Friday, 9 May 2014

Dropped foot: AFOs and FES

Do you have a dropped foot? Do you need a FES or AFO? They really make a difference. #MSBlog #MSResearch

"The abstract below describing qualitative research outcomes for MSers using functional electrical stimulation (FES) or ankle foot orthoses (AFOs) is quite a mouthful. The jargon used is very different to what we are used in the scientific and clinical fields. The bottom line is that if you have a dropped foot from weakness FES and/or AFOs make a difference they reduce fatigue, improved gait, reduce trips and falls, increase participation, and increase confidence; greater balance/stability is reported for AFOs, and increased walking distance, fitness and physical activity for FES. These results fit with my clinical experience and make a huge difference to your quality of life. Falls and fractures are a big problem for MSers with gait problems; anything that reduces this risk is worth exploring."

"Please note that these devices also help if your foot drop is intermittent, i.e. only happens when you get tired."

"Despite the benefits of FES access to  this treatment is patchy in the UK with many local commissioners not covering the cost. This is why it is important for organisations such as the MS Society and the European MS Platform (EMSP) to lobby healthcare providers in the UK and Europe to increase the access of MSers to treatments that improve the quality of their life. I am on my way to the EMSP Spring Conference in Dublin to help launch the new code of Good Practice, which tries to address health inequalities for MSers across Europe."


  

Abstract Purpose: A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from MS. 

Method: Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n = 12) and (b) compared habitual use of AFO (n = 7) or FES (n = 6). Two focus groups addressed AFO (n = 4) and FES (n = 6) experiences. 

Results: Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives. 

Conclusions: Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy. Implications for Rehabilitation Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES). Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n = 4) and FES (n = 6) on people with foot-drop from MS. Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use. On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.

2 comments:

  1. I hope you'll emphasise the fact that the MS postcode lottery applies equally to the type of orthotics offered. I'm one of the lucky ones - I was offered a sprung, carbon-fibre Dynamic Walk orthotic which stops hyperextension of the knee and greatly reduces footdrop. My friend has a SAFO, a tailor-made, silicon foot support..... both devices are a million miles away from the standard AFO. Another friend (who uses the local orthotics service) has been told that there is no alternative to the clumsy, fixed device. And our PCT has never paid for FES....

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  2. I have serious foot drop. I use a MUSmate (google it) and have recently started to use an AFO. The AFO does give me more confidence because my ankle is stable and significant reduction in hyperextension of the knee. I still need to use a rollator but I can walk much further and I am more confident. I have far fewer falls but lack of flexibility in the ankle does make it more difficult to stand up again It is vital that sole of AFO has padding to support instep and toes. An AFO has been a big success for me

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