Consultation on ensuring fair and transparent pricing for NHS services

A  consultation to help ensure fair and transparent pricing for NHS services is opened today by the Department of Health.

From April 2014, Monitor and the NHS Commissioning Board will take over responsibility for pricing NHS services from the Department. They will do this through the national tariff. These arrangements will place responsibility for pricing with the bodies best placed in the new system to undertake it.

This consultation seeks views on the Department of Health's proposals for:

• which providers can formally object to Monitor's way of calculating prices
• what level of objections from commissioners and/or providers would require Monitor to: reconsider how it calculates prices, or refer its way of calculating prices to the Competition Commission, who will then decide whether or not it is appropriate.

• Respond to the consultation online
• Read Fair and transparent pricing for NHS services – A consultation on proposals for objecting to proposed pricing methodology
• Download consultation response form
• Read answers to frequently asked questions for this consultation

The closing date for responses is 21 December 2012.

This consultation should be considered alongside current consultations on a new licensing regime for providers of NHS services and procurement regulations for NHS commissioners.

Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare

Role of ankle foot orthoses in the outcome of clinical tests of balance, Disability and Rehabilitation: Assistive Technology, Informa Healthcare

Nilovana Panwalkar, Alexander S. Aruin

Purpose: The purpose of this study was to investigate the effect of ankle foot orthoses (AFOs) on the outcome of balance assessment. Methods: Ten healthy subjects participated in clinical tests of balance with and without bilateral ankle foot orthoses (AFOs). The following clinical tests were performed: the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), the Limits of Stability (LOS) and the Functional Reach test. Results: A statistically significant effect of AFOs was seen in the outcomes of the MCTSIB test (p = 0.042), LOS test (p = 0.021) and Reach test (p = 0.003). Conclusions: The results indicate that the use of AFOs may impede the performance of clinical tests of balance. This outcome should be taken into consideration while performing balance evaluations with patient populations in the clinic.

Implications for Rehabilitation

• Ankle foot orthoses (AFOs) are effective means of improving ambulation in patients.
• The use of AFOs may influence the outcome of clinical tests of balance.
• The role of AFOs should be taken into consideration while performing balance evaluations in the clinic.

Source: http://informahealthcare.com/doi/abs/10.3109/17483107.2012.721158

Clustering and classification of regional peak plantar pressures of diabetic feet

• Craig J. Bennetts
, 
• Tammy M. Owings
, 
• Ahmet Erdemir
, 
• Georgeanne Botek
, 
• Peter R. Cavanagh

Journal of Biomechanics

Accepted 7 September 2012. published online 22 October 2012. 
Corrected Proof

Abstract 

High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole. In the past, emphasis has primarily been placed on the identification of individual focal areas of elevated pressure. The goal of this study was to utilize k-means clustering analysis to identify typical regional peak plantar pressure distributions in a group of 819 diabetic feet. The number of clusters was varied from 2 to 10 to examine the effect on the differentiation and classification of regional peak plantar pressure distributions. As the number of groups increased, so too did the specificity of their pressure distributions: starting with overall low or overall high peak pressure groups and extending to clusters exhibiting several focal peak pressures in different regions of the foot. However, as the number of clusters increased, the ability to accurately classify a given regional peak plantar pressure distribution decreased. The balance between these opposing constraints can be adjusted when assessing patients with feet that are potentially "at risk" or while prescribing footwear to reduce high regional pressures. This analysis provides an understanding of the variability of the regional peak plantar pressure distributions seen within the diabetic population and serves as a guide for the preemptive assessment and prevention of diabetic foot ulcers.

Source: http://www.jbiomech.com/article/S0021-9290(12)00521-0/abstract

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

• J. Boudarham
, 
• R. Zory
, 
• F. Genet
, 
• G. Vigné
, 
• D. Bensmail
, 
• N. Roche
, 
• D. Pradon

Received 1 February 2012; accepted 17 September 2012. published online 16 October 2012. 

Abstract 

Background

A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.

Methods

Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.

Findings

The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.

Interpretation

Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.

Keywords: Kinematic, Kinetic, Spatiotemporal, Hyperextension, Stance and swing phase

Source: http://www.clinbiomech.com/article/S0268-0033(12)00226-4/abstract

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BAPOmag 2012 Issue 3

BAPOmag 2012 Issue 3 Now available and BAPO Members can download the latest issue from the Members section of our website.

www.bapo.com

Bionic limbs

www.bbc.co.uk/news/health-17153052

Anatomical Origin of Forefoot Varus Malalignment

1. Rebecca S. Lufler, PhD*, 
2. T. M. Hoagland, PhD†, 
3. Jingbo Niu, MD, DSc‡and 
4. K. Douglas Gross, PT, DSc‡

Abstract

Background: Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus.

Methods: Forty-nine feet from 25 cadavers underwent bilateral measurement of forefoot alignment using adapted clinical methods, followed by dissection and measurement of bony talar torsion. The relationship between forefoot alignment and talar torsion was determined using the Pearson correlation coefficient.

Results: Mean ± SD forefoot alignment was −0.9° ± 9.8° (valgus) and bony talar torsion was 32.8° ± 5.3° valgus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, −0.11 to 0.44; P = .22).

Conclusions: These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus. (J Am Podiatr Med Assoc 102(5): 390–395, 2012)

Source: http://www.japmaonline.org/content/102/5/390.short