EP.50A service evaluation of orthotic provision for neuromuscular patients at the John Walton neuromuscular research centre

An orthotic is defined as 'an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal systems'. Orthotics can play a key role in the management of symptoms associated with neuromuscular disease. Indications include: contracture management, improving position of a joint, to restrict unwanted movement and improve stability, managing pain, improving function or any combination of these. Prescription depends on the type of neuromuscular condition, functional assessment and the outcome of prior management. In Newcastle, neuromuscular patients identified as having an orthotic need, are referred into a specialist joint clinic run by an orthotist and specialist neuromuscular physiotherapist who will assess their orthotic requirement and prescribe and monitor as appropriate. To better understand orthotic provision an audit / service evaluation was performed. Data were retrospectively reviewed over a 12 month period between July 2017 and July 2018. Orthotics were classified according to type and diagnosis. Separate categories were added to the analysis to identify appointments that were for alterations or other activity related to the orthotics service. Over one year there were a total of 167 contacts, 82% of which were with adults. The five most common conditions were FSHD, DMD, DM1, LGMD and BMD. The 6 most common orthotics provided were flexible ankle supports, rigid AFO's, knee braces, collars, CCD's and dynamic AFO's. Flexible ankle supports and knee braces were most commonly prescribed to patients with FSHD, rigid AFO's and CCD's were most commonly provided to patients with DMD and BMD and patients with DM1 were most commonly prescribed flexible ankles supports and AFO's. This service evaluation has helped identify and understand current service provision. Data collection will continue over time to increase cohort size, identify changes in orthotic needs and provision and to audit the service in the future. Further research exploring effectiveness can be developed from this baseline information.