what-when-how
In Depth Tutorials and Information
7
urement, but generally ignores depth. Patients can usually understand
what is meant by width but may not understand the concept of depth
unless it is demonstrated by the practitioner. Owing to the differences in
the lasts used for different footwear and even differences in international
sizing, there is lack of standardization. This makes it difficult for patients
to be able to identify for themselves footwear which is suitable for their
foot health and their needs in respect of footwear usage. To address this
problem a Footwear Suitability Scale was developed (
Nancarrow 1999
)
specifically for patients with diabetes. This has proven to be a useful tool
in practice in non-diabetic patients and as an educational tool in ensuring
that practitioners are able to identify, rationalize and explain the impor-
tance of each part of the shoe when providing advice for the patient (see
Table 6.2).
Evaluation of specialist therapeutic footwear
The 'Monitor Orthopaedic Shoes' (MOS) (see Appendix) has been devel-
oped and validated by a team in the Netherlands (van Netten et al) based
on previous work by Jannink (2005 and 2004). The MOS is a short and
easy to complete questionnaire that aims to measure the most relevant
aspects of use and usability from a patient's perspective, for all patients
to whom this footwear is provided - independent of disorder. MOS is an
evaluation instrument that can be used on two levels: first, it can measure
expectations (prior to prescription) of, experiences with, and use and
usability of footwear; second, the practitioner can use MOS as an evalu-
ation instrument that can help in identifying problems with footwear on
an individual level prior to provision or after wear. Insight into the use
and usability of footwear on both levels may lead to better identification
of problems related to usability, increasing patient satisfaction and rates
of use.
During the development of MOS, the emphasis has been placed on
the content validity of the evaluation instrument. Good content validity
increases motivation and reduces dissatisfaction among users (practition-
ers) and respondents (patients), and makes it more likely that other
stakeholders (such as policymakers and health insurance companies)
accept the results.
MOS can be used to gain an insight to patients' opinions on measured
aspects of use and usability separately. MOS was specifically designed
for first-time users. The difference between first-time and experienced
users is essential in the interpretation of outcomes of MOS. First-time
users compare their (future) pair of orthopaedic shoes (OS) with their
normal shoes, whereas experienced users compare their new pair of OS
