173
Brezovar, Burger / Rehabilitacija - letn. VII, supl. 3 (2008)
QUALITY OF TECHNICAL 
DOCUMENTATION -IS IT IMPORTANT?
A. Brezovar, H. Burger A. Brezovar, H. Burger
Institute for Rehabilitation, Ljubljana, Slovenia Institute for Rehabilitation, Ljubljana, Slovenia
data were recorded. Exactly one half of all the medical 
prescriptions included the desired function of orthosis, while 
the others mentioned only the expected functional level of 
the patient. 71.1% of technical documentation included a 
description of the used knee joint, 57.9% a description of the 
ankle joints and 5.3% the design of the thigh brim. It may 
be concluded that the quality of our medical records and 
technical documentation for KAFOs has to be improved.
Abstract 
The aim of the study was to determine the factors influenc-
ing the design and orthotic components of KAFOs, but 
due to insufficient data the second aim was to assess the 
quality of technical documentation. Medical and techni-
cal records of the subjects who had received a KAFO in 
2007 were examined and basic clinical and technical 
INTRODUCTION
In Slovenia, as is probably the case in most of the Central 
Europe, orthosis are prescribed by physicians. Physicians 
may specialize in various fields. The physician prescribing 
orthosis has to have a clear idea of the current treatment and 
the potentials and limitations of devices prescribed (1). In 
Slovenia, physicians prescribe which part of the body the 
orthosis is for and its desired function. In some cases, as for 
example in knee-ankle-foot orthosis (KAFO), that usually 
includes the prescription of materials. 
KAFOs are used for patients with functional disorders that 
affect both the knee and the ankle. Usually they are used in 
polio survivors, subjects after spinal cord injury and con-
secutive paraplegia, spina bifida and trauma (2). 
KAFOs may have different ankle and knee joints, be made 
from different materials, different ways may be used to apply 
posteriorly directed force at the knee joint and the tight part 
may have a quadrilateral brim or be without it (3). They 
may have a rigid ankle, limited range of motion or springs 
to help weak muscles. The knee joint can be free, offset or 
have various locks (cam lock, drop lock, lever lock). 
The aim of the study was to determine the factors influenc-
ing the design and orthotic components of KAFOs, but due 
to insufficient data the second aim was to assess the quality 
of technical documentation. 
METHODS AND SUBJECTS
Methods 
Medical and technical records of the subjects who had 
received a KAFO in 2007 were examined and basic clinical 
and technical data were recorded.
Subjects Subjects
All the subjects receiving a KAFO in 2007 were included 
into study.
RESULTS
Thirty-eight subjects, 23 men and 15 women, received 
KAFO in 2007. They were from 6 to 81 year old (46 on aver-
age). Fifteen were polio survivors, fourteen had spinal cord 
injury (SCI), three had pseudoarthrosis or delayed healing 
of femoral fracture, two arthrogryposis and one stroke, CP 
and spina bifida. 
Exactly one half of all the medical prescription included 
the desired function of orthosis, while the others men-
tioned only the expected functional level of the patient. 
Sixteen patients received orthosis for mild, 21 for moder-
ate and one for severe mobility limitations. In 57.9% of 
the medical records there was an indication of muscle 
strength, 50% included an exact description of the range 
of motion in joints of lower limbs and 44.7% described 
the limb length. 
71.1% of the technical documentation included a description 
of the used knee joint, 57.9% a description of the ankle joints 
and 5.3% the design of the tight brim. 
The patients who walked without additional walking aids 
had orthosis for mild mobility limitations, those who 
walked with 2 crutches mainly for moderate mobility 
limitations. All the orthosis for mild mobility limita-
tions had a quadrilateral brim, 13 out of 15 had a free 
knee joint and 10 out of 15 a free ankle joint. Almost all 
the free knee and ankle joints were prescribed for polio 
survivors.

174
DISCUSSION
The study found that the quality of our medical records 
and technical documentation has to be improved. Only one 
half of the medical records contained all the information 
necessary for the orthotist to decide about the design of 
orthosis and the most appropriate components. Technical 
documentation also lacked much important information. No 
data on the design or used components was found in all of 
the technical notes. The quality of both types of documen-
tation depended also on the person who filled it in. There 
were some who included all the necessary information 
in almost all the records, whereas others never wrote any 
important information. That does not necessarily mean that 
the examination was incomplete, but negative findings are 
often not recorded. Later, when the records are reviewed 
it is not clear whether something was not examined or the 
findings were negative. 
T wo types of medical records were used in the study; records 
from outpatient clinics and records for the admitted patients. 
For the admitted patients, much of the important information 
is contained in the files of physiotherapists or occupational 
therapists; however, those are not always brought to the 
orthotist when patients come for casting. 
Greater attention has to be paid to the fact that success-
ful orthotic prescription requires a detailed analysis of a 
patient’s physical and functional status, followed by careful 
consideration of their requirements (3) and that all findings 
have to be recorded and accessible to the whole team. 
In the patients with recorded data, the study found that the 
design and the components of the KAFOs mainly depended 
on the functional status of the patient (muscle strength, range 
of motion, abbreviation) and the expected functional level, 
while the diagnosis itself was not a very important factor.
CONCLUSION 
It may be concluded that the quality of our medical 
records and technical documentation for KAFOs has to be 
improved.
R References eferences:
1. Redford JB, Bajsmajian J, Trautman P . Orthotics: clinical 
practice and rehabilitation technology. New York etc.:
Churchil Livingstone, 1995.
2. Irby SE, Bernhardt KA, Kaufman KR. Gait changes over 
time in stance control orthosis users. Prosthetics and
Orthotics International 2007; 31(4): 353-361.
3. Bowker P , Condie DN, Bader DL. Pratt DJ. Biomechani-
cal basis of orthotics management. Oxford: Butterworth
Heinemann, cop. 1993.
Brezovar, Burger / Rehabilitacija - letn. VII, supl. 3 (2008)