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Ramdharry G.1,2, McDaid C.3, O'connor J.4, Booth A.3, Macaughan D.3, Fayter D.5, Rodriguez-Lopez R.6, Bowers R.7, Dyson L.4, Iglesias C.4, Lalor S.8, O'connor R.9, Phillips M.10
1Kingston University, School of Allied Health, Midwifery and Social Work, London, United Kingdom, 2University College Hospitals NHS Foundation Trust, Queen Square Centre for Neuromuscular Diseases, London, United Kingdom, 3University of York, Department of Health Sciences, York, United Kingdom, 4Newcastle University, Institute of Health and Society, Newcastle, United Kingdom, 5University of York, Centre for Reviews and Dissemination, York, United Kingdom, 6University of York, Centre for Reviews & Dissemination, York, United Kingdom, 7University of Strathclyde, Biomedical Engineering, Glasgow, United Kingdom, 8St George's Hospital NHS FoundationTrust, Queen Mary's Hospital, London, United Kingdom, 9University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom, 10Royal Derby Hospital, Derby, United Kingdom
Background: Patients who have knee instability associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). The UK National Institute for Health Research commissioned research on
(i) the devices that are used in the National Health Service for these conditions,
(ii) the evidence available on their effectiveness, and
(iii) the perspective of patients.
This presentation will report on (i).
(i) the devices that are used in the National Health Service for these conditions,
(ii) the evidence available on their effectiveness, and
(iii) the perspective of patients.
This presentation will report on (i).
Purpose: A web survey was administered targeting orthotists, physiotherapists and doctors in rehabilitation medicine. The aim was to identify the types of orthoses currently being used by the NHS for the management of instability of the knee in adults with NMD and CNS disorders, the frequency of use, and care pathways.
Methods: The target population was orthotists, physiotherapists and rehabilitation physicians, within the UK, who provide care to patients with NMD and/or CNS conditions and who have knee instability. The sample frame was membership lists of the Association of Chartered Physiotherapists Interested in Neurology (ACPIN); British Association of Prosthetists and Orthotists (BAPO); British Society of Rehabilitation Medicine (BSRM).
Survey questions were developed from a group interview (n=11) and individual interviews (n=4) with participants from all three professions. It was distributed as an open survey link, via an e-mail invitation from the relevant organisation. Results were collated using Qualtric software and downloaded into Microsoft Excel®. All responses collected for each question were analysed, with the response rate for each question calculated.
Results: 238 health care professionals (HCPs) agreed to participate (80 orthotists, 94 physiotherapists, 50 rehabilitation medicine physicians, 14 other professionals) with 138 completing the survey.
No single group dominated provision among NMD conditions: respondents reported managing people with poliomyelitis, post-polio syndrome, muscular dystrophy, Charcot Marie Tooth disease, motor neurone disease and GuillainBarré Syndrome. Similarly, no single group dominated provision among CNS conditions, although HCPs most commonly reported managing people with stroke and multiple sclerosis. A range of orthoses are prescribed for knee instability related to NMD or CNS conditions: KAFOs (75%), AFOs (94%) and knee brace (89%). A substantial proportion of respondents also prescribed shoe adaptations (66%) and insoles (70%). Approximately half of the devices prescribed were reported as custom-made. At least 50% of HCPs thought that comfort and confidence in mobility were extremely important outcomes. Just over one-quarter of respondents did not use formal outcome measures to assess the effectiveness of the devices provided. If used, the most common were the visual analogue scale, the 10-m Walk Test and the Timed Up and Go Test. One-third of participants reported that they formally assess patient satisfaction.
Conclusion(s): Several different orthoses, both custom-made and prefabricated, are provided through the NHS to manage knee instability that is related to NMD and CNS disorders. Services are delivered in diverse ways with variations in prescribing professionals, patient pathways and outcome measurement.
Implications: It is currently unclear what the optimum model of delivery, best measures of outcome to ensure maximum benefit for patients and best value for money. Further investigation is required and is applicable beyond the UK.
Funding acknowledgements: Funding for this study was provided by the Health Technology Assessment programme of the UK National Institute for Health Research.
Topic: Neurology
Ethics approval: Ethical approval s sought from and granted by the University of Yorks Department of Health Sciences Research Governance Committee.
All authors, affiliations and abstracts have been published as submitted.
