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Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders
BACKGROUND: Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary exper...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847977/ https://www.ncbi.nlm.nih.gov/pubmed/36652463 http://dx.doi.org/10.1371/journal.pone.0279292 |
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author | van Duijnhoven, Elza Koopman, Fieke S. Ploeger, Hilde E. Nollet, Frans Brehm, Merel-Anne |
author_facet | van Duijnhoven, Elza Koopman, Fieke S. Ploeger, Hilde E. Nollet, Frans Brehm, Merel-Anne |
author_sort | van Duijnhoven, Elza |
collection | PubMed |
description | BACKGROUND: Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary expert setting may improve treatment outcomes. AIM: To examine the effectiveness of specialist care orthoses compared to usual care orthoses on personal goal attainment and walking ability. DESIGN: Cohort study. POPULATION: Adults with NMD who experienced walking problems due to calf and/or quadriceps muscle weakness and were provided with a specialist care lower limb orthosis between October 2011 and January 2021. METHODS: Three months after provision, the specialist care orthosis was compared to the usual care orthosis worn at baseline in terms of personal goal attainment (Goal Attainment Scaling (GAS)), comfortable walking speed (m/s), net energy cost (J/kg/m) (both assessed during a 6-minute walk test), perceived walking ability and satisfaction. RESULTS: Sixty-four adults with NMD were eligible for analysis. The specialist care orthoses comprised 19 dorsiflexion-restricting ankle-foot orthoses (AFOs), 22 stance-control knee-ankle-foot orthoses (KAFOs) and 23 locked KAFOs. Overall, 61% of subjects showed a clinically relevant improvement in GAS score. Perceived safety, stability, intensity, fear of falling and satisfaction while walking all improved (p≤0.002), and subjects were satisfied with their specialist care orthosis and the services provided. Although no effects on walking speed or net energy cost were found in combined orthosis groups, specialist care AFOs significantly reduced net energy cost (by 9.5%) compared to usual care orthoses (from mean (SD) 3.81 (0.97) to 3.45 (0.80) J/kg/m, p = 0.004). CONCLUSION: Guideline-based orthotic care within a multidisciplinary expertise setting could improve treatment outcomes in adults with NMD compared to usual orthotic care by improvements in goal attainment and walking ability. A randomized controlled trial is now warranted to confirm these results. |
format | Online Article Text |
id | pubmed-9847977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-98479772023-01-19 Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders van Duijnhoven, Elza Koopman, Fieke S. Ploeger, Hilde E. Nollet, Frans Brehm, Merel-Anne PLoS One Research Article BACKGROUND: Lower limb orthoses intend to improve walking in adults with neuromuscular disorders (NMD). Yet, reported group effects of lower limb orthoses on treatment outcomes have generally been small and heterogeneous. We propose that guideline-based orthotic care within a multidisciplinary expert setting may improve treatment outcomes. AIM: To examine the effectiveness of specialist care orthoses compared to usual care orthoses on personal goal attainment and walking ability. DESIGN: Cohort study. POPULATION: Adults with NMD who experienced walking problems due to calf and/or quadriceps muscle weakness and were provided with a specialist care lower limb orthosis between October 2011 and January 2021. METHODS: Three months after provision, the specialist care orthosis was compared to the usual care orthosis worn at baseline in terms of personal goal attainment (Goal Attainment Scaling (GAS)), comfortable walking speed (m/s), net energy cost (J/kg/m) (both assessed during a 6-minute walk test), perceived walking ability and satisfaction. RESULTS: Sixty-four adults with NMD were eligible for analysis. The specialist care orthoses comprised 19 dorsiflexion-restricting ankle-foot orthoses (AFOs), 22 stance-control knee-ankle-foot orthoses (KAFOs) and 23 locked KAFOs. Overall, 61% of subjects showed a clinically relevant improvement in GAS score. Perceived safety, stability, intensity, fear of falling and satisfaction while walking all improved (p≤0.002), and subjects were satisfied with their specialist care orthosis and the services provided. Although no effects on walking speed or net energy cost were found in combined orthosis groups, specialist care AFOs significantly reduced net energy cost (by 9.5%) compared to usual care orthoses (from mean (SD) 3.81 (0.97) to 3.45 (0.80) J/kg/m, p = 0.004). CONCLUSION: Guideline-based orthotic care within a multidisciplinary expertise setting could improve treatment outcomes in adults with NMD compared to usual orthotic care by improvements in goal attainment and walking ability. A randomized controlled trial is now warranted to confirm these results. Public Library of Science 2023-01-18 /pmc/articles/PMC9847977/ /pubmed/36652463 http://dx.doi.org/10.1371/journal.pone.0279292 Text en © 2023 van Duijnhoven et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article van Duijnhoven, Elza Koopman, Fieke S. Ploeger, Hilde E. Nollet, Frans Brehm, Merel-Anne Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title | Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title_full | Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title_fullStr | Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title_full_unstemmed | Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title_short | Effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
title_sort | effects of specialist care lower limb orthoses on personal goal attainment and walking ability in adults with neuromuscular disorders |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847977/ https://www.ncbi.nlm.nih.gov/pubmed/36652463 http://dx.doi.org/10.1371/journal.pone.0279292 |
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