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Master Thesis

Analyse de la prescription, de l’utilisation et de la satisfaction des aides techniques de marche et des orthèses suro-pédieuses chez le patient hémiplégique après un AVC ischémique

Abstract : Introduction: there are no reliable data on the types of walking aids and ankle-foot orthosis prescribed to hemiparetic patients following a stroke, or how patients perceive and use these devices at a distance from the acute phase. The main objective of this study was to analyze the frequency of prescription of these devices in patients with persistent hemiparesis secondary to ischemic stroke. The secondary objectives were to quantify their use at a distance from the acute phase, to evaluate the benefits perceived by the patients and to check the adequacy of these devices with the data present in the hospitalization reports. Methods: this was a survey with retrospective analysis of the medical records of 52 patients initially hospitalized, within the Neuro-Vascular Unit of Bordeaux between August 2014 and July 2015 and then in one of the rehabilitation services in the region. Subsequently, a prospective semi-directed telephone interview was conducted with patients and/or their caregivers to collect information on the use of these devices, possible changes to the initial prescription and patient satisfaction. A statistical analysis was then caried out to verify their adequacy with the data present in the medical files. Results: at the discharge from rehabilitation services, 36 patients (70%) had a walking aids and 26 (50%) had a ankle-foot orthosis. 18 months after the stroke, 26 changes were made and 3 more patients reported using a ankle-foot orthosis. The multipod cane and the Chignon ankle-foot orthoses were the most prescribed and used devices. The physiatrist was the professional most often involved in adjustments to these devices. 58% of patients with walking aids and 48% with a ankle-foot orthoses reported using it daily. More than 90% of them reported a significant improvement in their walk with these devices and if 97% were satisfied with their walking aids, 52% were not satisfied with their ankle-foot orthosis. Their prescription at discharge from rehabilitation services was mainly associated with the severity of the motor impairment (p = 0.005) and the score obtained at the modified FAC (p = 0.013). Discussion and conclusion: walking aids and ankle-foot orthosis are frequently prescribed in young patients with persistent motor impairment after stroke. If their prescription was adapted to patients’ clinical presentations, the choice of differents models as well as their long-term adjustment still seem largely subject to regional influence and to the personal experience of the physiatrist who is its first prescriber. The latter may have confidence in their judgment because patients continue to use these devices away from stroke, which they consider beneficial, although progress is still needed to improve their tolerance.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01766824
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Saturday, April 14, 2018 - 12:31:21 PM
Last modification on : Friday, April 20, 2018 - 1:22:46 AM

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Jean-Marc David. Analyse de la prescription, de l’utilisation et de la satisfaction des aides techniques de marche et des orthèses suro-pédieuses chez le patient hémiplégique après un AVC ischémique. Médecine humaine et pathologie. 2018. ⟨dumas-01766824⟩

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