Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey

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BACKGROUND: Dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) are often prescribed in polio survivors with calf muscle weakness to reduce or solve gait problems. However, orthoses are sometimes not being used and/or users are dissatisfied with the usability. AIM: To compare the usability of custom-made DR-AFOs provided in clinical care between users and discontinued users who have calf muscle weakness due to polio. DESIGN: Cross-sectional survey. SETTING: Outpatient post-polio university hospital clinic in the Netherlands. POPULATION: All polio survivors with calf muscle weakness, provided with a DR-AFO between 2004 and 2015 in our outpatient clinic. METHODS: DR-AFO use and usability according to the ISO 9241-11 standard were evaluated with a questionnaire sent out by postal mail. RESULTS: Forty of 57 questionnaires were returned. Five respondents did not fulfil the eligibility criteria. DR-AFO use among the 35 eligible respondents was 74%. Compared to discontinued users, users were significantly more often male (users: 16 of 26 vs. discontinued users: 0 of 9, P=0.001), more limited in their walking ability without DR-AFO (P=0.007), perceived more effectiveness, both overall (P=0.001) and on their personal goals of use (P=0.006), and were more satisfied with orthosis-related aspects (P=0.011), such as comfort. CONCLUSIONS: Almost three quarters of the polio survivors used their orthosis. Use was related to several aspects of usability, indicating that it is important to consider usability in the prescription process of DR-AFOs for polio survivors with calf muscle weakness. CLINICAL REHABILITATION IMPACT: When prescribing DR-AFOs, it is important to consider that the orthosis is most likely used when the experienced walking problems are large and the DR-AFO reduces these problems. We recommend discussing the patient's personal goals for DR-AFO use and the anticipated improvement on the individual's walking problems as well as possible hindrance of the orthosis during daily life activities. Furthermore, providers may need to pay extra attention to females and should particularly take care that the experienced fit and comfort are satisfactory. Incorporating these suggestions in clinical practice may further improve DR-AFO use among polio survivors with calf muscle weakness.
Original languageEnglish
Pages (from-to)575-584
Number of pages10
JournalEuropean journal of physical and rehabilitation medicine
Issue number5
Early online date26 May 2020
Publication statusPublished - 1 Oct 2020


  • Muscle weakness
  • Orthotic devices
  • Patient satisfaction
  • Postpoliomyelitis syndrome
  • Treatment outcome

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