LAUSR

Background: Ankle foot orthoses (AFOs) are usually recommended to prevent deformities and to increase the standing and walking performance in children with spastic cerebral palsy (CP). Objective: To compare the body functions and structures, activity and participation levels, and environmental factors according to AFO-wearing time in children with spastic CP. Study design: Prospective, cross-sectional-observational-clinical study. Methods: Eighty children with spastic CP (Gross Motor Function Classification System I–III; mean age 7.3 ± 3.9 years) were divided into two groups with equal ages and duration of AFO usage, which is provided as a part of routine clinical care: 6–12 hours per day group (n = 40) and 12–24 hours per day group (n = 40). The outcomes measured were calf muscle's spasticity with the modified Ashworth Scale (MAS), passive ankle dorsiflexion angle (DA), 66-item Gross Motor Function Measurement, Pediatric Berg Balance Scale, and Pediatric Quality of Life Inventory (PedsQL). Parental satisfaction was measured with a Visual Analog Scale. Multifactorial ANOVA was used to compare the groups, corrected for 66-item Gross Motor Function Measurement. Results: No significant differences for the Pediatric Berg Balance Scale, MAS, and DA were found between the groups. Significant differences for the PedsQL (76.99 vs. 57.63; mean difference [MD], 15.60; 95% confidence interval [CI], 10.99∼20.22), daily living activities (65.30 vs. 35.92; MD, 25.72; 95% CI, 17.58∼33.86), fatigue (76.9 vs. 56.85; MD, 23.11; 95% CI, 16.87∼29.35), and satisfaction (8.08 vs. 5.21; MD, 2.46; 95% CI, 1.64∼3.27) were found between the groups; 6–12 hour group had superiority for each outcome (P < 0.001). Wearing time was significantly correlated with PedsQL (r = −0.524, P < 0.001) and satisfaction (r = −0.521, P < 0.001) but not with MAS or DA. Conclusions: AFO-wearing time seems to depend on the child's activity and participation levels rather than body functions and structures in children with spastic CP. Prolonged AFO-wearing time was negatively correlated with both the activity-participation level and parental satisfaction.