Hospital Directions show: November 21-22, 2012

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Hospital Directions show: November 21-22 Hospital Directions Show 21-22 November Olympia, London http://www.hospitaldirections.co.uk/ The NHS is going through significant change with high expectations for improved efficiency and savings. NHS Chief Executive David Nicholson set the organisation a massive challenge to deliver savings of £20bn by 2015, at the same time as the government launched the biggest reform of healthcare services since the inception of the NHS. It has left hospitals desperately trying to manage rising demand against the backdrop of a real-terms cut to funding. The new structures in primary care mean that hospitals are forging fresh relationships with commissioners, who are in turn under pressure to deliver more health services in the community and nearer to people's homes. In the past, when such funding challenges have arisen, services have been slashed, waiting lists increased and training and quality compromised. But with an ageing population, increasing levels of obesity, and rising expectations, the NHS can't afford such short sighted solutions. Secondary care will not survive this squeeze and reform unchanged. However, investment in prevention, improvement, information and infrastructure during these tough times could make frontline hospital services more productive in the future. Now the need for strong leadership and efficiency improvement is greater than ever. Offering comprehensive speaker streams on Innovation, Efficiency and Leadership, Hospital Directions will bring senior hospital managers together from the fields of patient services, human resources, information technology, estates management and procurement to listen to – and share – best practice. Experts will speak on service redesign, integration and innovation; improved use of information, evidence and technology; new approaches to leadership, recruitment and performance management; flexible and efficient estates and facilities management; and progressive procurement and use of the private sector. Six speaker streams run over two days, jam-packed with seminars, and supported by an exhibition, and will bring managers together from across the different disciplines and from all around the country. Tickets for Hospital Directions are being offered free up to 10 individuals for their hospitals. Register now at www.hospitaldirections.co.uk/register

BAPO Practical orthotic assessment course

BAPO Practical orthotic assessment and is due to run on 20^th October 2012 and is aimed at developing upon the

required skills for graduate orthotists and is to be held at Peacocks in Newcastle upon Tyne.

Download your application form here

SPINAL IMAGING IN PATIENTS WITH INFANTILE AND JUVENILE IDIOPATHIC SCOLIOSIS: IS ROUTINE MAGNETIC RESONANCE IMAGING INDICATED?

K. O'Shea, H. Mullett, C. Goldberg, D. Moore, E. Fogarty and F. Dowling.

Author Affiliations

Abstract

Surgical correction of spinal deformity in patients with neural axis abnormalities has established risks of causing further neurological injury. It is necessary to identify individuals with a predisposition for such abnormalities before treatment is instituted.

Objective: Examination of the association between idiopathic scoliosis and underlying neural axis abnormalities in the infantile and juvenile age groups.

Design: Retrospective chart and radiographic review.

Subjects: Ninety-four (36 infantile, 58 juvenile) consecutive patients with non-congenital scoliosis under the age of eleven years.

Outcome measures: These consisted of the MRI findings, neurological examination, associated curve morphology and necessity for neurosurgical intervention or surgical curve correction.

Results: Approximately 25% of patients presenting as idiopathic juvenile scoliosis had underlying neural axis abnormalities. No patient with apparent infantile idiopathic scoliosis had an abnormal spinal MRI scan. Using the Z score for independent proportions, there was a statistically significant difference between infantile and juvenile scoliosis and the presence of an underlying neural axis abnormality (Z score of 2.089, equivalent to p<0.02).

Conclusions: We advocate routine MR spinal imaging in all patients with juvenile idiopathic scoliosis. In infantile idiopathic scoliosis, to avoid unnecessary general anaesthetics, one should image the spinal canal only when clinically indicated.

http://www.bjjprocs.boneandjoint.org.uk/content/84-B/SUPP_III/336.5.abstract

An advanced virtual model of the human foot has been created by researches to drive forward improvements in treating serious injuries and illness.

The 3D model depicts bones, joints, ligaments, muscles and tendons in an unprecedented level of detail.

Continue reading the main story

"Start Quote

The Glasgow/Maastricht foot is a game-changer"

Prof Jim WoodburnGlasgow Caledonian University

It will be used to develop advanced treatments for conditions ranging from foot and ankle problems to amputations.

The 3.7 million euro a-footprint project is being led by Glasgow Caledonian University (GCU).

The human foot is particularly difficult to model because of its complexity.

Researchers worked in partnership with the Maastricht University and Danish biomechanical firm AnyBody Technology on what had been named the Glasgow/Maastricht Foot Model.

It is estimated that 200 million Europeans suffer from disabling foot and ankle conditions and the model should lead to more efficient orthotic devices, cutting recovery times and reducing symptoms.

It will also have aplications in treating flat feet or foot drop - which prevents recovering stroke patients from moving their ankles and toes.

GCU's Professor Jim Woodburn, who is the project co-ordinator, said: "Previous to this development, most computer models of the human body ended in a black rectangle - the foot was simply too complicated to model. The Glasgow/Maastricht foot is a game-changer.

"It opens the door to a huge range of applications, including the manufacture of better and more efficient orthotics, resulting in quicker recovery times, reduced symptoms and improved functional ability for those suffering from conditions which afflict the foot and lower leg."

The simulation can be used to test potential cures as well as developing new orthotic devices, using 3D printing techniques.

Source: http://www.bbc.co.uk/news/uk-scotland-glasgow-west-19660736

Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature

1. Mihai Bragaru, Rienk Dekker, Jan HB Geertzen

Abstract

Background: Sport prostheses are used by both upper- and lower-limb amputees while participating in sports and other physical activities. Although the number of these devices has increased over the past decade, no overview of the peer reviewed literature describing them has been published previously. Such an overview will allow specialists to choose appropriate prostheses based on available scientific evidence rather than on personal experience or preference.

Objective: To provide an overview of the sport prostheses as they are described by the papers published in peer reviewed literature.

Study Design: Literature review.

Methods: Four electronic databases were searched using free text and Medical Subject Headings (MESH) terms. Papers were included if they concerned a prosthesis or a prosthetic adaptation used in sports. Papers were excluded if they did not originate from peer reviewed sources, if they concerned prostheses for body parts other than the upper or lower limbs, if they concerned amputations distal to the wrist or ankle, or if they were written in a language other than English.

Results: Twenty-four papers were included in this study. The vast majority contained descriptive data and consisted of expert opinions and technical notes.

Conclusion: Data concerning the energy efficiency, technical characteristics and special mechanical properties of prostheses or prosthetic adaptations for sports, other than running, are scarce.

Clinical relevance An overview of the peer reviewed literature will enable rehabilitation specialists working with amputees to choose a prosthesis that best suits their patients' expectations on the available scientific evidence. Identifying the information gaps present in the peer reviewed literature will stimulate new research and eventually broaden the base of scientific knowledge.

Source: http://poi.sagepub.com/content/36/3/290.abstract

 

Development of a simple stance-control system for persons with poliomyelitis and an associated gait analysis

Nakanishi, Y. Kato, N. ;  Wada, F. ;  Hachisuka, K. ;  Watanabe, Y. ; Okumura, K. ;  Arai, M. 

ABSTRACT

A simple stance-control system (SSCS) was developed, which is a new device attached to the upper lateral frame of a carbon fiber-reinforced plastic knee-ankle-foot orthosis (carbon KAFO). The SSCS consisted of two pressure sensors beneath the heel and metatarsal phalangeal joints, connecting cables, microcomputer, motor controlling the lever of Swiss-lock knee joint, and battery box. Normally the SSCS is off, and the Swiss-lock knee joint is mechanically fixed in the extended position, whereas the SSCS is on during the swing phase according to the information from the pressure sensors, and the Swiss-lock knee joint is released by pulling up the lever. Therefore, a patient using a carbon KAFO with SSCS can flex his/her knee joint during the swing phase and to maintain it in the extended position during the stance phase. The safety while using the SSCS was confirmed in four healthy men and the gait pattern was measured by using a three-dimensional motion analysis and force plate system. These results revealed that the SSCS attached to a carbon KAFO did not unlock the Swiss-lock knee joint on the five conditions in daily living activities, and enabled a patient to control his/her lower limb during the stance phase and flex it during the swing phase.

Source:  http://ieeexplore.ieee.org/xpl/articleDetails.jsp?arnumber=6275704

On page(s): 169
Conference Location :  Kobe
Print ISBN: 978-1-4673-1617-0
INSPEC Accession Number: 12948666
Digital Object Identifier :  10.1109/ICCME.2012.6275704
Date of Current Version :   23 August 2012
Issue Date :   1-4 July 2012

Functional Gait Analysis Before and After Delayed Military Trauma-Related Amputation A Report of Three Cases

Barri L. Schnall, MPT, LT Scott C. Wagner, MD, Jenna D. Montgomery, BS, Marilynn Wyatt, PT, MA,

and MAJ Benjamin K. Potter, MD

The current conflicts in Iraq and Afghanistan have produced

a large number of service members with severe

combat-related injuries. Eighty-two percent of service

members with combat-related injuries have sustained extremity

trauma, which accounts for 54% of wounds overall1.

Of all the lower-extremity amputations performed at military

treatment facilities, approximately 13% (125 of 975) were the

result of delayed or ''elective'' procedures2. Recent studies have

shown that the outcomes of extensive salvage procedures for

severely injured limbs are not necessarily definitive in a nonmilitary

population3 and that early amputation can be preferable

to limb salvage in many such instances3-12.

Some military and nonmilitary population studies have

considered a delayed amputation as occurring within as little as

twenty-four hours postinjury, while other studies have cited a

range over years4,13,14. Up to 15% of combat-related amputations

have occurred later than twelve weeks postinjury, and the military

medical community has adopted this as a reasonable timeframe

during which initial operative efforts at limb salvage can be attempted

2,14. Given the incidence of trauma-related amputation in

the active duty military population, as well as the likely underreported

frequency of similar scenarios in civilian trauma settings

3,8,15-17, the goal of this report is to provide an analysis of gait in

combat-injured patients before and after delayed amputation.

Our institutional review board approved the retrospective review

of the data presented in this manuscript. The three patients included

in this case series were informed that data would be submitted

for publication, and they all gave consent.

Source: http://caseconnector.jbjs.org/data/Journals/JBJSCC/4401/CC_02_01_00073.pdf

Oscar Pistorius could have run with longer blades at the Paralympics, says prosthetics supplier - Telegraph

Oscar Pistorius could have run with longer blades at the Paralympics, says prosthetics supplier - Telegraph
A clinical prosthetics specialist for the company that supplies both Oscar Pistorius and Alan Oliveira with their running blades says Pistorius would have been perfectly within his rights to experiment with longer blades at the Paralympics to achieve greater speed.

Read more

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated wa...

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated walking - Corrected Proof

via Gait & Posture - Articles in Press by Kota Watanabe, Harold B. Kitaoka, Tadashi Fujii, Xavier Crevoisier, Lawrence J. Berglund, Kristin D. Zhao, Kenton R. Kaufman, Kai-Nan An on 8/31/12

Highlights: ► We examined the flatfoot motion utilizing a dynamic foot-ankle simulator. ► Magnetic tracking system monitored the cadaver foot bone movements 3-dimensionally. ► Kinematics in the intact condition were consistent with normal gait analysis data. ► Kinematics altered in the flatfoot condition in coronal and transverse planes. ► The simulated flatfoot was consistent with patients data with flatfoot.Abstract: Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot–ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.

AGE OF DIAGNOSIS AND PROGNOSIS OF IDIOPATHIC SCOLIOSIS UNRELATED TO INFORMATION ON HEREDITY

A Grauers a , b , A Danielsson c , MK Karlsson d and P Gerdhem a

Author Affiliations

paul.gerdhem@karolinska.se

Abstract

Purpose To compare information on heredity among patients with idiopathic scoliosis.

Methods 1440 patients with idiopathic scoliosis were recruited. Information on prevalence of scoliosis among relatives was obtained by questionnaire.

Results 1256 (87%) were women and 184 (13%) were men. 204 (14%) of the participants were juvenile (4-9 yrs) at time of diagnosis. 1236 (86%) were adolescents (10-19 yrs) at time of diagnosis.

141 of the 204 patients (69%) with juvenile scoliosis had been treated (73 brace, 68 surgery) and 817 of the 1236 patients (66%) with adolescent scoliosis had been treated (490 brace, 327 surgery).

23% had at least one parent and 13% had at least one grandparent with scoliosis. When comparing female and male patients there was no difference in proportion of parents with scoliosis (p=0.97, Chi-square) or grandparents with scoliosis (p=0.35). 26% of patients with juvenile scoliosis had at least one parent with scoliosis compared to 22% for patients with adolescent scoliosis (p=0.23). 18% of patients with juvenile scoliosis had at least one grandparent with scoliosis compared to 12% for patients with adolescent scoliosis (p=0.04).

When dividing the patients into groups according to treatment (observed, brace, or surgery), there was no difference in proportion of parents with scoliosis (p=0.59) or in proportion of grandparents with scoliosis (p=0.99).

Conclusion It is unlikely that information on heredity is of importance for the prognosis of idiopathic scoliosis. We found no difference in heredity among patients with juvenile and adolescent scoliosis or between males and females.

http://www.bjjprocs.boneandjoint.org.uk/content/94-B/SUPP_XXXI/23.abstract

INVITATION FOR CONSULTATION STANDARDS OF PROSTHETIC AND ORTHOTIC PRACTICE

As you may know, HCPC have recently launched consultations on the profession-specific standards of proficiency for a number of the Allied Health Professions including ours and this has prompted a review and revision of our own Standards.
 
We are committed to engaging with our members, taking account of their views and input in the way that we carry out our work.

It is the intention of BAPO that these standards will form the baseline of practice for Prosthetists, Orthotists and Assistant Practitioners in the UK by providing more detailed information and guidance for both day to day practice and service planning. As such they sit alongside all other regulatory documents by which the profession is guided.
 
We expect the revised standards to be useful not only for Prosthetists and Orthotists, but for all healthcare commissioners and providers, Service Heads and managers, other healthcare professionals and interested members of the public.
 
When fully approved, the Standards will be freely available to all stakeholders.
 
Please review the draft standards which can be found under these links or on the member only section of the BAPO website under Downloads & Documents/Guidelines:

NHS Commissioning Support Bulletin – Issue 4

• Welcome from Dr Joe Rafferty
• Commissioning support appointments
• Configuration of 'scale' services finalised
• Checkpoint 3 update
• CCG authorisation: commissioning support supplement
• HR update
• Finance director appointments process
• Branding and identity
• Ready Reckoner 2
• Scenario report helps shape CCG development
• News in brief

A COMPARISON BETWEEN ISIS2 AND PLAIN X-RAY IN THE MEASUREMENT OF CURVE PROGRESSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

R.T. Benson, F. Berryman, C. Nnadi, J. Reynolds, C. Lavy, G. Bowden, J. Macdonald and J. Fairbank

Author Affiliations

Abstract

Plain radiography has traditionally been used to investigate and monitor patients with adolescent idiopathic scoliosis. The X-ray allows a calculation of the Cobb angle which measures the degree of lateral curvature in the coronal plane. ISIS2 is a surface topography system which has evolved from ISIS, but with much higher precision and speed. It measures the three dimensional shape of the back using structured light and digital photography. This system has the benefit of not requiring any radiation. Lateral asymmetry is the ISIS clinical parameter estimating the curve of the spine in the coronal plane. The aim of this study was to compare this parameter to the Cobb angle measured on plain X-ray.

Twelve patients with idiopathic adolescent scoliosis underwent both a standing AP spine X-ray and an ISIS2 scan on multiple occasions. Both scan and X-ray were done within one month of each other. No patient underwent surgery during the study period. The Cobb angle and the degree of lateral asymmetry were calculated.

Twelve patients mean age 12.5 years (range 10-16) were investigated using both ISIS2 and X-ray. They had a mean 2.3 (1-5) combined investigations allowing for 30 comparisons. The correlation between the two measurements was r =0.63 (p=0.0002). The Cobb angle measured on ISIS2 was less than that measured by radiograph in 27 out of 30 comparisons. The mean difference between the measurements was mean 6.4° with a standard deviation of 8.2° and 95% confidence interval of 3.3° to 9.4°.

In adolescent idiopathic scoliosis, curve severity and rib hump severity are related but measure different aspects of spinal deformity. As expected, these relate closely but not precisely. ISIS2 offers the promise of monitoring scoliosis precisely, without adverse effects from radiation. The small numbers in this series focus on the group of patients with mild to moderate curves at risk of progression. In this group, ISIS2 was able to identify curve stability or progression, without exposing the subjects to radiation.

http://www.bjjprocs.boneandjoint.org.uk/content/94-B/SUPP_X/149.abstract

Education outcomes framework

The Department of Health (DH) has responsibility for setting the education and training outcomes for the system as a whole.

Health Education England is responsible for setting up a new system that can produce the flexible workforce we need to address future challenges, that aspires to excellence in training as well as a better educational experience for all staff (including trainees and students), and is supported by a fair and responsive funding system.

The Education Outcomes Framework and HEE's approach to quality will directly link education and learning to improvements in patients' outcomes. By providing a clear line of sight and improvement to patient outcomes, it will help address variation in standards and ensure excellence in innovation through high quality education and training.

Work is currently underway to develop indicators which will help measure delivery against these outcomes.

The five high level domains of the Education Outcomes Framework are identified in the guidance document From Design to Delivery published in January 2012, and outlined below:

Excellent education: Education and training is commissioned and provided to the highest standards, ensuring learners have an excellent experience and that all elements of education and training are delivered in a safe environement for patients, staff and learners.

Competent and capable staff: There are sufficient health staff educated and trained, aligned to service and changing care needs, to ensure that people are cared for by staff who are properly indcuted, trained and qualified, who have the required knowledge and skills to do the jobs the service needs, whilst working effectively in a team.

Adaptable and flexible workforce: The workforce is educated to be responsive to innovation and new technologies with knowledge about best practice, research and innovation, that promotes adoption and dissemination of better quality service delivery to reduce variability and poor practice.

NHS values and behaviours: Healthcare staff have the necessary compassion, values and behaviours to provide person centred care and enhance the quality of the patient experience through education, training and regular Continuing Personal and Professional Development (CPPD), that instils respect for patients.

Widening participation: Talent and leadership flourishes free from discrimination with fair opportunities to progress and everyone can participate to fulfil their potential, recognising individual as well as group differences, treating people as individuals, and placing positive value on diversity in the workforce and there are opportunities to progress across the five leadership framework domains.

Consultation launched on proposals for commissioners to deliver best value

Proposals for regulations to protect patients' interests by ensuring that commissioners always deliver best value are being consulted on by the Department of Health.

The consultation sets out proposals for requirements to:

• ensure good procurement practice by commissioners including requirements to act transparently, avoid discrimination and purchase services from the providers best placed to meet patients' needs
• ensure that commissioners enable patients to exercise their rights to choose as set out in the NHS Constitution
• prohibit commissioners from taking actions that restrict competition where this is against patients' interests
• ensure that commissioners manage conflicts of interest and that particular interests do not influence their decision-making.

Responding to the consultation

• Respond to the consultation online
• Read Securing best value for NHS patients: Requirements for commissioners to adhere to good procurement practice and protect patient choice
• Download consultation response form

The closing date for responses is 26 October 2012.

If you have any questions on this consultation, please emailpccr.consultation@dh.gsi.gov.uk

The regulations for commissioners will be made under Section 75 of the Health and Social Care Act 2012.  The Department will take account of responses before developing regulations based on these proposals to be laid in Parliament in January 2013 and to come into force in April 2013.

Spare Parts exhibition turns prosthetic limbs into works of art

http://www.bbc.co.uk/news/entertainment-arts-19162750

Adaptive changes of foot pressure in hallux valgus patients

Jianmin Wen, Qicheng Ding, Zhiyong Yu, Weidong Sun, Qining Wang, Kunlin Wei

Abstract 

Background

Hallux valgus (HV) is one of the most common deformities in podiatric and orthopedic practice. Plantar pressure technology has been widely used in studying the pressure distribution in HV patients for better assessment to plan interventions. However, previous studies produced an array of controversial findings and most of them only focused on the forefoot.

Methods

We examined the dynamic changes of foot pressure of the whole foot with a large-sample investigation (229 patients and 35 controls). Foot pain, which has been largely neglected previously, was used to group the participants.

Results

Compared to healthy controls, patients had significantly higher loading of the first and second metatarsals, where the transverse arch usually collapses, and significantly less loading of the hallux. Moreover, forces in most regions reached their maximum late, indicating a slow build-up of loading. Patients shortened the loading duration on their forefoot, loaded more on the medial foot starting from early foot contact, and delayed the medial-to-lateral load transition. Notably, nearly all these changes were more pronounced in patients with pain.

Conclusions

Biomechanical changes in HV patients are not only caused by physical deformity but also by modified neural control strategies, possibly to alleviate discomfort and to accommodate the foot deformity. Our results suggest that dynamic evaluation of the whole foot and consideration of foot pain are necessary for the functional assessment of foot pressure in HV patients. The foot balance changes have important clinical implications.

source: http://www.gaitposture.com/article/S0966-6362(12)00124-5/abstract?elsca1=etoc&elsca2=email&elsca3=0966-6362_201207_36_3&elsca4=elsevier

Diabetic Foot Ulcerations: Biomechanics, Charcot Foot, and Total Contact Cast

Sabina Malhotra, DPM, Eunis Bello, DPM, Stephen Kominsky

Diabetes is the seventh leading cause of death in the United States; approximately 6% of the US population has been diagnosed with diabetes. Fifteen percent of all people with diabetes will develop a foot ulceration, and 14% to 20% of them will require an amputation. During the past 25 years, much has been learned and written about lower extremity complications associated with diabetes. The single most significant discovery relative to diabetic foot ulceration is the role of peripheral sensory neuropathy. Once the correlation between the absence of sensation and foot breakdown was made, treatment algorithms began to develop. For the first time, the concept of biomechanics and the role of weight-bearing stress were considered when applying different treatments to the patient with a diabetic foot ulcer. Wound classification systems developed to aid the physician in treating what had been a very frustrating group of patients; those with diabetic foot ulcerations. From that, a myriad of treatments developed. In fact, the technology of wound management became a billion dollar business and, to this day, continues to present the clinician with unending options to effectively manage and heal wounds on the diabetic lower extremity.

Source: http://www.semvascsurg.com/article/S0895-7967(12)00040-3/abstract

Comparison of the efficacy of laterally wedged insoles and bespoke unloader knee orthoses in treating medial compartment knee osteoarthritis

Mokhtar Arazpour, Monireh Ahmadi Bani, Maryam Maleki, Farhad Tabatabai Ghomshe, Reza Vahab Kashani, Stephen W Hutchins

Abstract

Background: Patients suffering from medial compartment knee osteoarthritis (OA) may be treated with unloader knee orthoses or laterally wedged insoles.

Objectives: The aim of this study was to identify and compare the effects of them on the gait parameters and pain in these patients.

Study Design: Quasi-experimental.

Methods: Volunteer subjects with medial compartment knee OA (n = 24, mean age 59.29 ± 2.23 years) were randomly assigned to two separate groups and evaluated when wearing an unloader knee orthosis or insoles incorporating a 6° lateral wedge. Testing was performed at baseline and after six weeks of each orthosis use. A visual analog scale score was used to assess pain and gait analysis was utilized to determine gait parameters.

Results: Both orthoses improved all parameters compared to the baseline condition (p= 0.000). However, no significant differences in pain (p = 0.649), adduction moment (p= 0.205), speed of walking (p = 0. 056) or step length (p = 0.687) were demonstrated between them. The knee range of motion (p = 0.000) were significantly different between the two interventions.

Conclusion: Both orthoses reduced knee pain. Maximum knee range of motion was increased by both interventions although it was 3 degrees less when wearing the knee orthosis.

http://poi.sagepub.com/content/early/2012/08/02/0309364612447094.abstract

Help for Heroes and MoD criticised by injured troops

Has anyone watched tonight's Newsnight on bbc2?

http://www.bbc.co.uk/news/uk-19112550

Effectiveness of different orthoses on joint moments in patients with early knee osteoarthritis: Lateral wedge versus valgus knee bracing

Min Zhang, Pei-yu Qu, Mei-lan Feng, Lan Jiang, Xiao-yan Shen, Yan-hong Ma and Yue-hong Bai 

JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (SCIENCE)

Volume 17, Number 4 (2012), 505-510, DOI: 10.1007/s12204-012-1313-x

Abstract

The purpose of the study was to test the biomechanical differences between a lateral wedge and a valgus knee bracing on the knee joint moment during walking in patients with early stage of medial compartment knee osteoarthritis (OA). We conducted a crossover randomized design to compare gait parameters of 32 patients (with early stage medial compartment knee OA) in three different conditions during walking: with a custom-made lateral wedge of 5° (in standard shoes), with a valgus knee bracing (in standard shoes), and with control condition (in standard shoes). Both two-orthose conditions showed decreased loading patterns (knee adduction moment and knee adduction angular impulse) on the knee joint in dynamic condition (statistic probability P < 0.05). The decreased loading on OA knee in wedge condition was associated with a laterally shifted location of centre of pressure and increased ankle valgus degree and moment at the same foot (P < 0.05). It was not found significant differences in loading of the knee between these two-orthose conditions. These results indicated that, under dynamic condition, patients wearing lateral wedge and valgus knee bracing showed changes of moments on knee joints. Lateral wedge was as effective as valgus knee bracing in the treatment of early stage of knee OA

Source: http://www.springerlink.com/content/rg3391676830x156/