1440 - Orthotic-related Limb Pain and Modification during Inpatient Stroke Rehabilitation

Objectives: Off-the-shelf ankle-foot orthotics (AFOs) are widely used in therapy training for stroke patients with gait dysfunction in the inpatient rehab. However, pain and skin breakdown resulting from the poor fitting braces hinder effective gait training and potentially lead to hospital acquired injures. Our study aims to demonstrate the prevalence of the orthotic-related limb pain and skin breakdown during AFO usage for patients with stroke in the acute inpatient rehab unit.

Design: 30 patients who met enrollment criteria were enrolled into the IRB-approved prospective study. Patients received individualized therapy sessions and were assessed daily by therapists regarding any specific limb pain and skin breakdown regarding the orthotic. Data obtained includes age, gender, length of stay, pain and skin assessments, and number of orthotic modifications during rehabilitation. A survey was constructed and filled out by therapists recording their satisfaction scores related to the production, modification, and efficiency the AFO for their respective patients.

Results: There were 2.2 modifications made to AFOs on average during acute inpatient rehabilitation. AFO modifications doubled from pre- to post-therapy (p < 0.05). Limb pain scores tripled from pre- to post-therapy (p < 0.05). Limp pain developed 8 days after using AFOs (if no limb pain was present before, and excluding those that never developed pain). Skin breakdown developed 9.5 days after using AFOs (if no skin breakdown was present before, and excluding those that never developed skin breakdown). Our survey demonstrated low satisfaction from the therapy team.

Conclusions: Our study demonstrates that using an AFO (even for just 1 hour/session, over 3-5 sessions per week) is associated with increase in skin breakdown (33%) and limb pain (200%, p < 0.05), and required multiple modifications throughout rehabilitation. The next phase of this study will assess the same outcomes for custom fabricated 3D printed AFOs in the acute inpatient rehab setting.