During my orthotic residency, a physical therapist and I were discussing orthotic options for a patient with post-stroke hemiparesis. The therapist had concerns about the KAFO I was recommending and advocated for an AFO. As I explained the rationale for the KAFO, she leaned in and said, “Here’s a dirty little secret-most of these things end up in the closet.” As the discussion continued, it was obvious that her comment was intended as a statement about patient compliance, and not related to the quality of the devices provided. Whether the therapist was right or not in her general appraisal of KAFOs and compliance, many practitioners would affirm that use of the devices they provide often does not match their recommendations or expectations. In many cases we consider this nonuse a significant detriment to the patient’s health and function. Our impressions of the frequency and causes of noncompliance based on our past experience often influence our clinical decisions and recommendations. This article reviews themes found in a number of recent studies about patients’ compliance when using assistive devices, orthopedic footwear, and lower-limb orthoses.
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