The International Society for Prosthetics and Orthotics Canada

Interviewees: 

David Marcotte PT MSc, Lethbridge-Layton-Mackay Rehabilitation Centre

Richard Preuss PT PhD, School of Physical and Occupational Therapy, McGill University

Article: Barriers and facilitators to lower extremity orthotic compliance in the pediatric population: A scoping review of the literature

David Marcotte, Erica Ferri, Xiaotong Xue, Anastasia Katsolis, Elise Rajotte, Katrina Cardiff 

School of Physical and Occupation Therapy, McGill University

Lethbridge-Layton-Mackay Rehabilitation Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR)

Key Takeaways

• Many factors can influence a child’s compliance with their orthotic device
• Parental beliefs and perceptions were found to be an important factor affecting orthotic compliance
• Appearance, comfort and function of the device are important considerations when designing and fabricating an orthosis
• Communication between the clinician and other healthcare providers as well as with the child and caregiver is important throughout the treatment process
• Many barriers found were linked to financial constraints and access to high quality care, which is an even greater concern in lower-income settings

Please tell us about your lab, your team, and your research interests.

This was a student-led project, done as a requirement of the Master of Science (Applied) in Physical Therapy programs at McGill University.  The group that conducted this research comprised of students (including DM), a supervising faculty member (RP), and two physiotherapists from the Lethbridge-Layton-Mackay rehabilitation Centre (ER & KC).  The idea for this project was put forth by the two physiotherapists who worked with many children who have prosthetic and orthotic needs.  

What are you working on right now that you are most excited about? 

Because this research was done as a program requirement and not through a research lab this scoping review has been the only published research on the topic from our group. 

Transportation was found to be a barrier to orthotic compliance.  One possible way to mitigate this factor is by having clinics partner with schools where clinicians can then provide on-site visits with the children.  This not only allows any potential issues with the orthosis to be addressed quickly, but it also takes some of the burden off of caregivers to frequently bring their children to many appointments during the treatment process.  The success of this collaboration has been seen firsthand at the school where David works as a physiotherapist, such that the out-patient clinic he works at has implemented a similar partnership.

What are next steps based on your research? How can we integrate your findings into clinical practice?

Many of the articles covered in the scoping review focused on foot abduction orthoses and clubfoot, which highlights the need for more research to be done focusing on other types of orthoses, other pathologies or conditions, and older children to gain a better understanding of how device design, appearance and functionality impact use and compliance.  Additionally, research surrounding interventions designed to increase compliance in the aforementioned groups could be beneficial for clinical practice.

Involving the child in the design process is something that can easily be done during the treatment process and is something that we found to increase compliance.  When the child has a say in the pattern or colour of their device, they get excited to see the final device and wear it, and we have seen firsthand that this small step can increase compliance.  Additionally, relating the benefits of the device to an activity that the child enjoys participating in can help lead to increased device compliance.

Because transportation was found to be such a critical barrier to orthotic compliance, the value of schools or rehabilitation settings partnering with prosthetic and orthotic clinicians cannot be overstated.  This has been shown to reduce some of the impact transportation difficulties have on orthotic compliance in the pediatric population in real-world settings.

The importance of communication from a clinical standpoint cannot be overstated, especially with multidisciplinary teams.  Poor communication was often listed as a barrier to compliance in many of the articles reviewed for this article, so finding ways to obtain feedback with regards to how satisfied children and families were with the treatment process and areas for improvement can provide valuable information to clinicians.

Lastly, the stigma surrounding assistive device use must be addressed.  Normalizing their use by seeing peers or adults is one way to show children that using an orthotic or prosthetic is nothing to be ashamed of.