Predicting adherence to ankle-foot orthoses in people with stroke: an application of the theory of planned behaviour

Background: Ankle-foot orthoses (AFOs) are often prescribed for people with stroke to address motor impairment. However, not all patients adhere to using their AFOs as prescribed. Predictors of AFO adherence are likely to constitute useful targets for interventions that aim to promote this behavior. Objective: To identify the predictors of AFO adherence in people with stroke using an established theoretical framework, namely the Theory of Planned Behavior (TPB; Ajzen, 1991). Study design: Prospective survey design. Method: N = 49 people who had been prescribed an AFO after a stroke completed a TPB questionnaire. One month later, they completed another questionnaire that measured adherence to AFOs as prescribed by an orthotic practitioner. Predictors of intention and AFO-adherence behavior were identified using regression analyses. Results Adherence to AFOs was 63%. The TPB accounted for 61% of the variance in intentions and 43% of the variance in AFO-adherence behavior. Attitude and perceived behavioral control were predictors of intention, and intention was the sole predictor of behavior. Conclusion The TPB is a useful model for explaining adherence to AFOs in people with stroke. Interventions could be designed to increase intentions to use an AFO as prescribed by promoting positive attitudes towards, and perceived behavioral control of AFO adherence.