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Snowdon N.J.1, O'Brien R.2, McLean S.2
1Sheffield Hallam University, Allied Health Professions, Sheffield, United Kingdom, 2Sheffield Hallam University, Faculty of Health and Wellbeing, Sheffield, United Kingdom
Background: Multiple sclerosis (MS) impacts on movement control, slowing somato-sensory feedback and making movement slower and more variable. Fabric orthoses could improve movement, possibly by providing support or enhancing sensory feedback, however, there is very limited research in multiple sclerosis. Studies using fabric orthoses in cerebral palsy have shown some improvement in postural stability and function but acceptability was reported to be poor. Although fabric orthoses are used by people with multiple sclerosis, little qualitative research has been conducted.
Purpose: The study aimed to investigate the experiences of people with MS who were long-term users of fabric orthoses. We aimed to explore the essential features of the orthoses and the importance of the orthoses to users.
Methods: Three participants were recruited via an orthotics manufacturer and one through the MS Society UK webpage. All had used an orthosis for at least two months on a regular basis. Face to face semi-structured interviews were conducted. Interpretative phenomenological analysis was used to analyse the data. Transcripts were annotated with exploratory comments and emergent themes identified. Themes were organised to convey the meanings arising from the data, firstly for each participant and then across the group.
Results: Essential features of the orthoses were considered to be compression and the directive forces within the orthoses. Participants felt their orthoses changed posture, thus improving function or inhibiting involuntary movement. The importance of the orthoses was encapsulated in two superordinate themes regaining control and weighing up the pros and cons. Regaining control explains the loss of control perceived as a result of MS and the feeling that the orthoses gave back a feeling of control over their body, their independence and how others perceived them. Weighing-up encapsulates both the sense of experimentation that brought them to use the orthosis and the comparison of pros and cons of orthotic use. Three participants explained skills and routines they had developed to successfully use the orthoses.
Three of the four participants had experience of a fabric orthosis that they no longer wore. Key points determining whether the orthotic was used were whether it addressed a problem of particular importance to the participant; whether there was an initial positive effect; whether orthotists reviewed the fit and design and whether the participant adapted their routines around using the orthosis.
Conclusion(s): User perspectives suggested that fabric orthoses improve control through compression and changes in posture. Negative aspects were minimised by developing skills, strategies and routines, however, this adaptation was discouraged if the problem prompting the orthotic was not of sufficient importance; if the initial effect was disappointing or if there was insufficient professional engagement with adapting the orthosis.
Implications: Successful prescription of an orthosis may require an assessment of a clients readiness to engage with orthotic wear and professional support may be needed until a routine of wear is established. Future studies should focus more on initial rather than long-term effect, as initial effect may predict adherence.
Funding acknowledgements: Funding provided by the Department of Allied Health Professions, Sheffield Hallam University.
Topic: Professional practice: other
Ethics approval: The protocol was approved by the Sheffield Hallam University Research Ethics Committee in October 2015 (Ref: 2015-6/HWB-HSC-5).
All authors, affiliations and abstracts have been published as submitted.
