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Practice Patterns of Hip Flexion Assist Orthosis Use in Multiple Sclerosis: A Retrospective Community-Based Analysis
Christopher R Bhatla1,2, Rajiv N Reebye3
1MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Objective:
To identify patterns of hip flexion assist orthosis (HFAO) use among ambulatory patients with multiple sclerosis (MS) and to assess factors influencing device adoption and discontinuation.
Design:
Retrospective chart review.
Setting:
Outpatient community physiatry clinic in New Westminster, British Columbia.
Participants:
Fifty-four ambulatory patients with MS who were previously assessed for HFAO use between November 2017 and October 2023. Patients were 35-92 years old, able to participate in gait evaluation, and had documented physical examinations. Patients with nonambulatory status or missing motor strength data were excluded. Participants were categorized into groups based on HFAO outcomes: regular use, no follow-up postpurchase, discontinued use, declined HFAO, or unsuccessful HFAO assessment.
Interventions:
Not applicable.
Main Outcome Measures:
Rates of HFAO use and discontinuation, hip flexor and knee extensor Medical Research Council (MRC) strength scores, lower-limb spasticity using the Modified Ashworth Scale (MAS), and qualitative factors associated with device adoption and nonuse.
Results:
Of 54 patients assessed, 48 were recommended an HFAO. Forty obtained a device, and 19 used it regularly. Thirteen patients discontinued use after a mean of 20 months, primarily due to pain/discomfort (38%) and device bulkiness (31%). Discontinuation was associated with higher lower-limb spasticity (mean MAS 1.5 vs 0.77, P=.011). Cost was the primary barrier to adoption (75%). Most patients exhibited hip flexor weakness (MRC=1-3) and relatively preserved knee extensor strength (MRC≥3).
Conclusions:
This study identifies clinical factors associated with HFAO use and discontinuation in ambulatory patients with MS, including hip flexion MRC scores of 1-3, knee extension MRC scores ≥3, and spasticity MAS scores <2. Comprehensive pre-prescription assessment, including pain screening and gait evaluation with and without a device, is recommended to optimize patient selection.
