Best Practice Statement : Use of Ankle-Foot Orthoses Following Stroke

The development of this Best Practice Statement (BPS) was a collaboration between NHS Quality Improvement Scotland (NHS QIS), National Centre for Prosthetics and Orthotics, University of Strathclyde and a multidisciplinary group of relevant specialists. NHS QIS is a strategic health board which has a lead role in supporting the NHS in Scotland to improve the quality of healthcare. It does this by producing advice and evidence in a number of different formats, including BPS. These statements reflect the commitment of NHS QIS to sharing local excellence at a national level, and the current emphasis on delivering care that is patient-centred, cost-effective and fair. As part of a scoping exercise commissioned by NHS QIS in 2007, allied health professionals (AHPs) across Scotland identified the use of AFOs following stroke in adults as a clinical improvement priority. Orthotic intervention following stroke has been recognised as a treatment option for many years, but there is wide variation in current practice, and a lack of evidence-based research to determine the optimal rehabilitation programme for individuals following stroke. Stroke is the most frequent cause of severe adult disability in Scotland, with approximately 8,500 diagnoses of first-ever stroke each year, and more than 70,000 individuals affected by the condition. A recent Scottish Government strategy document confirms stroke as a national clinical priority for the Scottish NHS. In addition to developing a BPS and sharing this with healthcare professionals across Scotland, the initiative also sought to develop resource material to support the implementation of the BPS and to share the work internationally. In order to inform the development of the BPS a systematic literature review on AFO use following stroke was undertaken, including work of both a qualitative and quantitative nature. The full literature review, together with recommendations for future research, was included in the BPS. As it was felt that many medical professionals and AHPs may be unfamiliar with the principles underpinning orthotic practice, additional educational resources that would improve understanding of the reasons why the recommendations were being made were developed and included in the BPS. In addition to the full BPS, the key recommendations were summarised as a two-page 'quick reference guide' for ease of use in a clinical setting