REVIEW ARTICLE|Articles in Press

Users’ Perceptions About Lower Extremity Orthotic Devices: A Systematic Review

Published:November 14, 2022DOI:



      To systematically review perceptions from adults, children, and caregivers in scientific and open sources to determine how well lower extremity orthotic devices (LEODs) meet users’ functional, expressive, aesthetic, and accessibility (FEA2) needs.

      Data Sources

      Scientific source searches were conducted in the National Library of Medicine (PubMed/MEDLINE) and Web of Science; open source searches were conducted in Google Search Engine in April 2020.

      Study Selection

      Inclusion criteria were reporting of users’ perceptions about a LEOD, experimental or observational study design, including qualitative studies, and full text in English. Studies were excluded if the device only provided compression or perception data could not be extracted. One hundred seventy three scientific sources of 3440 screened were included (total of 1108 perceptions); 36 open sources of 150 screened were included (total of 508 perceptions).

      Data Extraction

      Users’ perceptions were independently coded by 2 trained, reliable coders.

      Data Synthesis

      Across both source types, there were more perceptions about functional needs, and perceptions were more likely to be positive related to functional than expressive, aesthetic, or accessibility needs. Perceptions about expression, aesthetics, and accessibility were more frequently reported and more negative in open vs scientific sources. Users’ perceptions varied depending on users’ diagnosis and device type.


      There is significant room for improvement in how LEODs meet users’ FEA2 needs, even in the area of function, which is often the primary focus when designing rehabilitation devices. Satisfaction with LEODs may be improved by addressing users’ unmet needs. Individuals often choose not to use prescribed LEODs even when LEODs improve their function. This systematic review identifies needs for LEODs that are most important to users and highlights how well existing LEODs address those needs. Attention to these needs in the design, prescription, and implementation of LEODs may increase device utilization.


      List of abbreviations:

      AFO (ankle-foot orthosis), EA2 (expressive, aesthetic, and accessibility), FEA2 (functional, expressive, aesthetic, and accessibility), HKAFO (hip-knee-ankle-foot orthoses), KAFO (knee-ankle-foot orthoses), LEOD (lower extremity orthotic device), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
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