Practice Patterns of Hip Flexion Assist Orthosis Use in Multiple Sclerosis: A Retrospective Community-Based Analysis.

Only patients already referred for an HFAO assessment were included, so the sample is prefiltered and may not represent all patients with MS and hip flexor weakness. 85% of patients were independent in all ADLs and instrumental ADLs, and this proportion was uniform across outcome groups, so the study does not show how HFAO use differs in more dependent patients. The retrospective chart design cannot establish cause and effect. Expanded Disability Status Scale scores were not routinely charted, and spasticity was recorded inconsistently, so comparisons across groups are incomplete. Baseline pain was recorded only when raised as a clinical concern, so its role in selection and discontinuation cannot be assessed. Walking endurance, falls, concurrent use of gait aids or orthoses, joint range of motion, contractures, daily wear time, and type of HFAO use were not captured. Quantitative gait parameters were not measured during assessment or follow-up. Follow-up duration varied because it depended on routine appointment scheduling rather than a study protocol. All patients were seen by one physiatrist at one clinic, so patterns may differ elsewhere. Small group sizes prevented sex-based analysis.

The authors declare no conflicts of interest and received no funding. HFAOs are not covered by British Columbia's provincial health care plan, and patients pay out of pocket or use additional insurance. No remuneration is provided to the physiatrist or the clinic, although patients typically purchase the device at the same orthotist's practice.

Do not conclude that the hip flexion assist orthosis improves gait or that specific strength and spasticity scores cause better outcomes. This retrospective chart review describes what happened in records for patients already selected for assessment, and it did not measure quantitative gait outcomes or compare patients who were never considered for the device.