investigation, 63% of people used their AFO as recommended. The TPB accounted for 57% variance in intentions and 43% variance in use of AFOs as recommended. The significant amount of variance accounted for indicates the TPB is a useful model for understanding adherence to AFOs in people with stroke.;Attitude was the only significant predictor of intention, and intention was the only significant predictor of behaviour. These findings were broadly in line with the meta-analysis conducted, albeit, with a greater amount of variance explained. The higher level of variance found in the TPB study could potentially be explained by careful design of the questionnaire, and use of an elicitation investigation using participants with the same inclusion criteria, which ensured compatibility of measures.;The relationship between the underlying beliefs, the direct TPB constructs, and intention and behaviour, were analysed, enabling potential targets of a future intervention to be identified. Attitudinal beliefs, normative beliefs and control beliefs were significantly correlated with the direct constructs, demonstrating that the beliefs measured provided a good understanding of the cognitive foundations of attitude, subjective norms and PBC. Analysis of correlations between belief-based measures, intention, and behaviour enabled the identification of beliefs that could be targeted in a future intervention to increase adherence to AFO use.;These were positive attitudinal beliefs that AFOs can increase mobility, improve balance, and help a person to improve during rehabilitation, and also negative beliefs that AFOs may cause pain or discomfort, are heavy, and are effortful to use.;This thesis is the first body of work, which has applied a psychological model of behaviour to understanding AFO use in stroke, and therefore makes a significant contribution to the emerging cross-disciplinary field of psychology and physical rehabilitation for mobility disabilities. In addition, this work provides evidence of the efficacy of the TPB as a theoretical model for investigating other health behaviours, and specifically adherence behaviours in stroke.;Finally, this investigation has identified potential beliefs, which could be utilised in a future intervention to increase adherence to use of AFOs, by targeting the significant underlying attitudinal beliefs. More research is required to corroborate these findings, and important areas for future research have also been highlighted: there is the need for a stronger evidence base for recommendations for use of AFOs, and researchers should consider a broader range of outcome measures, which are more reflective of the patient experience of using an AFO in a real-world setting

Understanding the induction and settling-in process for students on prosthetic and orthotic practice placements

BACKGROUND The practice placement is an key element of undergraduate Prosthetic and Orthotic education programmes, where students can put theory into practice. Beginning a new placement can be a daunting experience and there is a need to ensure the student is wellsupported when beginning placement so that they can settle in and get the most from their experience. AIM To understand the induction process and the experience of a new student undertaking a Prosthetic and Orthotic practice placement METHOD The clinical placement co-ordinator of an ISPO approved undergraduate Prosthetics and Orthotics Programme underwent the induction process for a new placement and also attended a regular clinic for a day, in the role of student. Both the practice educator and the clinical placement co-ordinator reflected and shared their experience in order to understand differing perspectives. RESULTS The clinical placement co-ordinator attended an orthotic foot and ankle clinic in a local hospital, in the role of a student. Positive aspects of the experience included a clear induction process, and joining instructions, the opportunity to work with a range of clinicians and understand role of the orthotist in both inpatient and outpatient settings, and the importance of feeling welcomed by the team. Challenging aspects to the experience included managing first day nerves, trying to become familiar with several different IT systems, and the student not being accepted as an autonomous practitioner by some patients. From the practice educator's view, student supervision is enjoyable, and also challenges the clinician to develop their teaching skills and own knowledge. However challenges include limited space to accommodate students and additional time required to explain processes and procedures. DISCUSSION AND CONCLUSION Greater knowledge of differing perspectives of both the 'student' and the practice educator about the first day experience, has helped to inform practice educator training sessions, and pre-placement briefings for students provided by the University. It has also aided in understanding some of the challenges faced by practice educators during the Covid Pandemic in relation to the student experienc

Practice educators perceptions of student attributes and experience of supporting prosthetics and orthotics students on practice placement

Practice placements are a core requirement of Allied Health Profession training. Education is provided to prepare students for placement, but core characteristics are not well defined. A survey of practice educators experience of students from a UK institution aimed to highlight this information

Creating an accessible curriculum for students with disabilities at the National Centre for Prosthetics and Orthotics

The latest addition to the Disability Discrimination Act, passed in 2005, introduced a requirement for all public bodies, including Higher Education Institutions to promote and deliver disability equality across all policies and activities. An increased awareness of disability equality places new demands on educators to be proactive in ensuring their teaching does not inadvertently discriminate against people with disabilities. In responding to the University's Disability Equality Scheme, a review of the accessibility of teaching at the National Centre for Prosthetics and Orthotics (NCPO), a department in the University of Strathclyde's Faculty of Engineering, was carried out. There were specific challenges in responding to disability equality legislation due to the high content of practical and clinical work with genuine clients. This paper presents the review process, main findings and outcomes of that review. It also aims to help the audience consider and reflect on the accessibility of their own teaching. The review commenced with an e-mail survey of all of the department's current students and recent graduates. Students registered with disability services were also invited to a focus group discussion to share their views of the accessibility of the teaching. An e-mail survey of staff was also conducted, and was later followed by open discussion at a staff meeting. The responses to the surveys were grouped and then circulated to the authors. The focus group discussion was recorded and transcribed. The three authors independently revised the surveys and focus group discussion transcripts to search for common themes and possible recommendations. When the group met there was a high level of agreement on the recommendations and further discussion enabled additional recommendations to be added

Can psychology aid our understanding of orthotic adherence?

This study aims to examine the usefulness of a psychological theoretical model, Ajzen's (1991) Theory of Planned Behaviour (TPB), in explaining and predicting adherence to AFO use in people with stroke

Predicting adherence to ankle-foot orthoses in people with stroke : an application of the theory of planned behaviour

Background: Ankle-foot Orthoses (AFOs) are often prescribed for people with stroke to address the motor impairment. However not all patients adhere to using their AFOs as prescribed. Predictors of AFO-adherence are likely to constitute useful targets for interventions that aim to promote this behaviour. Objective: Identify the predictors of AFO-adherence in people with stroke using an established theoretical framework, namely the Theory of Planned Behaviour (TPB; Ajzen, 1991). Study Design: Prospective survey design. Method: N=49 people who had been prescribed an AFO following a stroke completed a TPB questionnaire. One month later, they completed another questionnaire that measured adherence to AFOs as prescribed by an orthotic practitioner. Predictors of intention and AFO-adherence behaviour were identified using regression analyses. Results Adherence to AFOs was 63%. The TPB accounted for 61% of the variance in intentions and 43% of the variance in AFO-adherence behaviour. Attitude was the sole predictor of intention, and intention the sole predictor of behaviour. Conclusion The TPB is a useful model for explaining adherence to AFOs in people stroke. Interventions could be designed to increase intentions to use an AFO as prescribed by promoting positive attitudes towards AFO adherence