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