Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review

Published:August 10, 2020DOI:



      We conducted 2 complementary scoping reviews to identify instruments that assess the experience and outcomes of custom ankle-foot orthosis (AFO) care in individuals with neurologic and traumatic conditions and to determine to what extent they might be psychometrically sound for AFO users. A stakeholder advisory committee considered to what extent the identified and psychometrically sound instruments might be feasible for use in developing quality measures for custom AFO users.

      Data Sources

      Both scoping reviews were conducted using PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Systematic Reviews. The following were used for the first scoping review only: Cochrane Central Register of Controlled Trials and the Physiotherapy Evidence Database.

      Study Selection

      The initial scoping review yielded 79 articles with 82 instruments, 16 of which were used in 4 or more studies. The second scoping review yielded 57 articles reporting psychometric properties.

      Data Extraction

      Psychometric properties for populations who use AFOs were summarized for 15 of the 16 instruments. The advisory committee eliminated 2 insrtruments, noted overlap between 4 instruments in terms of the constructs measured, and suggested 6 potential contemporary substitutes.

      Data Synthesis

      Most instruments assessed activity (specifically mobility) and pertained to the National Quality Forum domain of “Health-Related Quality of Life.” The 10-meter walk test, 6-minute walk test, Berg Balance Scale, Timed Up and Go, and Rivermead Mobility Index were reported to have adequate reliability and validity, and were considered feasible for administration in a clinical setting.


      Complementary scoping reviews demonstrated that some instruments with reasonable psychometric properties are available that are feasible to use in developing quality measures for custom AFO care. However, experience of care instruments suitable for this population were not identified but are needed for a comprehensive evaluation of care quality for AFO users.


      List of abbreviations:

      10MWT (10-meter walk test), 2MWT (2-minute walk test), 6MWT (6-minute walk test), AFO (ankle-foot orthosis), BBS (Berg Balance Scale), ICF (International Classification of Functioning, Disability and Health), MAS (Modified Ashworth Scale), MS (multiple sclerosis), NQF (National Quality Forum), OPUS CSD (Orthotic and Prosthetic Users’ Survey Client Satisfaction with Device), QUEST 2.0 (Quebec User Evaluation of Satisfaction with assistive Technology), RMI (Rivermead Mobility Index), SCI (spinal cord injury), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SMFA (Short Musculoskeletal Function Assessment), SIS (Stroke Impact Scale), TBI (traumatic brain injury), TUG (Timed Up and Go)
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