Quality of care is fundamental for achieving optimal patient outcomes, enhancing patient experiences, and engaging in improvement practices. Quality of care comprises 6 domains: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Despite robust frameworks guiding quality measurement in other health care fields, orthotics and prosthetics (O&P) rehabilitation lags in adopting these practices. As quality-of-care measures become more prevalent, particularly as the Centers for Medicare and Medicaid Services plans to shift to value-based care by 2030, the urgency to establish measures in O&P increases. Establishing specific evidence-based quality measures in O&P empowers the profession to define appropriate standards, helping to ensure that care remains tailored to patients' needs and produces optimal outcomes-while minimizing the risk of inappropriate, externally imposed benchmarks. Several key groups across the care continuum are highlighted in this article, because they will be responsible for transitioning toward quality-of-care assessment in O&P care: leaders in O&P organizations, researchers, manufacturers, clinic owners, clinicians, patients, and educators. When each group fulfills its responsibilities, it strengthens overall quality and enhances the value of care provided. This special communication highlights the imperative of incorporating quality-of-care measurement into O&P practice across each key group and calls for research to define meaningful measures, establish standardized indicators, and implement systems for quality improvement. This article provides a comprehensive perspective to inform and educate each key group in quality-of-care concepts to foster improvement efforts in O&P.
The first study to compare walking ability, balance and perceived daily functioning of two microprocessor stance-and-swing-phase-controlled knee-ankle-foot orthoses (SSCKAFOs) and a stance-control KAFO (SCKAFO). A 67-year-old man with knee instability due to the late effects of polio, currently using a NEURO TRONIC SCKAFO received two newly fabricated microprocessor-controlled SSCKAFOs: the NEURO HiTRONIC and C-Brace. Measurements taken after 10-weeks of using each SSCKAFO were compared to the SCKAFO baseline measurements. Outcomes included walking speed, walking energy cost, stair and hill descend, balance performance, balance confidence and perceived daily functioning. Compared to the NEURO TRONIC, both SSCKAFOs improved walking speed (NEURO HiTRONIC: +12.5%, C-Brace: +20.2%), walking energy cost (NEURO HiTRONIC: -11.4%, C-Brace: -12.4%), balance confidence (NEURO HiTRONIC: +11, C-Brace: +24 on the Activities Balance Confidence scale) and perceived daily functioning (NEURO HiTRONIC: +10, C-Brace: +14 on the Orthotics and Prosthetics User Survey-Lower Extremity Functional Status. Stair and hill descend improved exclusively with the C-Brace (both +2). Microprocessor-controlled SSCKAFOs showed improved functioning compared to a SCKAFO in a polio survivor with knee instability. Notably, the C-Brace SSCKAFO provided greater and additional benefits compared to the NEURO HiTRONIC SSCKAFO, highlighting its potential to further enhance daily life functioning.
Silicone cosmetic prostheses play a significant role in improving body image and reducing psychosocial issues among individuals with partial hand amputation; however, high weight and insufficient stiffness are their primary limitations. To design a novel silicone cosmetic prosthesis with a lightweight and durable internal structure using 3D printing and to evaluate its impact on user satisfaction and functional ability scores. This pilot semi-experimental pre-post study was conducted between February and September 2024 at a prosthetics and orthotics center in Tehran, on 7 individuals (4 males, 3 females; mean age 27.9 ± 7.6 years) with unilateral partial hand amputation. For each participant, a silicone cosmetic prosthesis with a 3D-printed internal thermoplastic polyurethane (TPU) structure was fabricated. User satisfaction was assessed using the TAPES questionnaire, and functional ability was evaluated using the DASH questionnaire. Prosthesis stiffness was measured using a force-displacement test, and fatigue resistance was assessed through a displacement-controlled cyclic loading test (25 mm) until failure. Outcomes were compared with participants' existing conventional full-silicone prostheses. The results indicated that the TPU prosthesis was lighter than the full-silicone prosthesis (0.200 ± 0.05 vs. 0.29 ± 0.09 kg; p = 0.001), stiffer (81.43 ± 27.07 vs. 27.29 ± 10.83 N; p = 0.028), and more resistant to fatigue in the tested sample (36,500 vs. 13,800 cycles). The mean DASH score was lower for the TPU prosthesis (43.69 ± 11.67 vs. 53.09 ± 11.56; p = 0.012), indicating superior functional ability. Additionally, overall satisfaction (TAPES) and separately measured satisfaction with prosthesis stiffness were higher in the TPU prosthesis. Participants reported longer daily wear time with the TPU prosthesis. In this pilot sample, silicone prostheses incorporating a 3D-printed internal TPU structure demonstrated improved mechanical and functional outcomes compared to conventional full-silicone prostheses. Despite the limitation of small sample size, these preliminary findings highlight the potential value of integrating lightweight and durable materials through 3D printing in the design of cosmetic partial-hand prostheses. Future studies with larger sample sizes are necessary to confirm and generalize these results.
Thermoplastic ankle-foot orthotics (AFOs) effectively manage foot drop but are time-intensive to fabricate, while 3D printing offers a faster, customizable alternative with promising early results. However, broader adoption requires further clinical evidence on biomechanical efficacy and user satisfaction, particularly for novel 3D-printed AFOs. This study compared the biomechanical effects of a 3D-printed ankle-foot orthosis (3D-AFO) with a standard thermoplastic AFO (S-AFO) during walking in individuals with unilateral foot drop and evaluated user satisfaction. Nine participants were assessed while walking barefoot, with S-AFO and 3D-AFO conditions. Gait was analyzed using a three-dimensional optical motion-capture system, and satisfaction was measured using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). The 3D-AFO significantly increased walking speed (0.62 v.s. 0.42 m/s barefoot; p = 0.040) and improved satisfaction regarding device dimensions (p = 0.014) and comfort (p = 0.020). SPM analysis showed both AFOs improved ankle kinematic symmetry during initial and terminal swing phases, with no significant differences at the hip or knee. Overall, the 3D-AFO improves patient satisfaction, walking speed, and ankle kinematics compared to barefoot walking. These results demonstrate that 3D-AFOs are a clinically viable and effective alternative to traditionally made S-AFOs for individuals with unilateral foot drop.
Waiting times for lower limb prosthesis in the public healthcare sector of South Africa can exceed 12-months. A cause of long waiting times is shortage of prosthetic components. However, sometimes prostheses are abandoned. Recycling components from unused prostheses to mitigate the shortage of components has not been studied. This study aimed to determine the reasons for lower limb prosthesis abandonment and to explore the possibility of recovering unused prostheses for component recycling in the public healthcare sector of the Eastern Cape Province, South Africa. A cross-sectional survey was conducted among individuals who had stopped using or had an unused lower limb prosthesis. Participants were recruited using total population sampling from three public hospitals with Orthotics and Prosthetics centres in the Eastern Cape. During routine follow-up (July-August 2025), 92 individuals who had received a lower limb prosthesis between January 2021 and January 2025, or their next of kin where applicable, were contacted. Individuals still using their prosthesis and children (<18 years) were excluded. The remaining 45 non-users or next of kin were invited to participate. A self-developed structured questionnaire was administered via short (10-15 minute) interviews, and data were analyzed descriptively using SPSS (version 31). A total of 43 participants aged 18-77 years (median 54; interquartile range 24), including 54% (n=23) male participants, consented to participate and completed the interviews. Twenty-two participants (51%) reported poorly fitting sockets as the reason for non-use. Forty-two (98%) participants were in favour of recycling components. Forty (93%) of the unused prostheses were modular. The majority were transtibial (81%), followed by transfemoral (12%) and knee disarticulation (7%). The main barrier to recycling identified was damaged components (19%). Thirty-nine (91%) prostheses were recovered from which 190 components can possibly be recycled. The findings extend existing knowledge on prosthesis abandonment and highlight an opportunity to implement component recycling practices to improve access, reduce waiting times, and lower costs in low-resource settings with high prosthetic service demand. The study may have important implications for prosthetic service delivery and policy in the Eastern Cape and South Africa.
The purpose of this study was to examine the relationships between demographic variables, ego-resilience and health-related quality of life (HRQoL) for individuals with upper limb amputations. As HRQoL continues to be an important measure of rehabilitative success, determining universal factors which correlate to and may predict HRQoL becomes more important in the clinical space. A sample of 90 previously administered outcomes from patients at a national upper limb prosthetic provider in the United States were gathered. The outcome measure, the Wellness Inventory, captured patient-reported data to screen for mental health status including ego-resilience, PTSD, depression, coping mechanisms. Scores from the Orthotics and Prosthetics Users' Survey (OPUS) HRQoL as well as the Ego-Resilience Scale (ER89) were utilized in this study, as well as pertinent demographic data. Comparative analyses were conducted on the data gathered. HRQoL and Ego-Resilience scores were analyzed alongside demographic factors: gender (77.8% male), age at time of amputation (mean age 38, SD = 12.9), level of amputation, ethnicity and marital status. Correlational analysis showed positive relationship between ego-resilience and HRQoL (ρ = 0.332, p = .002). Simple linear regression analysis found a significant relationship between ethnicity and HRQoL (β = 4.237, p = .047), and ego-resilience and HRQoL (β = 0.910, p=<.001). The multiple linear regression model identified ego-resilience and ethnicity as predictors for HRQoL (adjusted R² = .129, F = 7.576, p=<.001). Based on the findings in this study, ego-resilience has been identified as a significant predicting factor for HRQoL. Higher ego-resilience score and trait likely will result in higher HRQoL scores. Understanding of how demographic variables, such as ethnicity, may directly or indirectly impact HRQoL can also be beneficial in the recovery process.
Plantar fasciitis (PF) is a common musculoskeletal injury that can occur in adults of all ages and activity levels. This condition accounts for more than 1 million medical visits annually in the United States alone. Despite its name, PF is considered a degenerative condition rather than a primary inflammatory disorder. It is characterized by pain in the medial part of the heel that worsens with weight-bearing activity and prolonged standing. Treatment for PF can be conservative, including stretching complemented by formal physical therapy, NSAIDs, and orthotics. If symptoms have not improved after these options, the use of injectable treatments should be considered. If symptoms persist for more than 6 months, surgical release could be considered as a last resort. Different studies have demonstrated the efficacy and safety of high molecular weight hyaluronic acid (HA) injections in the treatment of patients with PF. The objective of the study was to evaluate the efficacy and safety of treatment with hybrid high-low molecular weight hyaluronic acid (HA) in patients diagnosed with plantar fasciitis through retrospective analysis of medical records. Patient functionality was assessed using the Spanish-validated Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ), and pain level was measured with the Verbal Numeric Rating Scale (VNRS), both before the procedure and after 12 months of post-treatment follow-up, in 10 patients diagnosed with PF who were administered hybrid high-low molecular weight HA (Sinovial HL® 1 ml) through ultrasound-guided injection into the plantar fascia. In all cases, the thickness of the plantar fascia was evaluated by ultrasound before the procedure and at 12 months. A significant reduction in pain assessed by the VNRS was observed when comparing baseline data to values at 12 months post-procedure (P<.001). In all cases, patients reported total absence of pain 12 months after the HA injection. Likewise, a statistically significant reduction in MOXFQ scores was observed between baseline values and those obtained at the 12-month follow-up. The mean scores decreased from 57.2 ± 4.3 points at baseline to 2.5 ± 2.8 points at 12 months, with a median difference of -55 points (IQR: -58.2 to -50.8; P=.002). Regarding the evaluation of ultrasound changes in plantar fascia thickness, the analysis revealed a statistically significant reduction at 12 months after the procedure compared to baseline measurements (median difference: -2.25 mm, IQR: -2.85 to -1.95; P=.002). The body mass index (BMI) was 27.8%, and the predominant gender was male (70%) compared to female (30%). The baseline characteristics of the patients and the results of the tests performed are shown in table 1. Ultrasound-guided infiltration with hyaluronic acid hybrid high-low molecular weight into the plantar fascia in patients with plantar fasciitis or intrafascial fiber rupture is an effective and safe treatment that maintains its positive effects for at least one year after the procedure. The use of ultrasound plays a fundamental role both at the time of infiltration and in the follow-up of the condition.
In individuals with musculoskeletal disorders such as chronic metatarsalgia, foot orthoses (FOs) are frequently prescribed to reduce plantar pressure, improve foot function and alleviate pain. During walking, medially wedged FOs (MWFO + MPs) with a metatarsal pad are more effective than standard FOs (SFOs) in reducing plantar pressure under the metatarsal heads. As stair ambulation involves higher physical demands than walking and modifies plantar loading, we questioned whether FOs remain effective during more challenging tasks. This study aimed to determine whether MWFO + MPs reduce peak plantar pressure under the metatarsal heads compared to SFOs during stair ambulation in individuals with chronic metatarsalgia. A secondary objective was to examine the effects of these FOs on lower limb 3D joint angles and moments. Twenty-two individuals (16 females and 6 males) with chronic metatarsalgia were recruited to participate in this cross-sectional descriptive study. Participants ascended and descended stairs under three conditions: (1) Shoe-only, (2) SFOs, and (3) MWFO + MPs. Peak plantar pressure, midfoot, ankle, knee, hip angles and moments were compared across conditions using repeated-measures ANOVAs and statistical parametric mapping. Both FOs reduced plantar pressure under the metatarsal heads and heel compared to shoe-only during stair ambulation. MWFO + MPs increased plantar pressure under the medial midfoot, decreased midfoot dorsiflexion, ankle plantarflexion angles compared to shoe-only. MWFO + MPs were more effective than SFOs in reducing peak plantar pressure under the 1st metatarsal head and modifying lower limb joint angles and moments. These findings extend the known biomechanical benefits of FOs in individuals with chronic metatarsalgia during more demanding tasks.
To evaluate trajectories and predictors of function and health-related quality of life (HRQL) in the 5 years following pediatric major trauma. While increasing proportions of children survive major trauma, largely trauma center-based, 1- to 2-year follow-up studies yield conflicting evidence regarding their long-term outcomes. This population-based prospective 5-year follow-up study was designed to recruit all consecutive pediatric (<18 years) major trauma patients registered in Australia's Victorian State Trauma Registry over a 12-month period. At 6, 12, 24, 36, 48, and 60 months postinjury, parents were interviewed to obtain children's function and HRQL using King's Outcome Scale for Childhood Head Injury and Pediatric Quality of Life Inventory (PedsQL), respectively. Multivariable regression models were used to investigate the associations between 5-year outcomes and potential predictors. Of 199 eligible patients, 5 years of follow-up data were available for 132 of 186 (71%) survivors. Children's function and HRQL improved throughout the follow-up period. At 5 years postinjury: 39% had fully recovered, while 39% experienced moderate to severe disability. The mean PedsQL physical score (89.0; SD:18.6) approximated population norms, while the psychosocial score was significantly lower (85.5; SD:16.9). Adverse outcomes were associated with older age, female sex, lower socioeconomic status, residence outside metropolitan areas, preexisting comorbidities, and injuries deemed intentional, compensable, or head trauma. A high proportion of children surviving major trauma experience moderate to severe long-term disability, with psychosocial HRQL lagging recovery of physical function. Prognostic factors are identifiable during acute admission, providing opportunities to develop clinical prediction rules and tailored interventions that mitigate inequitable risks of adverse outcomes.
Pelvic alignment plays a central role in maintaining postural stability, and asymmetries in pelvic orientation may alter plantar pressure distribution. In adolescents with idiopathic scoliosis (AIS), compensatory adaptations of the pelvis and lower limbs may contribute to imbalance and asymmetrical weight bearing. The aim of this study is to investigate the association between pelvic torsion, rotation, and tilt with static and dynamic plantar pressure asymmetries in adolescents with idiopathic scoliosis. This study included 60 adolescents with AIS aged 10-18 years. Pelvic parameters were obtained using the DIERS Formetric 4D surface topography system, and static and dynamic plantar pressure distributions were measured with the GaitScan system. Side-to-side differences in forefoot and rearfoot loading were compared using paired t-tests, and correlations between pelvic parameters and plantar pressure asymmetries were analyzed with Spearman's Correlation test (p < 0.05). Significant plantar pressure differences were found between the convex and concave side of curve. Forefoot loading was lower on the convex side (28.8% vs. 33.9%), whereas rearfoot loading was higher (71.6% vs. 66.6%, exact p = 0.002, effect size r = 0.48). Dynamic loading also favored the convex side (55.4% vs. 45.6%, exact p < 0.001, effect size r = 0.61). Correlations between pelvic torsion, rotation, and tilt with pressure asymmetries were weak and not significant. Adolescents with idiopathic scoliosis exhibit marked plantar pressure asymmetries, particularly under dynamic conditions.
This study quantified the ability of static three-dimensional foot geometry and sparse plantar pressure landmarks to reconstruct stance-phase plantar pressure distributions. Thirty-five healthy adults underwent 3D plantar scanning and dynamic pressure measurements during level walking. Two landmark configurations were defined: 16 sensors covering primary load-bearing zones and a reduced 2-sensor core set at the heel and third metatarsal head. A convolutional block attention module U-Net model was trained using 5-fold cross-validation to map the 3D foot image and landmark mask to pressure maps. Model accuracy was assessed by comparing predicted and measured vertical ground reaction force, peak plantar pressure, and centre of pressure trajectories. The 16-landmark configuration achieved 97.1 % vertical ground reaction force accuracy, 98.2 % peak-pressure accuracy, and 0.8 cm mean centre of pressure error; the 2-landmark configuration achieved 95.5 %, 98.9 %, and 1.3 cm, respectively. Errors were confined to regions within approximately 4 × 4 cm of each landmark. The results indicate that foot geometry combined with sparse anatomical landmarks provides sufficient boundary information to reconstruct biomechanically consistent pressure fields, enabling reduced-sensor insole designs for gait analysis and orthotic assessment.
Temporomandibular disorders (TMDs) comprise a heterogeneous group of conditions affecting the temporomandibular joints, masticatory muscles, and associated structures. Occlusal splint therapy remains one of the most prescribed conservative interventions for the management of TMD. However, considerable debate persists regarding its mechanism of action, clinical indications, and comparative effectiveness relative to other conservative management strategies. This article provides an overview of splint therapy in the management of TMD, focusing on stabilisation splints, anterior repositioning splints, and Nociceptive Trigeminal Inhibition Tension Suppression System (NTI-tss) appliances.
Chronic non-specific low back pain (CLBP) is a common and disabling condition. Lumbosacral orthoses are used in conservative care, but their clinical benefit remains unclear. This systematic review evaluated the clinical effectiveness of lumbosacral orthoses in adults with CLBP. A search was conducted in PubMed, Scopus, Ovid, PEDro, and Web of Science up to July 2025. Randomized controlled trials (RCTs) investigating lumbar or lumbosacral orthoses in adults with CLBP were included. Methodological quality was assessed using the PEDro scale, and the level of evidence was classified descriptively using the Oxford Centre for Evidence-Based Medicine framework. The review followed the PRISMA 2020 guidelines. Eleven RCTs involving 691 participants were included. The studies used different types of lumbosacral orthoses, including rigid, semi-rigid, soft, extensible, and inextensible designs. Intervention duration ranged from a single session to 12 months. Several studies reported improvements in pain or disability after lumbosacral orthosis use, especially in short-term intervention periods. The findings were not consistent across studies, and meta-analysis was not possible because of methodological heterogeneity. No study reported orthosis-induced muscle atrophy, but adverse effects, adherence, and patient tolerance were not consistently assessed. Objective neuromuscular outcomes and psychosocial measures were also limited. Current evidence suggests that lumbosacral orthoses may be helpful for selected individuals with CLBP, especially when used as part of multimodal rehabilitation. Further high-quality RCTs with standardized protocols and longer follow-up are needed.
Prescription of prosthetic ankle-foot devices is constrained by imprecise clinical guidelines and inconsistent scientific evidence, hindering optimal device selection for individuals with lower limb loss. This multisite, prospective, randomized crossover study aimed to identify patient-reported, performance-based, and biomechanical parameters sensitive to ankle-foot device type, providing a foundation for more objective and individualized prescription practices. Ninety-one individuals with unilateral transtibial limb loss completed the crossover trial, and 13 control participants without musculoskeletal impairment were enrolled to provide normative reference data. Participants were fitted with duplicate sockets and randomized to trial three ankle-foot device types: energy storing and returning, articulating, and powered. Participants were heterogeneous in demographic characteristics, including veterans, service members, and civilians. After one week of acclimation per device, participants completed performance-based (6-minute walk, Timed Up and Go, Four Square Step Test, Stair and Hill Assessment Indices, Amputee Mobility Predictor) and patient-reported (Prosthesis Evaluation Questionnaire, 12-Item Short Form Health Survey, Orthotics and Prosthetics Users' Survey) assessments; a subset (n = 29 completed) underwent full-body gait analysis to capture detailed biomechanical parameters. Biomechanical outcomes demonstrated the greatest sensitivity to device type, with 19 distinct parameters, primarily at the ankle, highlighting ankle mechanics as a key determinant of differences among prosthetic devices. Five Prosthesis Evaluation Questionnaire subscales were sensitive to device type, while performance-based measures showed no significant effects. Results revealed a dichotomy between biomechanical and patient-reported outcomes: Biomechanical parameters were more similar to control values for powered devices, whereas patient-reported outcomes favored non-powered devices. Linear discriminant analysis identified key gait features, including peak plantarflexion during preswing and peak ankle moment, which most strongly contributed to group separation and clinical discrimination. These findings identified distinct biomechanical and patient-reported parameters sensitive to ankle-foot device type and highlight the need for evidence-based, individualized prosthetic prescription to optimize device selection and improve patient outcomes.
暂无摘要（点击查看详情）
This study evaluated the compliance and effectiveness of individual exercise (IE) and group exercise (GE) in patients with adolescent idiopathic scoliosis (AIS) undergoing orthotic treatment. Forty patients with moderate AIS were randomized to IE (one-to-one supervision) or GE (3-4 patients per physiotherapist). Both followed the same orthotic protocol during a one-month adaptation period, six-month supervised exercise, and six-month follow-up. Outcomes included spinal deformity, compliance (self-report, digital-record), and quality of life (QoL). Baseline Cobb angles were 28.0±4.5° for IE and 27.2±4.3° for GE (P=0.546). Both groups had a similar curve type distribution: 10 thoracic, 4 thoracolumbar, and 6 lumbar curves. At the end of the study, the GE group showed a significantly smaller out-of-orthosis Cobb angle than the IE group (23.0±12.3° vs. 30.5±10.1°, P=0.041). Both groups showed higher compliance with exercise and orthosis wear during the supervision period than during follow-up. Patients in the GE group reported significantly better self-esteem (P=0.004) and emotional well-being (P=0.011) than those in the IE group. A supervised GE regimen was associated with better compliance, improved spinal deformity control, and enhanced psychosocial well‑being. Further research is warranted to confirm these benefits in larger cohorts and in the longer term.
暂无摘要（点击查看详情）
Orthotic management alone or with hand therapy (+HT) are cornerstones of nonoperative management for thumb carpometacarpal osteoarthritis, yet comparative data are scarce. To compare outcomes over the course of 12 months for orthotic management alone vs +HT for patients with thumb carpometacarpal arthritis. Prospective observational. We identified patients from our ongoing prospective nonoperative carpometacarpal osteoarthritis registry who elected for treatment with orthotic management alone or +HT from 2019-2023. We collected baseline and 1-, 2-, 6-, and 12-month surveys as well as patient-reported outcome measures. We used bivariate mixed-effect regression analyses to compare continuous variables between groups. A total of 25 orthotic management alone and +41 HT patients were identified. The +HT group had significant improvements in brief Michigan Hand Questionnaire (bMHQ) scores from baseline (mean 67 [SD 12]) at 1 and 2 months (53[5] and 51[8], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (56[2]) at 1 and 2 months (51[6] and 51[5], respectively). The orthotic management alone group had significant improvements in bMHQ scores from baseline (mean 63 [SD 15]) at 2 and 6 months (52[10] and 48[9], respectively), and for Patient-Reported Outcomes Measurement Information System Pain Interference scores from baseline (57[5]) at 2 and 6 months (51[9] and 50[8], respectively). Approximately 12% of patients in both groups received a corticosteroid injection by 12 months. Patients choosing +HT for initial management of their thumb carpometacarpal arthritis had some earlier benefits than those choosing orthotic management alone. Relatively few patients choosing either of these approaches progressed to corticosteroid injections within 12 months of initiating care. We need larger cohorts with better retention to improve comparisons of carpometacarpal osteoarthritis nonoperative care options.
Orthotic management of lateral epicondylitis remains suboptimal in working patients. Limited symptom relief and poor adherence to brace use during work are the key practical limitations. Therefore, the Dynamic Orthosis for Lateral Epicondylitis (DOLE) was developed for practical use at work. This study aimed to evaluate the work-related effectiveness of DOLE. We compared DOLE with conventional bracing (cock-up wrist splint and counterforce brace) in improving work-related function and pain. This retrospective cohort comparison treatment study enrolled employed patients with lateral epicondylitis at a single center. Patients received either conventional bracing (a cock-up wrist splint worn together with a counterforce brace; C group) or DOLE (D group) after its introduction. The primary outcomes were work-related function (Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] work module) and pain during work (visual analog scale) at 3 and 6 months. Outcomes were compared between groups using analysis of covariance with adjustment for the corresponding baseline value. In addition, at-work brace use was assessed using a questionnaire at 3 months. Thirty-five patients were included in this study (C group, n = 18; D group, n = 17). At 3 months, at-work use was rare for the cock-up splint (1/18) but common for the counterforce brace (18/18) in the C group. Conversely, 15 of 17 patients in the D group reported wearing DOLE during work. Baseline-adjusted analyses showed significantly better primary outcomes in the D group than in the C group at both 3 and 6 months. At 6 months, the baseline-adjusted between-group differences (D - C) were -23.6 (95% confidence interval, -40.0 to -7.2) for the QuickDASH work module and -23.0 mm (95% confidence interval, -35.0 to -10.9) for work pain on the visual analog scale. In working patients with lateral epicondylitis, DOLE use was associated with clinically meaningful improvements in the QuickDASH work module and work-related pain compared with conventional bracing. These findings suggest that DOLE may be a feasible work-compatible orthotic option and provide a rationale for larger prospective randomized studies.
Gait patterns in children with myelomeningocele (MMC) at various neurological levels have been described, both with and without orthotic support. Although the neurological level of the lesion serves as an important predictor of ambulatory potential, the expected walking ability is not always achieved, as additional factors such as spasticity may influence gait negatively. The aim of this study was to retrospectively compare gait patterns as assessed in childhood with those observed in adulthood. Of 59 individuals with MMC aged 18 years or older, 29 had undergone three-dimensional gait analysis in childhood (Ch-GA). These data were retrospectively analysed and compared with findings from a subsequent adult gait analysis (Ad-GA). The mean (standard deviation) age at the time of Ch-GA was 11.6 (4.1) years and at Ad-GA 25.9 (3.9) years. The median (range) interval between assessments was 15.0 years (5.1-17.2). Twenty-two participants maintained independent, non-assisted walking (Group A), 5 had transitioned from independent walking to using a walking aid (Group B), and 2 used a walking aid at both Ch-GA and Ad-GA (Group C), with individualized orthotic prescriptions provided at both time points. In Group A, two of eleven kinematic variables and six of eleven kinetic variables in the hip, knee, and ankle showed deterioration, and walking speed had decreased. Functional ambulation declined from 18 community ambulators and 4 household ambulators (Ha) in childhood to 8 and 14, respectively, in adulthood. In Group B, analysed with only Gait Deviation Index (GDI), values were unchanged, but all temporospatial gait parameters had deteriorated. Functional ambulation decreased from five individuals classified as Ha to two Ha and three non-functional ambulators. The two individuals in Group C, who used a walker at both assessments, largely maintained the same GDI values and temporospatial parameters as in childhood. Largely consistent with our original expectations, the findings indicate that gait patterns remain relatively stable from childhood to adulthood in individuals with MMC when supported by appropriate rehabilitation interventions, though some deterioration of gait and ambulation occurred. The results reflect gait-related changes that can be expected during growth in this population.