The Influence of Parental Education on the Utilization and Quality of Life Outcomes (QoL) of Solid Ankle-Foot Orthoses in Children with Cerebral Palsy: A Comparative Study in Bangladesh

Background: Solid ankle-foot orthoses (SAFOs) are commonly prescribed to improve lower-limb alignment, stability, gait performance, and functional mobility in children with cerebral palsy (CP). However, the effectiveness of SAFOs may depend on caregiver-related factors, including parental education, which can influence adherence to orthotic use and rehabilitation recommendations. This study investigated the relationship between parental education, SAFO utilization, and quality of life among children with CP in Bangladesh.
Methods: A quantitative cross-sectional study was conducted among 100 children with CP who used SAFOs and their parents or primary caregivers at the Centre for the Rehabilitation of the Paralysed (CRP), Savar and Mirpur, Dhaka, Bangladesh, between October and November 2025. Data were collected through face-to-face interviews using a structured questionnaire. SAFO utilization was assessed using a Likert-type utilization scale, while quality of life was evaluated using cerebral palsy-specific quality-of-life domains. Descriptive statistics were used to summarize participant characteristics. The Shapiro–Wilk test assessed data normality, and non-parametric analyses, including the Kruskal–Wallis test and Spearman’s rank correlation, were performed to examine associations between study variables.
Results: The majority of children were younger than 7 years (73%), male (69%), diagnosed with spastic diplegic CP (76%), and classified as Gross Motor Function Classification System (GMFCS) Level II (91%). No statistically significant association was found between parental education level and either SAFO utilization or quality-of-life scores (p > 0.05). However, SAFO utilization demonstrated a moderate positive correlation with quality of life (ρ = 0.449, p < 0.001), indicating that greater orthosis use was associated with better perceived well-being and functional outcomes.
Conclusions: Parental education was not significantly associated with SAFO utilization or quality of life among children with CP. Nevertheless, regular and effective use of SAFOs was positively associated with improved quality of life. These findings highlight the importance of consistent orthotic follow-up, caregiver education and training, affordability of assistive devices, and family-centered rehabilitation approaches to optimize outcomes for children with CP.