Physical Therapists' Use of Evaluation Measures to Inform the Prescription of Ankle-Foot Orthoses for Children with Cerebral Palsy

ABSTRACT

Aims: To examine how physical therapists (PTs) use evaluation measures to guide prescription and re-assessment of ankle-foot orthoses (AFOs) for children with CP. Methods: PTs in Canada who work with children with CP were invited to complete an online survey. Survey questions examined PT evaluation and interpretation of findings at initial AFO prescription and re-assessment. Closed-ended responses were analyzed using descriptive statistics, and a conventional content analysis examined responses to open-ended questions. Results: Sixty responses from ten provinces were analyzed. Three themes emerged from the open-ended responses, which were supported by closed-ended responses. (1) Focus on impairment-level measures. Although evaluation primarily involved observational, non-standardized measures of impairments and gait pattern, most respondents also considered participation-level constructs. (2) Lack of confidence/knowledge. Respondents reported a moderate level of confidence concerning decision-making about AFO type and characteristics. 3) Inconsistent practices between therapists, possibly reflecting the paucity of available evidence or individualization of the prescription. Conclusions: Non-standardized, observational assessment methods, and impairment-level constructs appear to guide AFO prescription decisions. Integrating current knowledge into practice, developing best practice guidelines, and developing standardized tools to assess the effects of AFOs on participation may promote confidence, consistency, and improved outcomes.

KEYWORDS:

• Ankle-foot orthoses
• cerebral palsy
• decision-making
• evaluation

Acknowledgments

The authors wish to thank the content experts who provided feedback during survey development: Shelley Mannell, Barbara Kelly, Chun Kim, Beth Watkins, and Chantale Ferland. Thank you also to Jean-François Lemay for survey translation, and to the physical therapists who completed the survey.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

Funding was received from the Physiotherapy Foundation of Canada and the Pedorthic Research Foundation of Canada.