The British Association of Prosthetists and Orthotists (BAPO) was established to encourage high standards of prosthetic and orthotic practice. It is committed to Continued Professional Development and education to enhance standards of prosthetic and orthotic care. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and associate members to their employers, BAPO enjoys the support of a high majority of the profession as members.
Tuesday 30 December 2014
Wednesday 24 December 2014
Satisfaction with cosmesis and priorities for cosmesis design reported by lower limb amputees in the United Kingdom: Instrument development and results
Nicola Cairns, Kevin Murray, Jonathan Corney, Angus McFadyen
Abstract
Background: Amputee satisfaction with cosmesis and the importance they place on cosmesis design have not been published in the literature.
Objectives: To investigate the current satisfaction levels of amputees in the United Kingdom with their cosmesis and the importance placed on attributes of cosmesis design to inform future cosmesis redesign.
Study Design: Cross-sectional questionnaire study.
Methods: Questionnaires were administered to lower limb amputees in the United Kingdom. Satisfaction scores and the overall importance ranking of cosmesis features were calculated. Statistically significant relationships between two demographic, satisfaction or importance variables were tested using Fisher's exact tests (one-tailed) at a significance level p = 0.05.
Results: Between 49% and 64% of respondents reported neutral or dissatisfied opinions with the cosmesis features (greater than 50% for five of the nine features). The three most important features identified were shape matching the cosmesis to the sound limb, free prosthetic joint movement underneath the cosmesis and natural fit of clothing over the cosmesis.
Conclusions: The results indicate that current cosmesis satisfaction levels of amputees in the United Kingdom are below what the medical device industry and clinical community would desire. The most important cosmesis features identified by the sample can be used to direct future cosmesis design research.
Clinical relevance The findings will enable the medical device industry to improve cosmesis design in the areas that are important to amputees. The findings also counter anecdotal opinions held by clinicians, providing an opportunity for them to evaluate any preconceptions they harbour and how this might influence their clinical work.
Tuesday 23 December 2014
Secretariat Festive Opening Hours
The Secretariat will close at 5pm on Tuesday 23 December and will re-open on Monday 5 January 2015.
The Secretariat staff would like to wish you all a very Merry Christmas and Happy New Year.
The Secretariat staff would like to wish you all a very Merry Christmas and Happy New Year.
The Management of Diabetic Foot Ulcers Through Optimal Off-Loading Building Consensus Guidelines and Practical Recommendations to Improve Outcomes
Robert J. Snyder, Robert G. Frykberg, Lee C. Rogers, Andrew J. Applewhite, Desmond Bell, Gregory Bohn, Caroline E. Fife, Jeffrey Jensen, James Wilcox
Background: We sought to develop a consensus statement for the use of off-loading in the management of diabetic foot ulcers (DFUs).
Methods: A literature search of PubMed for evidence regarding off-loading of DFUs was initially conducted, followed by a meeting of authors on March 15, 2013, in Philadelphia, Pennsylvania, to draft consensus statements and recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess quality of evidence and develop strength of recommendations for each consensus statement.
Results: Evidence is clear that adequate off-loading increases the likelihood of DFU healing and that increased clinician use of effective off-loading is necessary. Recommendations are included to guide clinicians on the optimal use of off-loading based on an initial comprehensive patient/wound assessment and the necessity to improve patient adherence with off-loading devices.
Conclusions: The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care.
Monday 22 December 2014
Effects of Custom-Molded and Prefabricated Hinged Ankle-Foot Orthoses on Gait Parameters and Functional Mobility in Adults with Hemiplegia: A Preliminary Report
Pardo, Vicky; Galen, Sujay; Gahimer, Julie E.; Goldberg, Allon
JPO Journal of Prosthetics & Orthotics:
January 2015 - Volume 27 - Issue 1 - p 33-38
doi: 10.1097/JPO.0000000000000053
Abstract
Introduction: Hinged ankle-foot orthoses (AFOs) have been shown to improve gait and functional mobility in both adult and pediatric populations with neurological disorders. Hinged AFOs provided to clients can either be prefabricated or custom-made. To date, there have been no studies comparing a custom-made articulated AFO (C-AFO) with a prefabricated articulated AFO (P-AFO) and the effects that they have on gait and functional mobility in individuals with hemiplegia after a stroke.
Materials and Methods: The purpose of this study was to determine if there were any differences in the gait and functional mobility parameters of patients with hemiplegia when wearing the C-AFO or the P-AFO and also to determine if there was a difference in the braced versus not-braced conditions. Fourteen participants with hemiplegia completed tests that assessed spatiotemporal gait parameters using the GAITRite walkway. In addition, participants completed tests to assess weight-bearing symmetry during sit-to-stand (using the Balance Master), stepping capabilities using the maximal step length (MSL) test, and functional mobility using the timed up and go test (TUG). Data were analyzed using a repeated measures analysis of variance with Bonferroni adjustments for multiple comparisons.
Results: There were no significant differences (P > 0.05) between the two braced conditions for the gait parameters, the TUG, the sit-to-stand symmetry, and the MSL. There were significant differences between the braced (C-AFO or P-AFO) and the shoes-only conditions for the gait parameters (gait speed, stride length, step length, and gait symmetry of the uninvolved leg) and for the functional mobility assessments (TUG and MSL-involved leg).
Conclusions: This preliminary study has shown that there was no significant difference in any of the gait or functional mobility parameters when wearing the C-AFO or the P-AFO, provided that the P-AFO provides optimal support and fits the individual's anatomical dimensions well. Significant differences in both gait and functional mobility measures were observed between the shoes-only and braced conditions. The results of this study also demonstrated that wearing a hinged AFO does contribute to a better gait and functional mobility in people who have had a stroke.
Friday 19 December 2014
WHO/Europe | Rehabilitation: key to an independent future for children with poliomyelitis in Tajikistan
Representatives of the Ministry of Health and Social Protection and a WHO disability-rehabilitation team in Tajikistan in collaboration with representatives of the International Society of Prosthetics and Orthotics conducted follow-up activities from 22 September to 8 October 2014 to support the implementation of intervention and follow-up plans for children and adults with chronic paralysis caused by poliomyelitis (polio). The plans were developed in March 2014 at rehabilitation camps organized to assess the needs of people, mostly children, who had contracted polio during a large outbreak in Tajikistan in 2010.
Working with the Ministry of Health and Social Protection, the team met children and adults with polio, visited the republican orthopaedic centre, trained doctors in 3 locations and visited the Department of Traumatology of Karabolo Hospital in Dushanbe.
As the main outcomes of the mission, the team:
- described the importance of continuous referral and follow-up for children with polio;
- provided the first training in Tajikistan on postoperative rehabilitation therapy;
- trained local orthopaedic surgeons in 12 complicated operative procedures;
- technically monitored 24 children’s orthoses (externally applied devices designed for and fitted to the body) and suggested corrective measures; and
- helped design a system for guaranteed regular follow-up of children with polio.
A member of the rehabilitation team said that timely rehabilitation interventions – such as physical therapy, occupational therapy, orthoses, wheelchairs, crutches and, if required, surgery – can make tremendous changes in the life of a person with polio. Using polio as an entry point, the aim was to build a system of rehabilitation for all people with disabling conditions that will help give them equal opportunities and a greater chance to live life with dignity.
Long-term effects of paralysis due to polio
After the first, six-month, acute stage of polio, gradual recovery of some muscle strength is possible with the help of gentle exercises and positioning. After 2–3 years, however, further significant recovery of muscle strength is unlikely. At this point, rehabilitation interventions with assistive devices can greatly contribute to functional independence.
All of the children who contracted polio during the 2010 outbreak are now in this chronic phase of rehabilitation, which will last for the rest of their lives.
Looking to the future
The recent mission comprised the second phase of a three-year project focused on community-based rehabilitation of people with disabilities and the development of human resources in this field. The project is supported by the United States Agency for International Development (USAID). In the first phase (March 2014), the team assessed 360 people with polio, mostly children, who represented the majority of known confirmed cases with paralysis due to the 2010 outbreak, and developed rehabilitation plans to address their needs.
These plans include therapeutic interventions and the identification of appropriate assistive devices. In choosing exercises and assistive devices, the aim is always to ensure the maximum of independence, comfort and confidence with the minimum of support. Many of the children may also require operations to correct or prevent deformities, although giving urgently needed orthotic and physiotherapy interventions now can decrease some children’s need for surgery in the next few years.
Tuesday 16 December 2014
Indicators of Future Ulceration in Diabetes Patients of Low-Moderate Foot Risk
Davida Louise O'Brien, Claire M. Buckley, Frank Hill, Maria Horgan, Ivan J. Perry and Magdalena Tyndyk
Abstract
Background & Aim: Diabetes Mellitus can cause serious health problems including foot complications. Peripheral neuropathy affects the outer appendages, most commonly the lower limbs. Ulceration of the feet has a high possibility of advancement to amputation; thus greatly diminishing quality of life. This study investigates if patients with diabetes, who are at low-moderate risk of foot disease, have any underlying biomechanical signs which may indicate that they are at risk of future ulceration.
Methods: Twenty patients with Diabetes Mellitus at low-moderate risk of foot disease and 32 healthy individuals participated in this study. All participants completed a self-administrated questionnaire (assessing sociodemographic
and lifestyle factors) and underwent a clinical foot screening examination (plantar sensation, pedal pulses and ankle range of motion), gait assessment (spatio-temporal parameters) and barefoot plantar pressure analysis. Results between the 2 groups were compared.
Results: Major differences were observed in area of plantar pressure distribution, walking speed and foot alignment between low-moderate risk participants with diabetes and healthy controls. Low-moderate risk participants with diabetes recorded elevated dynamic plantar pressure in regions of metatarsal heads and the heel. Plantar pressure was correlated with arch type and foot alignment (p<0.05). Dissimilarities were not observed for lifestyle behavior and ankle range of motion.
Conclusion: This pilot study demonstrated a group of patients with diabetes at low-moderate risk of foot disease showing significant differences in biomechanical measures that are linked to callus/ulcer formation. Risk factors for ulceration previously reported for high risk patients with diabetes also affect patients with low-moderate foot risk.
Saturday 6 December 2014
Biomechanical Effects of Valgus Knee Bracing: A Systematic Review and Meta-Analysis
- Rebecca F. Moyer, PT, PhDa,
- Trevor B. Birmingham, PT, PhDa, , (Dr.),
- Dianne M. Bryant, PhDa,
- J.Robert Giffin, MD, FRCS(C)b,
- Kendal A. Marriott, BScKinc,
- Kristyn M. Leitch, PhDd
Abstract
Objective
To review and synthesize the biomechanical effects of valgus knee bracing for patients with medial knee osteoarthritis.
Methods
Electronic databases were searched from their inception to May 2014. Two reviewers independently determined study eligibility, rated study quality and extracted data. Where possible, data were combined into meta-analyses and pooled estimates with 95% confidence intervals (CI) for standardized mean differences (SMD) were calculated.
Results
Thirty studies were included with 478 subjects tested while using a valgus knee brace. Various biomechanical methods suggested valgus braces can decrease direct measures of medial knee compressive force, indirect measures representing the mediolateral distribution of load across the knee, quadriceps/hamstring and quadriceps/gastrocnemius co-contraction ratios, and increase medial joint space during gait. Meta-analysis from 17 studies suggested a statistically significant decrease in the external knee adduction moment during walking, with a moderate-to-high effect size (SMD=0.61; 95%CI: 0.39, 0.83; p<0.001). Meta-regression identified a near-significant association for the knee adduction moment effect size and duration of brace use only (β, -0.01; 95% CI: -0.03, 0.0001; p=0.06); with longer durations of brace use associated with smaller treatment effects. Minor complications were commonly reported during brace use and included slipping, discomfort and poor fit, blisters and skin irritation.
Conclusions
Systematic review and meta-analysis suggests valgus knee braces can alter knee joint loads through a combination of mechanisms, with moderate-to-high effect sizes in biomechanical outcomes.
Keywords
- knee osteoarthritis;
- valgus knee brace;
- biomechanics;
- knee adduction moment;
- systematic review;
- meta-analysis
Thursday 4 December 2014
Guy's and St Thomas' NHS Foundation Trust, x2 Orthotists, London
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