A patient’s decision to use OS is influenced by the factor that is most important for an individual patient: an improvement of walking, to regain freedom and independence. This can, for example, be reached by a reduction in pain, prevention of ulceration, or by the comfort of OS. The interplay between these factors determines if an improvement of walking can be reached. In previous studies, other factors as cosmetic appearance and ease of use of OS have been found to be important as well [4
]. However, patients did not have to choose between these factors and an improvement of walking in those studies. When forced to choose, it was found that patients were making compromises between these factors and an improvement of walking. The result of those compromises determines the importance of cosmetic appearance and ease of use, and thereby the influence of these factors on a patient’s decision to use OS.
In addition to factors of ‘usability’, it was found that a patient’s decision to use OS was influenced by acceptance of OS as well. This finding is in line with research concerning AT in general, where it has been stressed that patients who have accepted their disability are more likely to use their AT [15
]. The main barrier in acceptance of OS was their visibility. According to patients, OS are the visible representation of their disability. It can be hypothesized that OS will be more easily accepted by patients who have accepted their disability. However, more research is needed to get a better grip on acceptance of OS, and to investigate the implications for clinical practice.
Communication and service of clinicians have been marked as pivotal moments, with the potential to influence a patient’s decision to use OS [9
]. That is again shown in this study. When the relationship between the patient and the clinicians is seen as a partnership in order to achieve well-being, patients will feel taken into account and will have confidence in their clinicians [9
]. This feeling may positively influence a patient’s decision to use OS. Communication is also the only way for a clinician to gain insight in the acceptance of a patient, and in the compromises the patient is willing to make with regard to cosmetic appearance and ease of use of OS. There is not one communication style that will ensure successful achievement of a partnership between the patient and the clinicians, as large individual differences in preferred style of communication in this study showed. An individual approach is therefore most important in clinical practice. If that is matched to the patient’s preferences, communication is the key for a clinician to positively influence a patient’s decision to use OS.
Since this is a study with a mixed-method design with priority on the qualitative part, the results should be regarded as inductive [17
]. Part of the findings of the qualitative part could be triangulated with findings of the quantitative part, which confirmed the qualitative findings. However, more quantitative research is still necessary to quantitatively investigate all relations found.
Other limitations of this study are found in two causes of possible selection bias. First, patients were selected after they had been provided with OS. Patients who refused their OS straight-away were therefore not included in this study. This is a legitimate exclusion, as only reasons were investigated for a patient’s decision to use a pair of OS they already had been provided with. Second, due to privacy reasons, no insight was available in the number and characteristics of eligible patients to whom an information letter was sent. It is therefore not known if the included patients differ from the patients that were not willing to participate, which limits generalisation. However, the characteristics of the patients included in this study are comparable with another Dutch study in which a large and representative group of patients was included [5
]. In our opinion, the issues raised in this study will be transferable to a larger group of patients.
The results of this study can be seen in a broader perspective, by applying them to a conceptual model for use of AT [13
] (Figure ). This shows that use of OS is influenced by acceptance of OS. Acceptance of OS is influenced by the perceived relative advantage (based upon factors of ‘usability’ important for an individual patient) and the contextual factors (‘communication and service’ and the ‘opinion of others’). When OS are being used, the impact of OS is determined by the outcomes of the factors of ‘usability’ of OS. This impact determines the benefits a patient perceives. The perception of these benefits is weighed against the potential benefits of parallel treatment options (if the patient has any options), to determine again the perceived relative advantage.
Figure 2 Results applied to the conceptual model for assistive technologies outcomes research . Note: OS=custom-made orthopaedic shoes. Use of OS depends on the acceptance. Acceptance is influenced by factors of the perceived relative advantage (more ...)