What can we learn from Ankle Foot Orthosis users Satisfaction?
Authors: Holtkamp F.  , van Zaalen Y.  
Published: February 2025

The purpose of this study was to answer the question what influences consumer satisfaction and how satisfaction is associated with use or non-use of the Ankle Foot Orthosis (AFO). For this goal an specially designed &ldquo;Design in Orthopaedic Engineering Questionnaire for Usability Evaluation of Orthoses&rdquo; (DOE-quest) was used to answer whether the results of a subjective device evaluation correlates with or rules out the person&apos;s expectations of this device. The questionnaire was sent to 500 AFO users (consumers), randomly selected by choosing an AFO user name every 10 subsequent names from the database of five participating Prosthetics and Orthotics companies, (P&amp;O). The five P&amp;O companies were selected from all over the Netherlands. Descriptive statistics were used to describe the consumer characteristics. Chi-square tests were used to describe the association between safety, durability, ease of use, comfort and effectiveness and variables of process satisfaction (delivery, maintenance, professionalism, delivery follow up, services in general).T- tests were performed to indicate whether variables met the Pareto principle. To determine the strength of linear dependence between satisfaction on the one hand and health related characteristics and AFO use on the other hand, Pearson product-moment correlation coefficients were calculated. In total 123 males and 87 females, a 44% response rate, who have a prescribed AFO for three months or longer completed the questionnaire. The distribution in types of orthosis was in favour of custom made, 85.1% and 14.9% off the shelf. EQ-5D scores (N=190) were between 0 and 1 (M= .71; SD= .22) reflecting a representative group of the whole range of the client population with light to severe health problems. Diagnoses leading to the AFO prescription were widespread. In general, 74.8% of prescribed OD&apos;s were considered satisfactory. Some personal characteristics appeared to be of great importance to AFO satisfaction and use. The delivery process was the only variable that met the 80% Pareto principle on all personal characteristics. In general, orthosis safety and comfort did not meet the Pareto principle of satisfaction. Females were less satisfied on orthosis comfort (p= .0001) and professionalism (p= .012) compared to males. Innovative insights were gained related to off the shelf and custom made orthosis. The numerous additional comments made in the questionnaire indicate that improvements in AFO design and evaluation process start with a better evaluation and check of the fitting and comfort of the AFO. If the fitting and comfort of the AFO is optimal, the use of the AFO can be expected to be highly frequent as well. The results of this study can be used to pinpoint aspects which are important in the design process of OD&apos;s: -Standard AFO evaluation after a week, three months and a year follow up, -More attention in training new prosthetic and orthotic staff regarding the evaluation process in enlarging awareness of the importance in querying the consumer.