Project Structure Susanne Dannehl Technische Universität Berlin Zentrum Mensch-Maschine-Systeme [email protected] www.prometei.de www.zmms.tu-berlin.de Study Concept for Analysing Compliance Improvement with Technical Aids Dipl.-Psych. Susanne Dannehl, Dr.-Ing. David Hochmann, Prof. Dr.-Ing. Marc Kraft Methods Although there are some theories in health psychology research to improve compliant behaviour, these methods have not yet been applied in orthotic treatments. The results in other health-related behaviours (like smoking cessation) indicate effective strategies to support patients in becoming compliant. Transferring these approaches to the constant usage of technical aids like knee or foot orthoses is the objective of this study. The first concern was to identify relevant factors, which affect the compliance. To date research of technical aids has given less attention to this topic. Although in a survey with 40 experts (orthopaedists, orthopaedic technicians) a significant awareness of the problems was identified for practitioners. They provided considerable information about important difficulties in the usage of orthotic devices and possibilities for improvements. Other important factors for analysing and improving adherence with technical aids were derived from theoretical statements of the „Health Action Process Approach“ (HAPA), developed 1992 by Schwarzer, Professor of Health Psychology in Berlin. In his theory, he summarized the appropriate variables, which contain attributes of patients. With a support of such attributes, like self-efficacy, compliance with several health related behaviours (e.g. usage of dental floss) could be improved significantly. A third group of factors, which may influence compliance, can be described as process variables. The quality of advice and comprehensibility of information can be relevant factors to improve the compliance and usage of technical aids in orthotic treatments. Conclusion Currently, a first conclusion can be drawn, that there is tremendous potential to be gained by further investigating the compliance of patients in the treatment with technical aids. A result of this study will be informative brochures for supporting patients in coping with relevant problems while using an orthosis. These interventions will be based on the aforementioned HAPA-theory. This additional treatment has to be efficient, without demanding special effort from health care provider or incurring extra costs. Start exploring usage issues with an expert survey Study design parameter for compliance measuring assembly of electronic monitoring development of interventions Study implementation recruitment of patient groups with knee or foot orthoses in different settings Sampling of recommendations for prospective improvement of adherence in treatment with technical aids 04/2009 04/2010 04/2011 04/2012 Introduction Compliance, which we define as the adherence e.g. to therapeutical advice, is a precondition for medical treatments. In usage of technical aids the compliance rate is low. A study by Hiemstra et al. (2009) demonstrated that after two weeks only 11 out of 44 patients wore knee immobilizers in at least 76 % of treatment time. Birmingham et al. (2008) found out that the compliance rate within a year was constantly around 63-65 % with functional knee braces as well as with neoprene sleeves. Under these conditions treatment outcomes can not be analysed validly, because for any measureable effect usage is necessary. This poster presents a concept of how to investigate and how to foster constistent usage of orthoses for lower limb. To be compliant or not to be compliant, that is the Question…! Subject matter in Shakespeare´s words Chart of HAPA-Model References Hiemstra, L.A., Heard, S.M., Sasyniuk, T.M., Buchko, G.L., Reed, J.G., Monteleone, B.J. (2009). Knee immobilization for pain control after a hamstring tendon anterior cruciate ligament reconstruction: a randomized clinical trial. American Journal of Sports Medicine; 2009 (37), 56-64 Birmingham, T.B., Bryant, D..M., Giffin, R.J., Litchfield, R.B., Kramer, J.F., Donner, A., Fowler, P.J. (2008). A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use After Anterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine; 2008 (36), 648 -53