A review of reciprocal walking systems for paraplegic patients: factors affecting choice and economic justification

The prescription of treatment systems which include orthoses to enable pati ents with high level thoracic spinal lesions to walk reciprocally is now wi dely practised. It remains a clinical option for which the efficacy is freq uently called into question. A broad range of experience has now been accum ulated with orthoses of this type, and this is reflected in the Literature. The indications for prescription and outcomes of treatment have, as a resu lt of the reported research, become clearer. However, the length of time ov er which the relevant work has been published and the variety of journals i n which it has appeared makes it difficult to perceive a coherent message. This review analyses the published work in order to identify the degree to which the therapeutic benefits which can accrue from ambulatory activity pr oduce an economically justified outcome. Provided appropriate supply proced ures are observed so that good patient compliance with the treatment is ach ieved, there is strong evidence that fewer pressure sores and improved inde pendence will occur at a level where real overall cost savings can be made. Factors which affect patient compliance and on which research findings have been published are identified. Comparisons are made between different orth oses with regard to these, so that more informed choice, taking into accoun t preferences of individual patients, can be made by clinicians.