Clinical Bottom Line
“How should I apply this information?”
Having evidence to support clinical decision making is critical. The authors can be commended for conducting this pilot study in an effort to assist therapists in making informed decisions regarding orthotic prescription for children with Down syndrome. The authors' review of current research provides a good background in support of the use of orthotics, yet points out the question of which orthotic is best and the question is still unanswered. Using a variety of examination tools such as gait analysis and biomechanical and anthropometric measures, as done in this study provides important objective information that can be helpful in making this decision. Using this information may assist in more accurate and specific prescription based on individual needs; however, trials of different orthotics may still be necessary before making final decisions.
“What should I be mindful about in applying this information?”
Unfortunately, as often is the case in research, questions remain unanswered. Although the authors set out to discover which orthosis would be best and to provide therapists with specific guidelines, this was not accomplished because of study limitations such as small sample size, lack of accommodation time wearing the orthotics, short-term follow-up, and other methodological issues. In addition, the reader should be reminded that correlational studies cannot be interpreted as cause and effect. Although significant relationships were seen between variables, this does not indicate that change in one would lead to a change in the other. Another important question is: Do gait characteristics or biomechanical alignment have a direct correlation to function; for instance, does a change in step length or width improve the quality of motor skill or movement or lead to an overall change in function? Perhaps, we should be looking more closely at functional outcomes.
Bottom line: Best practice at this point will continue to be individualized examination and evaluation using a wide variety of measurement tools with continual follow-up on orthotic effectiveness until further definitive answers are found through research.
Deborah Nervik, PT, MHS, DPT, DHS, PCS
California State University
Terry Roberts, PT, DPT
Arizona Orthopedic Physical Therapy–Kids Place
The authors declare no conflict of interest.