Patient and clinician perspectives on quality-of-care topics for users of custom ankle-foot orthoses

Objective As in all healthcare areas, there is a need to improve quality relevant to orthotic practice, but we lack information as to what aspects of healthcare quality are meaningful to measure. Thus, the objective was to identify issues that are important to the quality-of-care for people who use custom ankle-foot orthoses as identified by ankle-foot orthosis users, orthotists, and physical therapists. Design We conducted focus groups with custom ankle-foot orthosis users, orthotists, and physical therapists. A stenographer took verbatim notes and provided transcripts. Research staff members assessed the transcripts using thematic analysis. Results Participants included 5 ankle-foot orthosis users (1 focus group), 17 orthotists (2 focus groups), and 7 physical therapists (1 focus group). They discussed domains of quality-of-care relevant for people with ankle-foot orthoses. We identified 28 thematic codes addressing 10 broad themes of quality-of-care. Six of the broad themes (organizational characteristics, patient-clinician communication, care coordination, device fit and comfort, body function, activity, and participation) mapped to the National Quality Forum's person- and family-centered care concepts. Environment of care, clinician competencies, and device characteristics and usage were important to orthotic practice but do not map to any National Quality Forum concept. Participants did not mention the National Quality Forum concept of shared decision-making. Conclusions The quality themes provide information as to what aspects of healthcare quality are meaningful to measure with respect to orthotic care, thus providing guidance on how to measure and improve ankle-foot orthosis service delivery.