Improving ankle-foot orthosis design can best be done by implementing a user-centered approach.
To provide insight into the ideas of ankle-foot orthosis users with flaccid ankle muscle paresis on the importance of activities and suggestions for an improved ankle-foot orthosis design.
A focus-group discussion with eight ankle-foot orthosis users (57 ± 5 years, 50% female).
Main inclusion criteria were as follows: ⩾18 years, unable to stand on tip-toe and unable to lift toes. Main exclusion criterion was spasticity of lower extremity muscles. Transcribed data were coded according to the International Classification of Functioning, Disability and Health. Thematic analysis with inductive approach was chosen to order and interpret codes.
Ankle-foot orthosis users ranked walking the most important activity followed by sitting down/standing up from a chair. Their opinion was that ankle-foot orthoses facilitate walking and standing. Ankle-foot orthosis users suggested that an improved ankle-foot orthosis design should balance between stability and flexibility.
Current ankle-foot orthoses facilitate walking which was the most important activity according to ankle-foot orthosis users. An improved ankle-foot orthosis design should enable walking and should optimize between stability and flexibility dependent on the activity and the paresis severity.
Experienced users of ankle-foot orthosis agreed that matching ankle-foot orthosis functions to daily-life activities is a trade-off between stability and flexibility. An improved ankle-foot orthosis design should at least enable level walking.
People with flaccid ankle muscle paresis generally experience problems during walking due to reduced dorsiflexion strength (needed for clearance and controlled plantarflexion during loading response) and/or plantarflexion strength (needed for push-off).1 To improve functioning, an ankle-foot orthosis (AFO) can be prescribed.2 The function of an AFO determines what it must do.3 For people with flaccid paresis, the main AFO function is to compensate for muscle weakness, while for people with spastic paresis, this function is to re-align the joint.2 Due to these function differences, different AFOs can be used depending on the paresis, and therefore, these paresis types should be evaluated separately.
AFOs prescribed for people with flaccid ankle muscle paresis can improve walking.4 However, using an AFO can also come with disadvantages.4 Dorsal AFOs, for example, limit ankle range of motion (ROM).4 This can hamper activities that require a large ankle ROM such as slope walking.5 Improving AFO design can be done best by implementing a user-driven design process as the factors that are most important to users will be taken into account.6 User-driven design is more and more applied in product design to improve acceptance of an innovation by the user.7 In this case, when an AFO fits the needs of users better, adherence to using AFOs can improve.8,9Especially, a qualitative study design can reveal the most important factors since AFO users are not limited by pre-specified questions as is usually the case in quantitative study designs.10 More specifically, a focus-group discussion allowing users to interact is likely to reveal common issues.11 We found one study that evaluated experiences with AFOs.9 However, as they included people with spastic paresis, findings may not be applicable to people with flaccid paresis.
The aim of this explorative study was to provide insight into the ideas of AFO users with flaccid ankle muscle paresis, on the importance of activities and suggestions for an improved AFO design. Providing insight into the importance of activities requires ranking activities according to importance and exploring experiences with these activities.