影响小儿矫形骨科人群下肢矫形器获得的因素。

Factors that Influence Acquisition of Lower Extremity Braces in the Pediatric Orthopaedic Population.

机构信息

Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic.

LeBonheur Children's Hospital.

出版信息

J Pediatr Orthop. 2022 Jan 1;42(1):40-46. doi: 10.1097/BPO.0000000000001998.

DOI:10.1097/BPO.0000000000001998

PMID:34723893

Abstract

BACKGROUND

Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance.

METHODS

Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index.

RESULTS

Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P=0.045; 1.23-5.6, P=0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P=0.007). The ORs of failure to acquire were 2.12 (P=0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P<0.0001) in cerebral palsy versus clubfoot, and 4.12 (P=0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition.

CONCLUSIONS

In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear.

LEVEL OF EVIDENCE

Level III-retrospective cohort study.

摘要

背景

下肢支具佩戴依从性已在儿科领域进行了研究，但未包括未获得规定支具的情况。本研究的目的是评估获得支具作为支具佩戴依从性的一个组成部分。

方法

回顾了 2017 年至 2019 年期间为患者（0 至 21 岁）开具下肢支具的记录。诊断包括脑瘫、脊柱裂、跟腱短、马蹄足和其他疾病。支具类型分为马蹄足外展矫形器、踝足矫形器、膝部、髋部或定制/其他矫形器。记录支具的处方和获得日期。保险分为政府、私人或无保险。患者人口统计学特征包括年龄、性别、种族和计算出的区域贫困指数。

结果

在 1176 例规定的下肢支具中，有 1094 例（93%）获得了支具，而 82 例（7%）未获得。黑人和西班牙裔患者未获得规定支具的几率分别是白人患者的 1.64 倍和 2.71 倍（95%置信区间：1.01-2.71，P=0.045；1.23-5.6，P=0.015）；无保险患者未获得规定支具的几率是私人保险患者的 8.48 倍（95%置信区间：1.93-31.1，P=0.007）。与 0 至 3 岁患者相比，4 岁或以上患者（P=0.003）、脑瘫患者（P<0.0001）和跟腱短患者（P=0.01）未获得规定支具的几率分别为 2.12 倍、4.17 倍和 4.12 倍。性别或区域贫困指数与支具获得失败之间无显著相关性。

结论

在我们的队列中，7%的规定支具未获得。黑人和西班牙裔、无保险和年龄较大与未获得规定支具相关。规定用于治疗马蹄足的支具比用于治疗脑瘫或跟腱短的支具更易获得。支具佩戴依从性是治疗成功和复发的既定因素。本研究确定了获得规定支具失败的风险因素，这是提高依从性的关键步骤。这些结果可能有助于改变当前的系统，从而提高支具佩戴的依从性。