title: Experiences of functional electrical stimulation (FES) and ankle foot orthoses (AFOs) for foot-drop in people with multiple sclerosis.
abstract: OBJECTIVE
  A constructivist phenomenological study explored impacts of ankle foot orthoses (AFOs) or functional electrical stimulation (FES) on people with foot-drop from multiple sclerosis (MS).
  
  
  METHODS
  Focus groups following topic guides were analysed using interpretative phenomenological analysis, with researcher reflexivity, participant verification and peer checking of analysis. Participants with sustained use of the devices (under 2 y) were invited from two quantitative studies that (a) investigated immediate FES effects (n = 12) and (b) compared habitual use of AFO (n = 7) or FES (n = 6). Two focus groups addressed AFO (n = 4) and FES (n = 6) experiences.
  
  
  RESULTS
  Similar numbers of positive and negative aspects were described for AFO and FES. Both reduced fatigue, improved gait, reduced trips and falls, increased participation, and increased confidence; greater balance/stability was reported for AFOs, and increased walking distance, fitness and physical activity for FES. Barriers to both included avoiding reliance on devices and implications for shoes and clothing; a non-normal gait pattern was reported for AFO, and difficulties of application and limitations in the design of FES. However, participants felt the positives outweighed the negatives.
  
  
  CONCLUSIONS
  Participants felt benefits outweighed the drawbacks for AFO and FES; greater understanding of user preferences and satisfaction may increase likelihood of usage and efficacy. Implications for Rehabilitation Interventions to reduce the impacts of foot-drop in people with multiple sclerosis (MS) are important to optimise physical activity participation and participation in life; they include ankle foot orthoses (AFOs) and functional electrical stimulation (FES). Research is lacking regarding user satisfaction and perceived outcomes, therefore, two separate focus groups were conducted from a constructivist phenomenological perspective to explore the impacts of AFOs (n = 4) and FES (n = 6) on people with foot-drop from MS. Some similar positive aspects of AFO and FES use were described, including reduced fatigue, improved gait and fewer trips and falls, while common barriers included finding the device cumbersome, uncomfortable, and inconvenient, with some psychological barriers to their use. On balance, the impacts of the devices on improving activities and participation were more important for participants than practical barriers, highlighting the importance of combining understanding of individual experiences and preferences with clinical decision-making when prescribing a device to manage foot-drop.
authors.affiliation: a School of Health Sciences, Queen Margaret University , Edinburgh , UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bulley
authors.affiliation: a School of Health Sciences, Queen Margaret University , Edinburgh , UK.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mercer
authors.affiliation: b Slateford Medical Centre , Edinburgh , UK , and.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Hooper
authors.affiliation: c Kenilworth Medical Centre , Cumbernauld , UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Cowan
authors.affiliation: a School of Health Sciences, Queen Margaret University , Edinburgh , UK.
authors.forename: Sasha
authors.initials: S
authors.lastname: Scott
authors.affiliation: a School of Health Sciences, Queen Margaret University , Edinburgh , UK.
authors.forename: Marietta L
authors.initials: ML
authors.lastname: van der Linden
keywords: Ambulation; degenerative; mobility; neurological