Description of Orthotists Level of Involvement in Early Post Stroke Management in Denmark: A Cross-Sectional Survey

Abstract: Background: Following a stroke the ability to walk is often impaired due to compromised motor-control, muscle weakness and spasticity, resulting in deviations during gait. Ankle-foot orthoses (AFO) can be used for people with hemiparesis to improve stability during stance phase and clearance during swing phase. There has been much discussion whether AFOs have a positive effect during early rehabilitation post stroke (in this study defined as six weeks from the initial stroke onset).Objectives: The aim was to describe the level of involvement of Danish Certified Prosthetists and Orthotists (CPO) in early rehabilitation of stroke patients in Denmark, and to describe danish orthotists view on their involvement in early rehabilitation of stroke patients.Method: A cross-sectional survey, in form of a self-administered questionnaire, was conducted during March and April 2021 in Denmark. The survey was sent to Danish CPOs who were currently members of the Danish professional organization for prosthetists/orthotists. A total of 110 members received the questionnaire by e-mail, 80 of which were registered as certified. The questionnaire consisted of 43 items (of which a minimum of 26 questions needed answering) with mainly closed ended questions. Descriptive statistics were used for data analysis, with frequencies, percentage and summarizing tables.Results: The response rate was 31.25 % (n=25). The survey demonstrated that only few participants (n=3) were involved in early gait rehabilitation, stroke patients were seen as out-patients in orthotic clinics (92%, n=23), usually 4–6-month post stoke (44%, n=11) and often with a referral from another member of the multidisciplinary team (MDT) (56%, n=14). Danish CPOs believed that orthotic assessment was an essential part of gait re-education (80% n=20), and that the orthotist should be part of the early gait rehabilitation (88%, n=22). Most of the orthotists (72%, n=18) were confident in recommending a treatment plan including lower extremity orthosis and were confident in advising the multidisciplinary team (MDT) in the use of orthosis (80%, n=20).Conclusion: It is uncommon for danish CPOs to be involved in the early rehabilitation of stroke patients and the Danish CPOs often first meet the patient late in the rehabilitation process. The CPOs believe that they should be part of early gait rehabilitation and that orthotic assessment should be part of gait re-education.