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- Title
CLINICAL OUTCOME MEASURES TO EVALUATE THE EFFECTS OF ORTHOTIC MANAGEMENT POST-STROKE.
- Authors
Ramstrand, Nerrolyn
- Abstract
Background Effective orthotic management should ultimately improve outcomes for individual patients in a meaningful way. Measuring the effectiveness of specific interventions is essential for good practice, and a core component of evidence-base healthcare (1). While historically neglected, the selection of appropriate outcome measures to evaluate clinical interventions is a critical step in the process of optimising the provision of lower limb orthoses (2) and reflects how the clinician has operationalised "success" (3). A major obstacle to the implementation of outcome measures into orthotic care is the lack of consensus regarding the selection of the measures themselves. As such, there is uncertainty about which tools to use, when to use them, which patient presentations to use them with and in what context. In addition, outcomes used in research settings are not always available or suitable within the clinical setting. This systematic review aimed to identify clinical outcome measures that have been used in research to evaluate the results of lower limb orthotic management in individuals who have had a stroke. It is anticipated that this work will form a foundation for future studies aimed at identifying the most appropriate clinical outcomes measures to apply in orthotic management of this population. Methods A search for relevant literature was conducted in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases. No limits were placed on the year of publication. The search string was developed to include key words, a broad range of synonyms and, when relevant, MeSH terms related to stroke, orthotic devices and lower extremities. Relevant studies were assessed for methodological quality by both authors using the relevant standardised critical appraisal tool from the Joanna Briggs Institute (4). Data extracted from the articles included citation (author/year), study design, sample characteristics (age, time post stroke, sample size, drop-outs), description of the orthotic intervention, accommodation time, testing procedures, clinical outcome measures used and results of the study. Results 62 articles were included in the final analysis; 44 case-series studies, 17 randomised control trials and one cohort study. The most commonly applied outcome measure to evaluate lower-limb orthotic interventions was the 10-meter walk test followed by the timed-up-and-go test. These two measures were also the most frequently used combination. When classified according to the ICF, most outcome measures addressed issues related to body structure and function and activities. Very few outcomes related to participation or environmental factors were identified. Conclusion Within the field of prosthetics and orthotics, recovery assessment post stroke appears to focus on measuring functional status and activity. With increasing promotion of the biopsychosocial model of health, assessment of orthotic management for stroke recovery should be broadened to include an assessment of body function, activity and participation.
- Subjects
BIOPSYCHOSOCIAL model; STROKE; ORTHOPEDIC apparatus; LEG; KEYWORDS; META-analysis; FUNCTIONAL assessment
- Publication
Rehabilitation / Rehabilitacija, 2019, Vol 18, p22
- ISSN
1580-9315
- Publication type
Article