A preliminary study to identify data needs for improving fit of hand and wrist orthosis using verbal protocol analysis

The delayed delivery, poor fitting and discomfort of customised orthoses are reported in rehabilitation clinics as resulting in more invasive interventions. The current practice of orthosis customisation relies heavily upon the experience and fabrication processes of therapists. In order to better understand the current practice, and thus identify data that is required for better comfort moving towards a data-driven customisation, this article describes a study generating working models of therapists. Customisations of hand and wrist orthoses for 18 patients were observed. Verbal protocol analysis was employed to extend the current understanding of fabrication processes. Working models of four therapists were established with quantitative evaluation on major phases, interactive activities and iterations of performing tasks during fabrication, revealing different working models between in- and out-patient departments (e.g. fabrication for in-patients was more complex and focussed on ergonomic fitting whereas fabrication for out-patients paid attention to durability) which were qualitatively explained. Practitioner summary: Fit and comfort are imperative for orthosis design and fabrication, however the current practice of customisation of an orthosis relies upon the experience of individual hand therapist. The article presents working models of hand therapists, and relevant data that would enable customisation of orthosis for better fit. Abbreviations: VPA: verbal protocol analysis; h&w: hand and wrist; LTT: low temperature thermoplastic; ANOVA: analysis of variance.