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Ankle-foot orthoses among children with cerebral palsy : a cross-sectional population-based register study of 8,928 children living in Northern Europe

Stockman, Jessica LU orcid ; Eggertsdóttir, Guðbjörg ; Gaston, Mark S ; Jeglinsky-Kankainen, Ira ; Hollung, Sandra Julsen ; Nordbye-Nielsen, Kirsten ; von Rosen, Philip LU and Alriksson-Schmidt, Ann I LU (2023) In BMC Musculoskeletal Disorders 24(1).
Abstract

BACKGROUND: Cerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age.

METHOD: Aggregated data on 8,928 participants... (More)

BACKGROUND: Cerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age.

METHOD: Aggregated data on 8,928 participants in the national follow-up programs for CP for the respective countries were used. Finland does not have a national follow-up program for individuals with CP and therefore a study cohort was used instead. Use of AFOs were presented as percentages. Logistic regression models were used to compare the use of AFOs among countries adjusted for age, CP subtype, GMFCS level, and sex.

RESULTS: The proportion of AFO use was highest in Scotland (57%; CI 54-59%) and lowest in Denmark (35%; CI 33-38%). After adjusting for GMFCS level, children in Denmark, Finland, and Iceland had statistically significantly lower odds of using AFOs whereas children in Norway and Scotland reported statistically significantly higher usage than Sweden.

CONCLUSION: In this study, the use of AFOs in children with CP in countries with relatively similar healthcare systems, differed between countries, age, GMFCS level, and CP subtype. This indicates a lack of consensus as to which individuals benefit from using AFOs. Our findings present an important baseline for the future research and development of practical guidelines in terms of who stands to benefit from using AFOs.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescent, Child, Humans, Ankle, Gait/physiology, Foot Orthoses, Cerebral Palsy/diagnosis, Cross-Sectional Studies, Europe/epidemiology
in
BMC Musculoskeletal Disorders
volume
24
issue
1
article number
443
pages
7 pages
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85160892540
  • pmid:37268928
ISSN
1471-2474
DOI
10.1186/s12891-023-06554-z
language
English
LU publication?
yes
additional info
© 2023. The Author(s).
id
b16659c7-e368-46c1-93f6-abbe1b6a3cdc
date added to LUP
2023-06-07 09:37:56
date last changed
2024-06-15 03:46:58
@article{b16659c7-e368-46c1-93f6-abbe1b6a3cdc,
  abstract     = {{<p>BACKGROUND: Cerebral palsy (CP) is an umbrella term where an injury to the immature brain affects muscle tone and motor control, posture, and at times, the ability to walk and stand. Orthoses can be used to improve or maintain function. Ankle-foot orthoses (AFOs) are the most frequently used orthoses in children with CP. However, how commonly AFOs are used by children and adolescents with CP is still unknown. The aims of this study were to investigate and describe the use of AFOs in children with CP in Sweden, Norway, Finland, Iceland, Scotland, and Denmark, and compare AFO use between countries and by gross motor function classification system (GMFCS) level, CP subtype, sex, and age.</p><p>METHOD: Aggregated data on 8,928 participants in the national follow-up programs for CP for the respective countries were used. Finland does not have a national follow-up program for individuals with CP and therefore a study cohort was used instead. Use of AFOs were presented as percentages. Logistic regression models were used to compare the use of AFOs among countries adjusted for age, CP subtype, GMFCS level, and sex.</p><p>RESULTS: The proportion of AFO use was highest in Scotland (57%; CI 54-59%) and lowest in Denmark (35%; CI 33-38%). After adjusting for GMFCS level, children in Denmark, Finland, and Iceland had statistically significantly lower odds of using AFOs whereas children in Norway and Scotland reported statistically significantly higher usage than Sweden.</p><p>CONCLUSION: In this study, the use of AFOs in children with CP in countries with relatively similar healthcare systems, differed between countries, age, GMFCS level, and CP subtype. This indicates a lack of consensus as to which individuals benefit from using AFOs. Our findings present an important baseline for the future research and development of practical guidelines in terms of who stands to benefit from using AFOs.</p>}},
  author       = {{Stockman, Jessica and Eggertsdóttir, Guðbjörg and Gaston, Mark S and Jeglinsky-Kankainen, Ira and Hollung, Sandra Julsen and Nordbye-Nielsen, Kirsten and von Rosen, Philip and Alriksson-Schmidt, Ann I}},
  issn         = {{1471-2474}},
  keywords     = {{Adolescent; Child; Humans; Ankle; Gait/physiology; Foot Orthoses; Cerebral Palsy/diagnosis; Cross-Sectional Studies; Europe/epidemiology}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Musculoskeletal Disorders}},
  title        = {{Ankle-foot orthoses among children with cerebral palsy : a cross-sectional population-based register study of 8,928 children living in Northern Europe}},
  url          = {{http://dx.doi.org/10.1186/s12891-023-06554-z}},
  doi          = {{10.1186/s12891-023-06554-z}},
  volume       = {{24}},
  year         = {{2023}},
}