A Qualitative Study of User Perspectives on Outcomes of Orthotic Interventions

Background: Orthotic services offer various health benefits and it is estimated that for every £1 spent on orthotic care the savings to the NHS are up to £4. Several reports into orthotic services in the UK have reported a lack of data relating to outcomes of orthotic care. This lack of data means it is difficult to demonstrate the overall efficacy of orthotic services. There is also lack of clarity about the influences on positive outcomes and we do not know what outcomes are relevant to users. This qualitative study aimed to explore the influences on outcomes of orthotic interventions and opinions on outcome measurement from the user’s perspective. Method: An advisory group involving experts in the field along with a review of the literature was conducted. From this, semi-structured questions were developed, ethical approval obtained, and a focus group was undertaken with five users. Data was transcribed and analysed using thematic analysis.Results: The participants expressed a need for orthotic provision which enables them to function physically and psychologically in the context of all life’s activities. Current practice neglects the impact of altered body image and there is dissatisfaction related to waiting times, impacting on their desired outcomes. However, they expressed positive thoughts about the patient professional relationship and being involved in decision making. They identified fundamental issues around usability of three current outcome measure tools with no one outcome measurement tool being suitable for their complex conditions and interventions. Conclusions: Communication of the clinicians understanding about the physical, psychological and socio-economic impact of living with a chronic condition, being involved in decision making, continuity of care and timeliness of provision were identified as key factors influencing positive health outcomes. Due to the complexity of conditions presenting to orthotic services it would seem that there needs to be a range of outcome measures specific to the user’s condition and the orthoses provided for it. Mutually agreed and individualised goal setting may be a solution that ensure the user can self-monitor positive health gains and services can provide evidence for effective outcomes.