title: A user-centered qualitative study on experiences with ankle-foot orthoses and suggestions for improved design.
abstract: BACKGROUND
  Improving ankle-foot orthosis design can best be done by implementing a user-centered approach.
  
  
  OBJECTIVE
  To provide insight into the ideas of ankle-foot orthosis users with flaccid ankle muscle paresis on the importance of activities and suggestions for an improved ankle-foot orthosis design.
  
  
  METHODS
  A focus-group discussion with eight ankle-foot orthosis users (57 ± 5 years, 50% female).
  
  
  METHODS
  Main inclusion criteria were as follows: ⩾18 years, unable to stand on tip-toe and unable to lift toes. Main exclusion criterion was spasticity of lower extremity muscles. Transcribed data were coded according to the International Classification of Functioning, Disability and Health. Thematic analysis with inductive approach was chosen to order and interpret codes.
  
  
  RESULTS
  Ankle-foot orthosis users ranked walking the most important activity followed by sitting down/standing up from a chair. Their opinion was that ankle-foot orthoses facilitate walking and standing. Ankle-foot orthosis users suggested that an improved ankle-foot orthosis design should balance between stability and flexibility.
  
  
  CONCLUSIONS
  Current ankle-foot orthoses facilitate walking which was the most important activity according to ankle-foot orthosis users. An improved ankle-foot orthosis design should enable walking and should optimize between stability and flexibility dependent on the activity and the paresis severity. Clinical relevance Experienced users of ankle-foot orthosis agreed that matching ankle-foot orthosis functions to daily-life activities is a trade-off between stability and flexibility. An improved ankle-foot orthosis design should at least enable level walking.
authors.affiliation: 1 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Dymphy
authors.initials: D
authors.lastname: van der Wilk
authors.affiliation: 1 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Juha Markus
authors.initials: JM
authors.lastname: Hijmans
authors.affiliation: 1 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Klaas
authors.initials: K
authors.lastname: Postema
authors.affiliation: 1 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|2 Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands.
authors.forename: Gijsbertus Jacob
authors.initials: GJ
authors.lastname: Verkerke
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D004867:Equipment Design; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D005528:Foot / Q000503:physiopathology; D061826:Foot Orthoses / Q000706:statistics & numerical data*; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D000071066:Patient Reported Outcome Measures; D036301:Qualitative Research; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology*
keywords: Ankle-foot orthosis; focus group; paretic ankle muscles; user driven