Kane Kyra, Manns Patricia, Lanovaz Joel, Musselman Kristin
a School of Physical Therapy, College of Medicine , University of Saskatchewan , Saskatoon , Canada.
b Saskatchewan Health Authority , Children's Program , Regina , Canada.
Physiother Theory Pract. 2019 Feb;35(2):148-156. doi: 10.1080/09593985.2018.1441346. Epub 2018 Feb 21.
Physiotherapists, orthotists, and physicians are involved in the prescription of ankle-foot orthoses (AFOs) for children with cerebral palsy (CP); however, little is known about how prescription decisions are made in practice. Therefore, the study objective was to identify current AFO prescription and clinical decision-making practices for children with CP in Canada.
Focus groups were conducted in five pediatric rehabilitation facilities, with 32 clinicians. Semi-structured interviews focused on the goals and types of AFOs used, referral and follow-up processes, and clinical evaluation measures. Interpretive Description was used as a framework for analysis. Transcribed dialogue was imported into NVivo 11 for data coding and analysis. Three researchers participated in coding to establish categories and themes.
Categories included: what is made, how it is used, and factors that either support or challenge outcomes. Strengths and challenges of the current prescription process were discussed, including funding, communication, and technology to enhance clinical evaluation. Throughout the interviews, the theme of prescription as a collaborative, iterative, and individualized process emerged.
Processes, strengths, and challenges associated with AFO prescription in Canada were identified. This is a first step toward the development of guidelines to help clinicians improve AFO prescription for children with CP.
物理治疗师、矫形师和医生都参与为脑瘫（CP）患儿开具踝足矫形器（AFO）的处方；然而，对于实际中如何做出处方决策却知之甚少。因此，本研究的目的是确定加拿大CP患儿目前的AFO处方及临床决策实践。
在五个儿科康复机构对32名临床医生进行了焦点小组访谈。半结构化访谈聚焦于所使用的AFO的目标和类型、转诊及随访流程，以及临床评估措施。诠释性描述被用作分析框架。将转录的对话导入NVivo 11进行数据编码和分析。三名研究人员参与编码以确定类别和主题。
类别包括：制作的内容、使用方式，以及支持或挑战结果的因素。讨论了当前处方流程的优势和挑战，包括资金、沟通以及用于加强临床评估的技术。在整个访谈过程中，出现了处方是一个协作、迭代且个性化过程的主题。
确定了加拿大与AFO处方相关的流程、优势和挑战。这是朝着制定指导方针迈出的第一步，以帮助临床医生改善为CP患儿开具AFO处方的情况。
