Qualitative results
Interplay between all factors
Factors of ‘usability’ were consistently described as most important in comparison to factors of ‘communication and service’ and ‘opinion of others’. Factors of ‘usability’ determine whether the main goal of OS can be met. Therefore it always has an influence on a patient’s decision to use their OS.
"
Female pt B: “Yes, it works, it really works. And as soon as I take them off, I’ve got a problem.”
"
Factors of ‘communication and service’ were considered as less important in relation to the decision to use OS. However, good communication increased satisfaction, which had an indirect but positive effect on a patient’s decision to use their OS. This was further exemplified when patients were asked what they would do if confronted with a problem with their OS. Those who were satisfied with communication indicated they would go back and request changes, continuing to use their OS thereafter, whereas those who were dissatisfied with communication indicated they would not go back and would cease using their OS.
"
Female pt A: “I would continue to discuss the problem with them, until the OS fit perfectly.”
"
"
Male pt H: “You get dissatisfied, and you think, whatever, forget it. And then you don’t bother to return.”
"
The ‘opinion of others’ was deemed as being of little importance, with no one indicating that this would be of critical influence on their decision to use OS.
"
Male pt F: “What other people think is not important. As long as I can walk without pain, then they can say whatever they like.”
"
Interplay between factors of ‘usability’
Three factors were indicated as important for ‘usability’: improvement of walking, cosmetic appearance, and ease of use. Of these three factors, an improvement of walking was of most importance, and always had an influential role in a patient’s decision to use their OS. When an improvement of walking is achieved, patients felt they regained their freedom and independence.
"
Female pt K: “You feel free, you can walk again. It’s such a relief.”
"
An improvement of walking was described differently by patients, often depending on a patient’s pathology and their choice of wording. For example, they might highlight a reduction in pain, ease of walking, or comfort as being of most importance. However, when asked directly, patients clearly stated that these factors should not be viewed separately. Rather, the interplay of these factors together determines whether an improvement of walking can be achieved.
"
Female pt A: “A good fit and less pain go hand in hand.”
"
Two final factors had varied influence: cosmetic appearance was important for most (but not all) women and for half of the men; ease of use was rarely indicated as important, with most OS being easy to use. A compromise was seen in the interplay between these two factors and an improvement of walking.
"
Female pt K: “But, all in all, the look is not important, how I walk is important.”
"
"
Female pt C: “Taking my shoes off is difficult, but it’s more important that the pain is gone.”
"
Interplay between factors of ‘communication and service’
Five factors of ‘communication and service’ were important: i) taking the patient into account; ii) confidence in clinicians; iii) patient involvement; iv) speed of service; v) consistency in clinicians. There was little relevant interplay between these factors, all were considered as being important for good communication and service. However, large differences could be found in what style of communication was considered as being ‘good’. A communication style which is perfectly suited to one patient might be a completely wrong approach for another. This is exemplified with the following quotes of two female patients of a similar age:
"
Female pt E: “Yes, really nice, and I felt very comfortable. I had to walk a little, then I could hear them talking about me, amongst themselves, all the different problems I had. I really liked it.”
"
"
Female pt I: “You basically just sit there and keep quiet, like you’re a child. I found it so patronising, to be there while they talked about me, but not to me.”
"
Acceptance of OS
In addition to the factors and domains described, patients spontaneously indicated that they also had to accept their OS, the problems with their feet and their underlying condition. This acceptance had a major influence on their decision to use their OS.
"
Female pt I: “I choose to look less attractive, but to have no pain. And after a few weeks, that finally clicked. You have to accept it in your mind first, then later in your heart.”
"
"
Male pt I: “You accept, after all, that it is made to how your feet are.”
"
Quantitative results
‘Usability’ was consistently ranked as most important, while ‘the opinion of others’ was of relatively limited importance (Table
2). Some patients indicated ‘communication and service’ to be equally important as ‘usability’, whereas others indicated that it was of no importance (Table
2). All but one patient reported that the aim of their OS (i.e. the functional goal why OS were prescribed) was the most the important factor influencing ‘usability’ (Table
3). Although goals were described differently (depending on pathology and choice of wording; Table
3), all patients essentially had the same underlying goal: an improvement of walking, to regain freedom and independence.
Table 2
The relative importance of the three domains
Usability of OS | 54 ± 15 | 34 – 100 |
Communication and service | 35 ± 13 | 0 – 50 |
Opinion of others | 12 ± 11 | 0 – 33 |
Table 3
Factor in the domain usability of custom-made orthopaedic shoes indicated by the participant to be most important
Reduction of pain | 30% (7) |
Ease of walking | 26% (6) |
Increase in comfort | 17% (4) |
Reduction or prevention of wounds | 9% (2) |
More stability | 9% (2) |
Being able to do activities again | 4% (1) |
Easy donning and doffing | 4% (1) |