{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:18:15Z","timestamp":1791901095268,"version":"4.3.4"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Upper extremity orthoses are commonly used in rehabilitation to reduce pain, improve alignment, and support return to daily activities. These benefits depend on regular and correct use, yet adherence is influenced by personal, environmental, and device-related factors. Although a checklist of adherence-related items has been developed based on clinician expertise, it has never been evaluated by patients. Understanding how patients interpret these items is essential before the checklist can inform development of a patient-reported outcome measure (PROM) to support adherence. The aim of this study was to explore how people with lived experience of upper extremity pain and disability using upper extremity orthoses understand and respond to the items in an adherence checklist, and to identify areas requiring improvement. Cognitive interviews were conducted with adults who had used an upper extremity orthosis to evaluate a clinician-developed adherence checklist. Using a think-aloud approach and follow-up questions, participants described how they interpreted each item and selected responses. Directed content analysis was used to categorize interpretation issues related to clarity, relevance, and reference point. Thirteen participants were interviewed. Most items were interpreted as meaningful and easy to answer. However, several terms were perceived as confusing or overly technical, including \u201ccustomizability,\u201d \u201caesthetics,\u201d and \u201cundue strain.\u201d Interpretation of some items depended on context; for example, \u201cbreathability\u201d varied with weather, and \u201cflexibility\u201d depended on the intended function of the orthosis. \u201cAffordability\u201d was not relevant for many participants, indicating the need for a \u201cNot applicable\u201d response option. When asked about adherence, participants commonly described following instructions rather than a broader, multidimensional concept. Participants valued the intent and content of the items. Cognitive interviewing identified ways to improve wording, add contextual cues, and refine response options to better reflect diverse experiences. These refinements will support development of a patient-centred outcome measure for assessing adherence to upper extremity orthoses.<\/jats:p>","DOI":"10.1371\/journal.pone.0344771","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T17:31:01Z","timestamp":1773855061000},"page":"e0344771","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring patient interpretation of an orthosis adherence checklist: A cognitive interview study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4992-3634","authenticated-orcid":true,"given":"Marjan","family":"Saeedi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy Christine","family":"MacDermid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Johari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Szekeres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"pone.0344771.ref001","volume-title":"Orthotic design and fabrication for the upper extremity: a practical guide","author":"K Schofield","year":"2024"},{"issue":"1","key":"pone.0344771.ref002","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.jht.2021.10.005","article-title":"Utilization of 3D printed orthoses for musculoskeletal conditions of the upper extremity: a systematic review","volume":"36","author":"DA Schwartz","year":"2023","journal-title":"J Hand Ther"},{"issue":"4","key":"pone.0344771.ref003","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/17589983241268069","article-title":"What are the barriers to upper limb splint adherence, and how is adherence measured? 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