Exploring the rationale for prescribing ankle-foot orthoses and supramalleolar orthoses to children with cerebral palsy among pediatric orthotists in Australia.

Abstract

To explore the rationale for prescribing ankle-foot orthoses and supramalleolar orthoses in children with cerebral palsy among pediatric orthotists in Australia. Purposive, convenience, and snowballing sampling were used to recruit pediatric orthotists across Australia. Semistructured interviews were recorded and transcribed. The data were independently coded to derive themes and subthemes with illustrative first-person quotes. Participants (n = 16) in the sample were diverse in their age, years of clinical experience, and state of residence reflecting the breadth of pediatric orthotists in Australia. Two themes were generated: rationale for orthotic prescription and alignment of prescription rationale with child/family goals. Experienced clinicians could clearly articulate the key factors that influence their orthotic prescription aligned to the reasons why children/families sought orthotic intervention. Early to mid-career clinicians found this more challenging. The rationale for the orthotic prescription should be aligned with the child/family's treatment goals. With a clear focus on treatment goals, the rationale for prescribing either ankle-foot orthoses or supramalleolar orthoses could be clearer if clinicians focused on key primary factors (eg, presence of crouch gait) and then optimized the prescription using a range of secondary factors (eg, body mass).