Improving Compliance with the Use of Ankle Foot Orthosis in Children with Cerebral Palsy through a Family-Based Health Promotion Model: Systematic Literature Review
DOI:
https://doi.org/10.54832/phj.v7i2.1490Keywords:
cerebral palsy, ankle foot orthosis, family-based health promotion, adherence, caregiver, systematic literature reviewAbstract
This study aims to systematically synthesize the characteristics, components, theoretical framework, determinants, barriers, effectiveness, and research gaps related to family-based health promotion models in improving compliance with the use of ankle foot orthosis (AFO) in children with cerebral palsy (CP). The method used is Systematic Literature Review (SLR) with the PRISMA 2020 approach through a search of the Scopus database using keywords related to Family Health Promotion, Orthosis Use Adherence, and Pediatric Cerebral Palsy. Of the 659 initial articles, 71 main studies and 2 additional sources met the inclusion criteria to be analyzed through thematic synthesis and narrative integrative review. The results show that there is no single model that specifically integrates family-based health promotion to improve adherence to the use of AFO in CP children, but the literature provides a strong foundation through Family Systems Theory, Pender's Health Promotion Model, WHO Adherence Model, caregiver empowerment, personalized orthotic care, and digital health support. Key factors influencing compliance include family support, caregiver burden, self-efficacy, device comfort, health system, and social environment. In conclusion, improving compliance with the use of AFO requires an integrative approach that places the family at the center of health promotion, as well as opening up opportunities for the development of new conceptual models that are more comprehensive, personalized, and sustainable.
Downloads
References
Aguila, A., et al. (2026). Gamified family-centered digital health promotion interventions for child and family engagement.
Alaazi, D. A., Salami, B., et al. (2022). Mobilizing communities and families for child mental health promotion in Canada.
Alcantara, A. B., de Lima, L., et al. (2022). Child health promotion from the perspective of family health strategy nurses.
Arkar Silan, M., et al. (2025). Personalized musculoskeletal management and rehabilitation trajectories in children with cerebral palsy.
Arana-rivera, P., Nova-díaz, D. M., Eduardo, S., & Aguilera-albesa, S. (2025). The economic and social burden of pediatric cerebral palsy in Spain : a cost-of-illness study.
Bae, E., & Choi, E. K. (2025). Development of an integrated health promotion program for school-age children from vulnerable families in South Korea : a methodological study. 31(2), 107–119.
Bła, M. (2024). Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy : A Progress Evaluation.
Cheng, Y., Bailly, R., & Scavinner-dorval, C. (2022). Comprehensive personalized ankle joint shape analysis of children with cerebral palsy from pediatric MRI. di(November), 1–9. https://doi.org/10.3389/fbioe.2022.1059129
Dimitrova, R., & Brin, M. F. (2023). Treatment of pediatric spasticity, including children with cerebral palsy, with Botox (onabotulinumtoxinA). 1(December 2022).
Hammersley, M. L., Hedges, J., et al. (2022). Strategies to support sustained participant engagement in family health promotion studies.
Ho, Y. L., Mahirah, D., Ho, C. Z., & Thumboo, J. (2022). The role of the family in health promotion : a scoping review of models and mechanisms. 1–14.
Khaninezhad, L., Valiee, S., Moradi, Y., & Mahmoudi, M. (2024). The effect of a caring program based on the Pender ’ s health promotion model on caregiver burden in family caregivers of patients with chronic heart failure : A quasi ‑ experimental study. https://doi.org/10.4103/jehp.jehp
Kuchler, M., Rauscher, M., & Rangnow, P. (2022). Participatory Approaches in Family Health Promotion as an Opportunity for Health Behavior Change — A Rapid Review.
Laviolette, C., Johnson, C. M., et al. (2023). Nutrition effects of a family-centered health promotion program for children.
Li, J., Cheng, L., Tu, L., Wang, X., Wei, Y., Shen, F., Wang, J., & Chen, B. (2026). Connotation and Mechanism of Family Support for Patients with Chronic Diseases Under the Perspective of Health Promotion – A Scoping Review of Reviews. (February).
Lohrasebi, F., Maghsoudi, J., Mousa, A., & Akbari, M. (2023). The Effect of the Web ‑ Based Psychosocial Health Promotion Program on the Burden of Care in Family Caregivers of Patients with Chronic Mental Disorders. https://doi.org/10.4103/ijnmr.ijnmr
Mahmood, A., et al. (2024). Caregiver-delivered home-based rehabilitation interventions in children with cerebral palsy.
Mehri, S. M., Hashemian, M., et al. (2023). The effect of web-based family-centered empowerment program based on the Health Promotion Model.
Mei, H., Yang, L., et al. (2022). Genetic spectrum identified by exome sequencing in a pediatric cerebral palsy cohort.
Merino-Andrés, J., Hidalgo-Robles, Á., Pérez-Nombela, S., et al. (2022). Tool use for early detection of cerebral palsy: A survey of pediatric physical therapists.
Nielsen, K. K., Dahl-petersen, I. K., Jensen, D. M., Damm, P., Ovesen, P., Mathiesen, E. R., Kampmann, U., Vinter, C. A., Knorr, S., Andersen, L. L., Davidsen, E., Jensen, N. H., Aalders, J., Thøgersen, M., Timm, A., Støvring, H., & Maindal, H. T. (2025). Effectiveness of a Family-based Health Promotion Intervention for Women With Prior GDM : The Face-It RCT. The Journal of Clinical Endocrinology & Metabolism, 110(8), 2456–2470. https://doi.org/10.1210/clinem/dgae856
Nova-Díaz, M., et al. (2025). Economic and caregiver burden in families of children with cerebral palsy.
Park, S. I., & Cho, I. Y. (2022). Factors affecting parent health-promotion behavior in early childhood according to family cohesion.
Pimentel, V. R. M., de Sousa, M. F., et al. (2022). Health communication and health promotion in family health strategy.
Pirallahi, Z., Alavi, M., Akbari, M., & Aliyari, N. (2025). The effectiveness of mental health perceived stress and social health of family caregivers of chronic psychiatric. https://doi.org/10.4103/jehp.jehp
Rasadurai, A., Frank, N., Greuter, L., et al. (2023). Patient- and caregiver-reported outcome measures after selective dorsal rhizotomy in pediatric cerebral palsy.
Rodrigues, A. S., et al. (2025). Caregiver psychosocial resilience and health promotion outcomes.
Rticle, C. R. A. (2022). Factors affecting orthosis adherence after acute traumatic hand tendon repairs : A prospective cohort study dem Aydo g an MD. 35, 32–40. https://doi.org/10.1016/j.jht.2020.10.005
Saeedi, M., Macdermid, J. C., Ferreira, L., & Johari, S. (2026). Exploring patient interpretation of an orthosis adherence checklist : A cognitive interview study. 1–16. https://doi.org/10.1371/journal.pone.0344771
Sala, D. A., & Del Rosario, E. (2025). Effectiveness of botulinum toxin and ease of care outcomes in severe cerebral palsy.
Savaş, S., & Aydoğan, Ç. (2022). Factors affecting orthosis adherence after acute traumatic hand tendon repairs.
Selanne, L., et al. (2024). Gamified intervention for health promotion of families in child health clinics.
Simpson, E. A., Saiote, C., Sutter, E., et al. (2022). Remotely monitored transcranial direct current stimulation in pediatric cerebral palsy.
Takahashi, K., Mizukami, M., Watanabe, H., Kuroda, M. M., Shimizu, Y., Nakajima, T., Mutsuzaki, H., Kamada, H., Tokeji, K., Hada, Y., Koseki, K., Yoshikawa, K., Nakayama, T., Iwasaki, N., Kawamoto, H., Sankai, Y., Yamazaki, M., Matsumura, A., & Marushima, A. (2023). Feasibility and safety study of wearable cyborg Hybrid Assistive Limb for pediatric patients with cerebral palsy and spinal cord disorders. (November), 1–9. https://doi.org/10.3389/fneur.2023.1255620
Tanyanyiwa, A. T., et al. (2025). Voluntary sector roles in health promotion and social inclusion for families.
Tenaglia, A., Azizi, H., & Kim, H. (2022). A pediatric physiatrist’s approach to neuromuscular hip dysplasia in cerebral palsy.
Thaine, H., & Rodrigues, B. (2025). Perceptions of Family Health Strategy doctors and nurses on the promotion of adequate and healthy eating practices in light of the Dietary Guidelines , Santa Bárbara d ’ Oeste , 2022 : qualitative study.
Uysal, H. H., Ozel, C. B., Sel, S. A., Fidan, H., Burc, E., Erdem, S., & Gunel, M. K. (2025). Experiences of pediatric physiotherapists on the use of walking orthoses in children with cerebral palsy. 40(August).
Wang, H., Lu, Y., Dong, X., Yang, H., & Zhou, W. (2021). Genetic Spectrum Identified by Exome Sequencing in a Chinese Pediatric Cerebral Palsy Cohort. The Journal of Pediatrics, 242, 206-212.e6. https://doi.org/10.1016/j.jpeds.2021.11.019
Weniger, M., Beesdo-Baum, K., Ernst, J., et al. (2024). Preventive health chains and family-centered pediatric care systems.
