Examining physiotherapists’ knowledge of and attitudes towards ankle-foot orthoses in the treatment of stroke survivors

Abstract

After a stroke, many people will have impaired mobility. Physiotherapists are central to the rehabilitation of stroke survivors and have a number of options to assist in this rehabilitation, one of which is referral for ankle-foot orthoses. The evidence-base suggests that the use of ankle-foot orthoses on stroke survivor’s gait is positive (NICE. 2012), and they are a valuable tool to assist with functional gait and consequently recovery. However, physiotherapists may be reluctant to refer stroke survivors for ankle-foot orthoses, and by not doing so, and failing to interpret guidelines correctly, may deny the patient a legitimate route of rehabilitation.

The aim of the thesis is to establish whether physiotherapists are hesitant to refer stoke survivors for ankle-foot orthoses, and, if there is a reluctance, whether this is a result of a lack of knowledge or other beliefs.

Three distinct research methods were used to investigate the knowledge and attitudes of physiotherapists. The use of questionnaires, semi-structured interviews and pre and post-training questionnaires with experiential training on ankle-foot orthoses allowed for the collection of wide ranging data. A combination of their knowledge and understanding as expressed in reports of practice and clinical decision making provided the data. The results from all three methods were then analysed in light of existing practice guidelines and to identify common themes.

The lack of knowledge and the beliefs of the physiotherapists combine to contribute to their reluctance to refer stroke survivors for ankle-foot orthoses. The results, from all three methods, show that knowledge is dominated by the importance of swing period gait deviations and not the functionally more debilitating stance period gait deviations. The experiential training was shown to improve their knowledge of when to use ankle-foot orthoses. They reported positive views to use of ankle-foot orthoses and no reluctance regarding biomechanical and neurophysiological factors, but transferred their reluctance to other issues that could not be challenged with the evidence-base.

Integrating orthotists, who are experienced in the use of ankle-foot orthoses, into the rehabilitation of those stroke survivors who have most to benefit from ankle-foot orthoses, could help ensure the option of this legitimate route of rehabilitation.

Date of Award	2016
Original language	English
Awarding Institution	Coventry University
Supervisor	James Shippen (Supervisor) & Louise Moody (Supervisor)