Development of clinical guidelines for the prescription of orthoses in patients with neurological disorders in The Netherlands.

The objective of this study was to develop guidelines for the prescription of ankle-foot, knee, wrist-hand and elbow orthoses for patients with neurological disorders. The study is part of a more comprehensive study focusing on the development of clinical guidelines for the prescription of these orthoses in a wider patient population. Evidence from literature (reviews, randomized controlled trials with good quality), information from literature with a lower degree of evidence and information from structured interviews with experts in the field of orthotics, form the basis of statements presented in a Delphi procedure. The Delphi technique was used to gain consensus on statements published on the Internet. A group of experts in the field of orthotics and neurological disorders was asked to give their opinion on 41 statements. Statements with a general agreement of at least 75% were accepted. Statements with less general agreement were rewritten and the experts could react in a second and possibly in a third round. Afterwards, an opinion-based workshop was organized in which participants could react on preliminary guidelines and on Delphi-statements with between 65% and 75% agreement. Consensus on 32 statements was gained during the three rounds and the opinion-based workshop. These statements form the basis of the consensus based clinical guidelines for the prescription of orthoses in patients with neurological disorders.