{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T16:18:24Z","timestamp":1780589904780,"version":"3.54.1"},"reference-count":84,"publisher":"National Institute for Health and Care Research","issue":"55","license":[{"start":{"date-parts":[[2016,7,1]],"date-time":"2016-07-01T00:00:00Z","timestamp":1467331200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["13\/30\/02"],"award-info":[{"award-number":["13\/30\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"Background<\/jats:title>Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee\u2013ankle\u2013foot orthoses (KAFOs).<\/jats:p><\/jats:sec>Objectives<\/jats:title>To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.<\/jats:p><\/jats:sec>Methods<\/jats:title>Qualitative study of views of orthoses users \u2013 a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review \u2013 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis \u2013 a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>Qualitative study \u2013 a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients\u2019 prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review \u2013 a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis \u2013 in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from \u00a373 to \u00a33553.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Various types of orthoses are used in the NHS to manage patients with NMD\/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users.<\/jats:p><\/jats:sec>Limitations<\/jats:title>The population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs.<\/jats:p><\/jats:sec>Future work<\/jats:title>Future work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery.<\/jats:p><\/jats:sec>Study registration<\/jats:title>This study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228.<\/jats:p><\/jats:sec>Funding<\/jats:title>The National Institute for Health Research Health Technology Assessment programme.<\/jats:p><\/jats:sec>","DOI":"10.3310\/hta20550","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T10:52:13Z","timestamp":1470048733000},"page":"1-262","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis"],"prefix":"10.3310","volume":"20","clinical-trial-number":[{"clinical-trial-number":"isrctn65240228","registry":"10.18810\/isrctn","type":"results"}],"author":[{"given":"Joanne","family":"O\u2019Connor","sequence":"first","affiliation":[{"name":"Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorothy","family":"McCaughan","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catriona","family":"McDaid","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Booth","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Fayter","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roccio","family":"Rodriguez-Lopez","sequence":"additional","affiliation":[{"name":"Centre for Reviews and Dissemination, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Bowers","sequence":"additional","affiliation":[{"name":"Biomedical Engineering, University of Strathclyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Dyson","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia P","family":"Iglesias","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Lalor","sequence":"additional","affiliation":[{"name":"Queen Mary\u2019s Hospital, St George\u2019s University Hospitals NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory J","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Phillips","sequence":"additional","affiliation":[{"name":"Royal Derby Hospital, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gita","family":"Ramdharry","sequence":"additional","affiliation":[{"name":"Kingston University and St George\u2019s University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2016,7]]},"reference":[{"key":"key20160729154029841_ref1-bib1","doi-asserted-by":"crossref","DOI":"10.1093\/med\/9780199580354.001.0001","volume-title":"Neuromuscular Disorders in the Adult","author":"Hilton-Jones","year":"2011"},{"key":"key20160729154029841_ref1-bib2","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1097\/00008526-200606001-00004","article-title":"Ambulatory KAFOs: a physiatry perspective","volume":"18","author":"Hebert","year":"2006","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib3","volume-title":"Orthotics: A Comprehensive Clinical Approach","author":"Edelstein","year":"2002"},{"key":"key20160729154029841_ref1-bib4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1097\/00008526-200606001-00003","article-title":"A review of the literature pertaining to KAFOs and HKAFOs for ambulation","volume":"18","author":"Fatone","year":"2006","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib5","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1097\/00008526-200606001-00011","article-title":"Linked hip-knee-ankle-foot orthoses designed for reciprocal gait","volume":"18","author":"Campbell","year":"2006","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib6","volume-title":"Use of Ankle Foot Orthoses Following Stroke. Best Practice Statement","author":"NHS Quality Improvement Scotland","year":"2009"},{"key":"key20160729154029841_ref1-bib7","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/00008526-200606001-00007","article-title":"KAFOs for ambulation: an orthotist\u2019s perspective","volume":"18","author":"Michael","year":"2006","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib8","volume-title":"Medical Devices: Legal Requirements for Specific Medical Products","author":"Medicine and Healthcare products Regulatory Agency","year":"2014"},{"key":"key20160729154029841_ref1-bib9","volume-title":"Custom-made Medical Devices","author":"Medicines and Healthcare products Regulatory Agency","year":"2013"},{"key":"key20160729154029841_ref1-bib10","volume-title":"Orthotic Service in the NHS: Improving Service Provision","author":"Hutton","year":"2009"},{"key":"key20160729154029841_ref1-bib11","volume-title":"Fully Equipped: The Provision of Equipment to Older or Disabled People by the NHS and Social Services in England and Wales","author":"Audit Commission","year":"2000"},{"key":"key20160729154029841_ref1-bib12","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.nmd.2005.11.011","article-title":"Service provision for adults with long-term disability: a review of services for adults with chronic neuromuscular conditions in the United Kingdom","volume":"16","author":"Hill","year":"2006","journal-title":"Neuromuscul Disord"},{"key":"key20160729154029841_ref1-bib13","doi-asserted-by":"publisher","first-page":"491","DOI":"10.3109\/17483107.2010.549899","article-title":"Ankle foot orthoses for people with Charcot Marie Tooth disease: views of users and orthotists on important aspects of use","volume":"6","author":"Phillips","year":"2011","journal-title":"Disabil Rehabil Assist Technol"},{"key":"key20160729154029841_ref1-bib14","first-page":"27","article-title":"Poor compliance with ankle-foot-orthoses in Charcot-Marie-Tooth disease","volume":"44","author":"Vinci","year":"2008","journal-title":"Eur J Phys Rehabil Med"},{"key":"key20160729154029841_ref1-bib15","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1002\/pri.531","article-title":"Comparing gait performance of people with Charcot-Marie-Tooth disease who do and do not wear ankle foot orthoses","volume":"17","author":"Ramdharry","year":"2012","journal-title":"Physiother Res Int"},{"key":"key20160729154029841_ref1-bib16","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.ejpn.2006.07.002","article-title":"Knee-ankle-foot orthosis in children with Duchenne muscular dystrophy: user views and adjustment","volume":"10","author":"Garralda","year":"2006","journal-title":"Eur J Paediatr Neurol"},{"key":"key20160729154029841_ref1-bib17","doi-asserted-by":"publisher","first-page":"437","DOI":"10.3109\/17483107.2012.680940","article-title":"Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research","volume":"7","author":"Chisholm","year":"2012","journal-title":"Disability"},{"key":"key20160729154029841_ref1-bib18","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1097\/JPO.0b013e3181e98c82","article-title":"Usage follow-up after a knee-ankle-foot orthoses selection and training program in spinal cord injury patients","volume":"22","author":"Gatti","year":"2010","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib19","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1097\/00008526-200606001-00006","article-title":"Ambulatory KAFOs: a physical therapist\u2019s perspective","volume":"7","author":"Edelstein","year":"2006","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib20","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.rehab.2009.11.005","article-title":"Orthotic devices and gait in polio patients","volume":"53","author":"Genet","year":"2010","journal-title":"Ann Phys Rehabil Med"},{"key":"key20160729154029841_ref1-bib21","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1177\/0269215513486497","article-title":"A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke","volume":"27","author":"Tyson","year":"2013","journal-title":"Clin Rehabil"},{"key":"key20160729154029841_ref1-bib22","doi-asserted-by":"publisher","first-page":"CD006052","DOI":"10.1002\/14651858.cd006052.pub2","article-title":"Treatment for Charcot-Marie-Tooth disease","volume":"1","author":"Young","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"key20160729154029841_ref1-bib23","first-page":"437","article-title":"The effectiveness of non-surgical interventions in the treatment of Charcot foot","volume":"5","author":"Smith","year":"2007","journal-title":"Int J Evid Based Healthc"},{"key":"key20160729154029841_ref1-bib24","doi-asserted-by":"publisher","first-page":"CD006973","DOI":"10.1002\/14651858.cd006973.pub2","article-title":"Interventions for increasing ankle range of motion in patients with neuromuscular disease","volume":"2","author":"Rose","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"key20160729154029841_ref1-bib25","doi-asserted-by":"publisher","first-page":"CD003908","DOI":"10.1002\/14651858.cd003908.pub3","article-title":"Rehabilitation interventions for foot drop in neuromuscular disease","volume":"3","author":"Sackley","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"key20160729154029841_ref1-bib26","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/JPO.0b013e3182435db3","article-title":"Clinical benefits of stance control orthosis systems: an analysis of the scientific literature","volume":"24","author":"Zacharias","year":"2012","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib27","volume-title":"CRD\u2019s Guidance for Undertaking Reviews in Health Care","author":"Center for Reviews and Dissemination (CRD)","year":"2009"},{"key":"key20160729154029841_ref1-bib28","doi-asserted-by":"publisher","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"key20160729154029841_ref1-bib29","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2011"},{"key":"key20160729154029841_ref1-bib30","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1002\/jrsm.1064","article-title":"Issues relating to confounding and meta-analysis when including non-randomised studies in systematic reviews of the effects of interventions","volume":"4","author":"Valentine","year":"2013","journal-title":"Res Synth Methods"},{"key":"key20160729154029841_ref1-bib31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1002\/jrsm.1056","article-title":"Issues relating to study design and risk of bias when including non-randomised studies in systematic reviews on the effects of interventions","volume":"4","author":"Higgins","year":"2013","journal-title":"Res Synth Methods"},{"key":"key20160729154029841_ref1-bib32","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/S1473-3099(05)70024-4","article-title":"HIV and male circumcision: a systematic review with assessment of the quality of studies","volume":"5","author":"Siegfried","year":"2005","journal-title":"Lancet Infect Dis"},{"issue":"46","key":"key20160729154029841_ref1-bib33","doi-asserted-by":"publisher","DOI":"10.3310\/hta18460","article-title":"Interventions for adult Eustachian tube dysfunction: a systematic review","volume":"18","author":"Llewellyn","year":"2014","journal-title":"Health Technol Assess"},{"key":"key20160729154029841_ref1-bib34","volume-title":"Qualitative Research Methods","author":"Hennink","year":"2011"},{"key":"key20160729154029841_ref1-bib35","volume-title":"Qualitative Methods for Health Research","author":"Green","year":"2014"},{"key":"key20160729154029841_ref1-bib36","volume-title":"An Introduction to Qualitative Research","author":"Flick","year":"2014","edition":"5th edn."},{"key":"key20160729154029841_ref1-bib37","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"33","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"key20160729154029841_ref1-bib38","volume-title":"Handling Qualitative Data: A Practical Guide","author":"Richards","year":"2005"},{"key":"key20160729154029841_ref1-bib39","doi-asserted-by":"crossref","DOI":"10.4135\/9781412995658","volume-title":"Phenomenological Research Methods","author":"Moustakas","year":"1994"},{"key":"key20160729154029841_ref1-bib40","volume-title":"Interpreting Qualitative Data: Methods for Analysing Talk, Text and Interaction","author":"Silverman","year":"2006"},{"key":"key20160729154029841_ref1-bib41","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1177\/0163278713496425","article-title":"Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response","volume":"36","author":"Cho","year":"2013","journal-title":"Eval Health Prof"},{"key":"key20160729154029841_ref1-bib42","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1093\/fampra\/cmg509","article-title":"Using the internet to conduct surveys of health professionals: a valid alternative?","volume":"20","author":"Braithwaite","year":"2003","journal-title":"Fam Pract Manag"},{"key":"key20160729154029841_ref1-bib43","doi-asserted-by":"crossref","DOI":"10.4135\/9781412983877","volume-title":"Designing Surveys: A Guide to Decisions and Procedures","author":"Czaja","year":"2005"},{"key":"key20160729154029841_ref1-bib44","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.2196\/jmir.6.3.e34","article-title":"Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES)","volume":"6","author":"Eysenbach","year":"2004","journal-title":"J Med Internet Res"},{"key":"key20160729154029841_ref1-bib45","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/0309364610389352","article-title":"Stance control orthosis trial in patients with inclusion body myositis","volume":"35","author":"Bernhardt","year":"2011","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib46","first-page":"40","article-title":"Orthosis management in patients after poliomyelitis anterior acuta","volume":"49","author":"Bocker","year":"2011","journal-title":"J Rehabil Med"},{"key":"key20160729154029841_ref1-bib47","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1055\/s-0032-1331218","article-title":"Orthosis management in patients after poliomyelitis anterior acuta","volume":"23","author":"Bocker","year":"2013","journal-title":"Phy Med Rehab Kuror"},{"key":"key20160729154029841_ref1-bib48","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.clinbiomech.2012.09.007","article-title":"Effects of a knee-ankle-foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum","volume":"28","author":"Boudarham","year":"2013","journal-title":"Clin Biomech"},{"key":"key20160729154029841_ref1-bib49","doi-asserted-by":"publisher","first-page":"651","DOI":"10.2340\/16501977-0110","article-title":"Effect of carbon-composite knee-ankle-foot orthoses on walking efficiency and gait in former polio patients","volume":"39","author":"Brehm","year":"2007","journal-title":"J Rehabil Med"},{"key":"key20160729154029841_ref1-bib50","doi-asserted-by":"publisher","first-page":"206","DOI":"10.3109\/03093641003773189","article-title":"The effect of stance control orthoses on gait characteristics and energy expenditure in knee-ankle-foot orthosis users","volume":"34","author":"Davis","year":"2010","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib51","doi-asserted-by":"publisher","first-page":"646","DOI":"10.2340\/16501977-0105","article-title":"Oxygen consumption, oxygen cost and physiological cost index in polio survivors: a comparison of walking without orthosis, with an ordinary or a carbon-fibre reinforced plastic knee-ankle-foot orthosis","volume":"39","author":"Hachisuka","year":"2007","journal-title":"J Rehabil Med"},{"key":"key20160729154029841_ref1-bib52","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1080\/03093640600574474","article-title":"Clinical application of carbon fibre reinforced plastic leg orthosis for polio survivors and its advantages and disadvantages","volume":"30","author":"Hachisuka","year":"2006","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib53","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1038\/sj.sc.3100470","article-title":"A comparison of the attitude of paraplegic individuals to the Walkabout Orthosis and the Isocentric Reciprocal Gait Orthosis","volume":"35","author":"Harvey","year":"1997","journal-title":"Spinal Cord"},{"key":"key20160729154029841_ref1-bib54","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1016\/S0003-9993(97)90077-0","article-title":"Functional outcomes attained by T9-12 paraplegic patients with the walkabout and the isocentric reciprocal gait orthoses","volume":"78","author":"Harvey","year":"1997","journal-title":"Arch Phys Med Rehabil"},{"key":"key20160729154029841_ref1-bib55","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1016\/S0003-9993(98)90092-2","article-title":"Energy expenditure during gait using the walkabout and isocentric reciprocal gait orthoses in persons with paraplegia","volume":"79","author":"Harvey","year":"1998","journal-title":"Arch Phys Med Rehabil"},{"key":"key20160729154029841_ref1-bib56","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1177\/026921559701100406","article-title":"A pilot study to determine the efficiency of lightweight carbon fibre orthoses in the management of patients suffering from post-poliomyelitis syndrome","volume":"11","author":"Heim","year":"1997","journal-title":"Clin Rehabil"},{"key":"key20160729154029841_ref1-bib57","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1038\/sj.sc.3100462","article-title":"The use of an advanced reciprocating gait orthosis by paraplegic individuals: a follow-up study","volume":"35","author":"Jaspers","year":"1997","journal-title":"Spinal Cord"},{"key":"key20160729154029841_ref1-bib58","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3109\/03093649609164442","article-title":"Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients","volume":"20","author":"Kakurai","year":"1996","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib59","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1038\/sj.sc.3100459","article-title":"Clinical evaluation of a new orthosis, the \u2018walkabout\u2019, for restoration of functional standing and short distance mobility in spinal paralysed individuals","volume":"35","author":"Middleton","year":"1997","journal-title":"Spinal Cord"},{"key":"key20160729154029841_ref1-bib60","doi-asserted-by":"crossref","first-page":"111","DOI":"10.3109\/03093648209166778","article-title":"Clinical evaluation of a knee-ankle-foot-orthosis for hemiplegic patients","volume":"6","author":"Morinaka","year":"1982","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib61","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1097\/00008526-200012010-00008","article-title":"The relationship between performance, satisfaction, and well being for patients using anterior and posterior design knee-ankle-foot-orthosis","volume":"12","author":"Peethambaran","year":"2000","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib62","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1038\/sj.sc.3101047","article-title":"One year follow up of spinal cord injury patients using a reciprocating gait orthosis: preliminary report","volume":"38","author":"Scivoletto","year":"2000","journal-title":"Spinal Cord"},{"key":"key20160729154029841_ref1-bib63","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1055\/s-2003-40093","article-title":"Modern carbon fibre orthoses in the management of polio patients: a critical evaluation of the functional aspects","volume":"141","author":"Steinfeldt","year":"2003","journal-title":"Z Orthop Ihre Grenzgeb"},{"key":"key20160729154029841_ref1-bib64","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/sc.1988.6","article-title":"A clinical review of the adult hip guidance orthosis (Para Walker) in traumatic paraplegics","volume":"26","author":"Summers","year":"1988","journal-title":"Paraplegia"},{"key":"key20160729154029841_ref1-bib65","first-page":"2437","article-title":"Influence of reciprocating gait orthosis on walking function in paraplegic patients after ambulation","volume":"11","author":"Sun","year":"2007","journal-title":"J Clin Rehabil Tissue Engineering Res"},{"key":"key20160729154029841_ref1-bib66","first-page":"985","article-title":"The effects of alternative gait orthosis on activity of daily living and quality of life in patients with spinal cord injury","volume":"24","author":"Tang","year":"2009","journal-title":"Chinese J Rehabil Med"},{"key":"key20160729154029841_ref1-bib67","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1038\/sc.1991.13","article-title":"A comparative trial of two walking systems for paralysed people","volume":"29","author":"Whittle","year":"1991","journal-title":"Paraplegia"},{"key":"key20160729154029841_ref1-bib68","first-page":"2469","article-title":"Effect of the new reciprocating gait orthosis (Walkabout orthosis) in improving paraplegic patients\u2019 independent living ability","volume":"7","author":"Wu","year":"2003","journal-title":"Chinese J Clin Rehabil"},{"key":"key20160729154029841_ref1-bib69","first-page":"6","article-title":"Effects of lower limb orthosis therapy on the recovery of motor function in the post-stroke hemiplegic patients","volume":"9","author":"Yang","year":"2005","journal-title":"Chinese J Clin Rehabil"},{"key":"key20160729154029841_ref1-bib70","volume-title":"Reference Costs 2013\u201314","author":"Department of Health","year":"2015"},{"key":"key20160729154029841_ref1-bib71","doi-asserted-by":"crossref","first-page":"245","DOI":"10.3111\/13696990802078845","article-title":"Do tariffs and prices correspond with costs? A case study of orthotic braces","volume":"11","author":"Simoens","year":"2008","journal-title":"J Med Econ"},{"key":"key20160729154029841_ref1-bib72","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3109\/03093648909079407","article-title":"Questionnaire assessment of patient satisfaction with lower limb orthoses from a district hospital","volume":"13","author":"Fisher","year":"1989","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib73","volume-title":"High Quality Care for All: NHS Next Stage Review Final Report","author":"Department of Health (DH)","year":"2008"},{"key":"key20160729154029841_ref1-bib74","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.3109\/09638288.2010.529234","article-title":"Understanding the benefits of prosthetic prescription: exploring the experiences of practitioners and lower limb prosthetic users","volume":"33","author":"Schaffalitzky","year":"2011","journal-title":"Disabil Rehabil"},{"key":"key20160729154029841_ref1-bib75","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/1471-2474-8-104","article-title":"Rheumatoid arthritis patients\u2019 experiences of wearing therapeutic footwear: a qualitative investigation","volume":"8","author":"Williams","year":"2007","journal-title":"BMC Musculoskelet Disord"},{"key":"key20160729154029841_ref1-bib76","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.physio.2010.11.001","article-title":"User experiences, preferences and choices relating to functional electric stimulation and ankle foot orthoses for foot drop after stroke","volume":"97","author":"Bulley","year":"2011","journal-title":"Physiotherapy"},{"key":"key20160729154029841_ref1-bib77","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1682\/JRRD.2009.07.0096","article-title":"Multiple sclerosis and mobility-related assistive technology: systematic review of the literature","volume":"47","author":"Souza","year":"2010","journal-title":"J Rehabil Res Dev"},{"key":"key20160729154029841_ref1-bib78","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1586\/14737167.2015.982098","article-title":"Does assessing the value for money of therapeutic medical devices require a flexible approach","volume":"15","author":"Iglesias","year":"2015","journal-title":"Pharmacoecon Outcomes Res"},{"key":"key20160729154029841_ref1-bib79","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/0309364614556836","article-title":"A systematic review of questionnaires to assess patient satisfaction with limb orthoses","volume":"40","author":"Bettoni","year":"2016","journal-title":"Prosthet Orthot Int"},{"key":"key20160729154029841_ref1-bib80","doi-asserted-by":"publisher","first-page":"a1655","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"Craig","year":"2008","journal-title":"BMJ"},{"key":"key20160729154029841_ref1-bib81","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1177\/0309364611413496","article-title":"A candidate core set of outcome measures based on the International Classification of Functioning, Disability and Health for clinical studies on lower limb orthoses","volume":"35","author":"Brehm","year":"2011","journal-title":"J Prosthet Orthot"},{"key":"key20160729154029841_ref1-bib82","volume-title":"The Use of Brace to Retrain Hemiparetic Gait","author":"ClinicalTrials.gov"},{"key":"key20160729154029841_ref1-bib83","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1016\/j.gaitpost.2013.07.178","article-title":"Prevention of knee hyperextension in stroke patients using a knee orthosis: 3D computational gait analysis and dynamic EMG","volume":"38","author":"Frechtel","year":"2013","journal-title":"Gait Posture"},{"key":"key20160729154029841_ref1-bib84","doi-asserted-by":"publisher","first-page":"S229","DOI":"10.1016\/j.pmrj.2014.08.525","article-title":"An orthotronic mobility system improves perceived walking capabilities in traditional leg orthosis users","volume":"1","author":"Kannenberg","year":"2014","journal-title":"PM R"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta20550\/hta20550.xml","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2002518","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta20550\/hta20550.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2003436","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T15:48:40Z","timestamp":1692114520000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta20550\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":84,"journal-issue":{"issue":"55","published-online":{"date-parts":[[2016,7]]}},"alternative-id":["10.3310\/hta20550"],"URL":"https:\/\/doi.org\/10.3310\/hta20550","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"}]}}