Orthotists’ and physical therapists’ perspectives on quality of care indicators for persons with custom ankle-foot orthoses

ABSTRACT

Purpose: To describe the priorities of orthotists and physical therapists about quality measurement themes, and the feasibility and utility of collecting data from persons using custom AFOs that could inform quality measure development.

Materials and Methods: Online survey assessed respondents’ perspectives and experiences. An Advisory Committee representing professional, organizational, and accreditor groups distributed survey invitations.

Results: 461 orthotists and 153 physical therapists completed part or all of the survey; 60% rated 9 quality themes and 20 quality of care topics as extremely important, and 12 standard instruments as feasible and good to use for quality measurement. Patients were the preferred source of information for ease of scheduling, device weight, ease of donning and doffing, adherence to device use, beneficial effects, activity level and independence, and quality of life. Clinicians were the preferred source for material quality, device modifiability, and joint range of motion. Facility records were the preferred source for timeliness of device delivery and clinician follow-up. Respondents reported that gait speed and walking endurance were best obtained by patient performance.

Conclusions: Results provide insight on the topics orthotists and physical therapists regard as priorities for defining healthcare quality for persons using custom ankle-foot orthoses and instruments for data collection.

KEYWORDS:

• assessment
• orthotics
• outcomes
• policy and legislation

Acknowledgments

We value the time, commitment, and wisdom of the Advisory Committee members, including, Chellie Blondes, American Academy of Orthotists and Prosthetists; James Campbell, Hanger, Inc.; Dennis Clark, Walter Reed Experience; Catherine Carter, American Board for Certification in Orthotics, Prosthetics, and Pedorthics; Philicia Deckard, Brain Injury Association of Illinois; Mark DeHarde, Ultraflex Systems, Inc.; Doug Eckhoff, Consumer Representative; Andrea Ikeda, Extremity Trauma and Amputation Center of Excellence, Brooke Army Medical Center; Brian Kaluf, Ability Prosthetics and Orthotics, Inc.; Karyn Kessler, Hanger, Inc.; Kathleen N. Lohr, RTI International; Andrew Marshall, DAV; Joe McTernan, American Orthotic and Prosthetic Association; Heather Smith, American Physical Therapy Association; Paul Prusakowski, OPIE Software Developer; Chris Robinson, National Commission on Orthotic and Prosthetic Education; Robin Seabrook, National Commission on Orthotic and Prosthetic Education; Jill Seale, South College; Phil Stevens, Hanger, Inc.; Anna Taylor, National Stroke Association; Mark K. Taylor, Consumer Representative; Eva Wilkins, Consumer Representative; and James H. Wynne, American Board for Certification in Orthotics, Prosthetics, and Pedorthics.

Disclosure statement

The authors report no declarations of interest. The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Additional information

Funding

This work was supported by the United States Department of Defense [W81XWH-16-1-0788].