Patient Compliance and Factors Related to Usage of Plastic Ankle-Foot Orthoses by Chronic Stroke Patients


  • Piyapat Dajpratham Department of Rehabilitation Medicine, Faulty of Medicine Siriraj Hospital, Mahidol University
  • Chompunut Pongakkasira Sirindhorn National Rehabilitation Center, Department of Medical Services, Ministry of Public Health, Bangkok, Thailand
  • Pim Terachinda Department of Rehabilitation Medicine, Faulty of Medicine, Chulalongkorn University
  • Wantana Phutthakumnerd Department of Rehabilitation Medicine, Faulty of Medicine Siriraj Hospital, Mahidol University
  • Pattaraporn Sirirak Department of Rehabilitation Medicine, Veteran Hospital, Bangkok, Thailand


foot orthosis, patient compliance, stroke rehabilitation, ambulation


Objectives: To investigate chronic stroke patient compliance with usage of plastic ankle-foot orthosis (AFO) and to identify factors significantly associated with compliance with AFO use.

Study design: Cross-sectional study.

Setting: Department of Rehabilitation Medicine, Siriraj Hospital and Sirindhorn National Rehabilitation Center.

Subjects: Chronic stroke patients who had received a plastic AFO at least one year ago, had no cognitive impairment, no aphasia, and who had visited a physiatrist for follow-up.

Methods: Patients’ demographic and clinical data were collected. Modified Barthel Index (mBI) and Functional Ambulation Category (FAC) were used for assessment. Patients were asked to complete a specially designed AFO use questionnaire. Patient compliance was defined as AFO use for ambulation for more than 3 hours per day at least 5 days per week over a period of not less than a year.  Patients who did not meet those provisions were classified as non-compliant. Patient compliance/non-compliance with AFO usage was analyzed using descriptive statistics. Factors associated with compliance were analyzed using forward stepwise logistic regression.

Results: A total of 93 patients, 63 men and 30 women, with a mean age of 60 years were included in the study. Of those patients, 38.7% had discontinued the use of AFO, 61.3% reported continuous use of AFO, but only 23.7% were categorized as compliant with AFO usage.  FAC level 4 or 5, independent ambulator on level surfaces only and independent ambulator, respectively, was the only factor statistically significantly related to patient compliance (odds ratio: 15.2, 95% confidence interval: 1.9-120.6). 

Conclusions: Almost two-thirds of chronic stroke patients reported continuous usage of AFOs for at least a year, but only one-fourth could be categorized as compliant with AFO usage.  Independent ambulation, including ambulation on level surfaces only, was the only factor independently associated with compliance with AFO use.

Keywords: foot orthosis, patient compliance, stroke rehabilitation, ambulation


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