Patient-Centered Measurement of Mobility Outcomes in Lower Limb Orthosis Users
Abstract
Objective: The objective of this project is to improve care for people who use orthotic devices through the advancement of orthotic outcomes assessment. We will conduct three studies in this project to achieve this objective. First, we will survey a very large number of orthosis users using four distinct types of survey instruments that may apply to people who use orthotic devices. We will use results from this study to establish “normative” or reference values for users with different clinical conditions. Normative data help clinicians derive meaning from a survey score and direct the plan of care for their patient. We will also use the data to finalize a novel instrument that we developed explicitly for lower limb orthosis users. This new survey has been created using rigorous, patient-centered methods that we believe will improve its performance relative to other types of surveys. Second, we will assess and compare the reliability and validity of these four mobility instruments in order to determine which are best suited to measuring patients over time. The resulting evidence will help clinicians and researchers choose the most appropriate surveys for various patients and situations. Lastly, we will incorporate these instruments into routine practice at several orthotic clinics across the U.S. and assess their ability to detect clinically meaningful mobility changes in patients receiving new, upgraded, or replacement orthoses. The collective results from these studies will greatly advance our field’s ability to use these survey instruments in clinical care and research. Rationale: People with a lower limb impairment depend on their healthcare providers to evaluate their needs, select for them an appropriate orthosis (or orthoses), and document their clinical outcomes. Patient-reported outcome (PRO) instruments, like those studied in this project, are ideally suited to assessing the impact of an orthotic device in real-world situations. However, more information about how PRO instruments perform relative to one another is needed to select the right survey for an orthosis user, administer it appropriately, and understand the score it produces. At present, such information is largely unavailable because these instruments have not been systematically tested and compared. This lack of information limits clinicians’ abilities to measure outcomes for orthosis users in clinical care and limits researchers’ abilities to assess the effectiveness of new orthotic technologies. The proposed research will directly address this need by rigorously testing four promising instruments, including one we have designed specifically to evaluate the effectiveness of orthotic devices. Applicability and Impact of Research: The proposed research is directly relevant to the care of Service members, Veterans, and civilians who use orthotic devices to enhance their functional capabilities. Improved measurement of mobility for people who use orthoses is needed to guide healthcare decisions, evaluate clinical interventions, and assess novel devices in comparative effectiveness research. Surveys we have previously developed and tested are used by researchers and clinicians worldwide, including those at U.S. Department of Veterans Affairs Hospitals and U.S. Military rehabilitation facilities. We believe that results of this project will be similarly beneficial for the field, and those who use, provide, or study orthotic devices. Patients Who Will Be Helped by This Research: This research has the potential to benefit most or all of those Service members, Veterans, and civilians who use lower limb orthotic devices to enhance their mobility. Clinical Applications, Benefits, and Risks: Instruments to measure mobility from an orthosis user’s perspective are needed so that clinicians might better understand patients’ experiences with their devices in real-world situations, quickly identify problems, and intervene to optimize out
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010258
Entities
People
- Brian J Hafner
Organizations
- United States Army
- University of Washington