Acceptability and feasibility of fabric orthoses for movement control in multiple sclerosis

Multiple sclerosis (MS) is a common neurological disorder, characterised by slowed, diminished sensory feedback and weakness leading to reduced mobility. Fabric orthoses are suggested to improve movement by enhancing sensory feedback and providing a flexible exoskeleton. At the outset of this doctoral programme, only low quality evidence existed, acceptability was suggested to be poor and therapists commonly believed that fabric orthoses needed several weeks’ wear before any benefits might be seen. There was no published research evaluating use in MS. This thesis aimed to investigate the feasibility of fabric orthoses in MS. A series of inter-linked research projects were conducted, starting with systematic reviews investigating fabric orthoses, compression garments and joint supports. A qualitative investigation was conducted with people with MS who were long-term fabric orthosis users. Latterly, the project focussed on orthotic shorts as a means of improving walking and, following a small pilot study, a mixed methods feasibility study was conducted evaluating acceptability and potential efficacy. The programme of research generated new knowledge. Specifically, fabric orthoses were shown to have an important influence on confidence. Acceptability was shown to be affected by how fabric orthoses are introduced and the support provided in the early stages of use. The recently proposed Theoretical Framework of Acceptability was used for analysis, demonstrating for the first time how that framework might be interpreted and its value in evaluating and improving acceptability of healthcare interventions. Orthotic shorts were demonstrated to be acceptable to people with MS. Changes in walking ability were measurable after 30 minutes’ wear and included improved speed, decreased variability of footfall and improved adaptability of trunk and pelvic movement. A suggested mechanism of effect has been proposed and a proof of concept randomised controlled trial designed. Overall, the doctoral programme has demonstrated potential for use of fabric orthoses in MS.