BAPO Bulletin June 2015

NICE

BAPO has responded to 3 NICE consultations this month on your behalf.

Stroke, Osteoarthritis and Pressure Ulcers.

HCPC Fees Increase

BAPO responded as your professional body on the consultation to increase HCPC fees. Unfortunately although we did not support the fee increases, they have decided to increase the registration fee from £80 to £90 for all registrants.

Workforce Planning

BAPO is currently involved in workforce planning nationally with 3 different work-streams in England, Scotland and Northern Ireland.

We actively need your help to identify practitioners who are working in a different way, whether its using innovative technology, integrated in different teams or pushing the boundaries of their clinical practice- we want to hear from you for a quick synopsis.

Time is pressing, we need this evidence by 12^th June. Please e-mail us at enquiries@bapo.com with your details if you want to be involved.

2015/16 Work-streams

BAPO work-streams for 2015/16 have been identified.

·       Workforce planning

·       Professional review

·       Centres of Excellence Scheme

·       Commissioning (service specification document)

·       We will also conduct a membership review to investigate what we do as an association, where your money goes and what you want out of the association in the future.

These work-streams will run alongside existing engagement with the Orthotic service review in England, creating an evidence base for clinical practice and supporting our regional groups.

Interested in one of the subjects above and want to become involved? Contact enquiries@bapo.com

Confidential Patient Communication Guidance

Independent guidance to help ensure safe, confidential and effective emailing between patients and healthcare professionals has been published by the Professional Record Standards Body (PRSB).

The guidance, created and backed by key organisations representing care professionals and patients, reflects PRSB findings that 9 out of 10 people want this electronic option to be more widely available. It builds on existing email practice to ensure that safety, confidentiality and effectiveness are assured for patients and professionals, allowing a real alternative to letters and faxes that currently cost the NHS more than £100m a year.

The PRSB, an independent body, was asked to consult widely with patient and professional representatives to develop the guidance, which is published to coincide with the new Secure Email standard issued by the health service’s authority in this area – the NHS Standardisation Committee for Care Information (SCCI). The guidance reflects the findings of a new PRSB report into the issue, entitled Faster, better, safer, healthier communications.

Access the report here.

Access the standards and guidance here.

For further information email the PRSB at info@theprsb.org 

For details on our short course programme, please visit our website www.bapo.com

Parliament recognises that allied health professionals (AHPs) possess a diverse range of unique skills

That the Parliament recognises that allied health professionals (AHPs) possess a diverse range of unique skills and expertise in rehabilitation and enablement that are key to supporting self-management and enabling active, independent and productive living; believes that AHPs are crucial in the treatment and prevention not only of physical ill health but also of mental ill health; recognises the added value that AHPs can have in terms of preventative, upstream approaches; acknowledges that AHP interventions can significantly reduce unnecessary hospital admission and can help to reduce dependency on care services, resulting in savings to health and social care; recognises and congratulates the increasing number of AHPs in Scotland on the important role that they play in prevention, early intervention and enablement in supporting the health and wellbeing of the people of Scotland throughout their lives; believes that this approach can be further strengthened through the ongoing integration of health and social care services; further believes that the valued role of AHPs would be best supported by understanding the areas that are most in need and therefore calls for an audit of the National Delivery Plan for the Allied Health Professions in Scotland, 2012 – 2015 with a specific focus on performance of self-referral as a primary route for access and musculoskeletal AHP waiting times;  - See more at: http://www.scottish.parliament.uk/parliamentarybusiness/report.aspx?r=9955&i=91428&c=1829342#sthash.MCYREGND.dpuf

Shoe Collections

Are you collecting orthopaedic shoes for charity? Please get in touch with the secretariat for details of services that have footwear that can be donated.  Collection would be required.

enquiries@bapo.com

0141 561 7217 

QuDoS awards

Are you an Orthotist working with MS. Do you want to demonstrate your role in the  treatment of MS? The QuDoS awards is now live www.qudos-ms.com. Details of the various categories and how to enter is on the website.

BAPO Bulletin April 2015

The Executive Committee are meeting on 25^th April to set the workstreams for 2015 for the association. Issues were raised at the AGM by the membership which will be discussed and an action plan will be circulated in the next month.

Professional Affairs Committee are meeting on Friday 24^th April. Included in the Agenda are progression of treatment posters; review of our standards in light of HCPCs intended update; consideration of Jonathan Wright’s proposal for a professional review; progression of regional meetings; developments with NICE and much more!

Insurance renewal

The BAPO Insurance policies renews on 01/05/15 and if by any chance you have not returned your insurance renewal form before this date then you will no longer covered under the BAPO Membership Policies so please return your form ASAP.

HCPC

HCPC have 2 consultations running at the moment.

The first is on planned changes to their Standards of conduct, performance and ethics. The consultation will run from 1 April until 26 June 2015, expecting that new standards will be in place in early 2016.


The second is on a planned rise to their annual fees.

To see the consultations and to take part visit http://www.hcpc-uk.org/aboutus/consultations/

Department of Health NHS England

New handbooks to support personalised care planning for long term conditions - NHS England has published three new handbooks to support commissioners and practitioners in planning services for people with long term conditions (LTCs), in order to achieve more effective, personalised care for this group. LTCs currently account for £7 of every £10 health and social care spend in England. The guides cover three key areas: identifying people in the population with LTCs that are most vulnerable and at risk of unplanned hospital admissions; planning personalised care and support; and best-practice multi-disciplinary working across professional and organisational boundaries.  The handbooks are available on NHS England’s website at http://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/ltc-care

Surveys

Latrobe university is running a survey open to 30^th June, 2015. They are interested in work related injuries for Prothetists and Orthotists and would like to survey the profession in the UK. You can access the survey through the link on the BAPO website front page or by clicking the link below https://latrobe.co1.qualtrics.com/SE/?SID=SV_b4sP2QYFtTB8UuN

James Lind Alliance are looking for Orthotists to assist on the Early OA of Hip and Knee survey which aims to identify your most pressing unanswered questions about the diagnosis, surgical and non-surgical treatment, and likely outcomes of early OA of hip and/ or knee. This will ensure that future research can be prioritised according to the needs of patients, carers and health professionals.

The survey takes about 10 minutes to complete, so please take this opportunity to influence the future of early OA of hip and knee.

The Survey can be found here  http://tiny.cc/lb71vx  Further information here http://tiny.cc/3d71vx

Short courses

Advanced orthotic technology: functional stimulation for drop foot and associated weakness in neurologically impaired gait.

Saturday 16^th May- Birmingham cost £135Critical Appraisal course

Thursday 18^th  June  Seacroft Hospital, Leeds   £70

For more details on our short course programme, please visit our website www.bapo.com

Taycare - Orthotist Vacancy

For full details of this vacancy please click here

Ottobock - Commercial Manager Prosthetics & Orthotics: Egham

For full details of this vacancy please click here

Effectiveness of Total Contact Insoles in Patients with Plantar Fasciitis

Hilda Alcântara Veiga Oliveira, Anamaria Jones, Emília Moreira, Fabio Jennings and Jamil Natour

Abstract

Objective To assess the effectiveness of total contact insoles (TCI) in patients with plantar fasciitis (PF).

Methods A double-blind randomized controlled trial was carried out with intention-to-treat analysis. Seventy-four patients were randomly allocated to use a TCI made of ethylene vinyl acetate (study group, n = 37) or a flat insole (control group, n = 37). The following assessment tools were used: visual analog scale for pain while walking and at rest, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, Foot Function Index and Foot Health Status Questionnaire for foot function, 6-min walk test (6MWT), and baropodometer FootWalk Pro for plantar pressure analysis. The groups were evaluated by a blinded assessor at baseline and after 45, 90, and 180 days.

Results The groups were homogeneous for the majority of variables at baseline. The over-time comparisons show a statistical difference between the groups for pain while walking (p = 0.008) and the 6MWT (p = 0.010). Both groups showed significant improvements in pain at rest, foot function, and some quality of life variables (physical functioning, bodily pain, vitality, and social functioning), with no significant statistical differences between them. The baropodometer recorded no changes from the use of the insoles.

Conclusion A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF.

Source: http://www.jrheum.org/content/early/2015/03/10/jrheum.140429.abstract 

Effects of Ankle–Foot Orthoses on Functional Recovery after Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Ryo Momosaki, Masahiro Abo, Shu Watanabe, Wataru Kakuda, Naoki Yamada, Shoji Kinoshita 

The purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation.

Subjects and Methods

This study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission.

Results

In this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001).

Conclusions

These data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

Source: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122688 

Rehabilitation Interventions for Children With Cerebral Palsy: A Systematic Review

In a systemic review of the literature, Abbaskhanian et al suggests that clinicians should depend on their clinical experience and patient values to handle the clinical decision-making process in determining the prescription of AFOs.

The found evidence encouraging the use of an articulated ankle foot orthosis (AFO) by children with CP because of the enhanced function when using this type of orthosis. Yet, other studies indicated the advantages of a rigid orthosis for children with greater disabilities involving spasticity and contracture. 

http://cdn.neoscriber.org/cdn/serve/70/08/7008dff33bed20188825836989b3259d1b77212b/jpr-03-361.pdf

Opcare - Orthotists, Various Positions

Please click here for further information on the job advertisements available.

BAPO Measuring Change Document - April 2015

Measuring Change: An Introduction to Clinical Outcome Measures in Prosthetics and Orthotics

In today’s demanding and pressured healthcare environment it is essential that the effects of medical interventions, including prosthetic and orthotic care, are accurately assessed and recorded. Outcome measures (OMs) are useful in assessment, clinical decision making and evidencing the outcomes of treatment to either the service user or third parties. OMs also facilitate clinical audit and research. 

The Measuring Change document is the result of a one year project by a working group formed by members of the BAPO Professional Affairs and Education committees. The working group initially conducted a survey of Prosthetists and Orthotists in the UK to determine existing use and knowledge of OMs. Following this, a small group of OMs were selected and literature reviews were conducted to identify the measures’ psychometric properties in addition to normal data and minimal clinically important difference values. The included OMs are the numeric pain rating scale (NRS-11), socket comfort score (SCS), 10 metre walk test (10MWT), timed up and go (TUG) and disabilities of the arm, shoulder and hand (DASH). The Measuring Change document includes the results of the reviews, instructions on how to use and interpret the selected OMs, a summary of the survey results, and an introduction to relevant psychometric terms and concepts. The primary aim of the document is to enable Prosthetists and Orthotists to understand and use simple OMs in clinical practice to improve patient care.

Measuring Change is available for BAPO members to download from the members section of BAPOnline. Non-members may request hard copies (paperback, 40 pages, full colour) from enquiries@bapo.com at a cost of £10.

Opcare - Orthotist, Various

Please click here to view job advertisement.

RSL Steeper - Various Job Vacancies

Please click here to view job advert.

HCiViocare - Prosthetist, Glasgow

For further information on the position available please click on the link.

HCiViocare

LimbPower - 2015 Advanced Rehabilitation Clinic

LIMBPOWER DELIGHTED TO ANNOUNCE 2015

ADVANCED REHABILITATION CLINIC

LimbPower, the National Disability Sports Organisation dedicated to helping amputees and the limb impaired reach their sporting potential, are holding another Advanced Rehabilitation Clinic following the success of the initiative launched last year.  This clinic will help primary amputees build confidence, strength, stability and empower them in the early stages of their quest to improve their mobility.

 

LimbPower’s Advanced Rehab Clinics aim to bridge the current gap that exists between the rehab offered by the NHS, and the ability to participate in sports, fitness and lifestyle activities.  The current service teaches amputees how to walk using their artificial limb with training on basic techniques, but there is much more that could be done to aid amputees in the early stages of rehabilitation which would have a huge impact on their quality of life. 

Research shows that participation in physical activity enhances the lives of amputees, reducing the risk of medical interventions such as knee and hip replacements and even improving life expectancy. 

For 2015, the Advanced Rehab Clinic will include a separate programme dedicated to carers, partners and case managers, ensuring that this important support network are equipped with the information to assist in the ongoing progress of the amputee.

Kiera Roche, LimbPower Founder commented; “Back in 2006 I attended a running clinic where I was taught the basic techniques of running, but what really opened my eyes were the day-to-day benefits of the stability exercises and leg strengthening exercises I was taught to improve my gait and balance.  We have used these techniques within our own successful ‘Learn to Run’ clinics since then, but the Advanced Rehab Clinics will allow us to reach those new amputees who are yet to even consider sport as something for them and help them to get the most from their prosthetics.”

 

The one-day course will be a mix of educational and practical training sessions focussing on core stability, proprioception of the artificial limb, gait training exercises and general health and fitness.  The course will encourage new amputees to take control of their own rehabilitation and well-being and equip them to take part in any sport or activity they choose.

The 2015 Advanced Rehab Clinic will be on the 15^rd April at and be held at Roehampton University.  Anyone interested in finding out more details should contact Gemma Trotter on Gemma@limbpower.com

Freedom to Speak Up: Give your views on supporting NHS staff to raise concerns about care

A consultation on plans to support NHS staff to speak up about poor care and patient safety has launched.

It follows the publication of Sir Robert Francis's Freedom to Speak Up review in February 2015, which made recommendations on how to create a culture where NHS staff feel safe and confident in speaking out. The report was commissioned by Health Secretary Jeremy Hunt in response to concerns about the reporting culture and the treatment of whistleblowers in the NHS.

The recommendations were accepted in principle by the Government, and we are now consulting on the best way to implement the principles and actions. Specific actions we are seeking views on include:

• Every NHS organisation having a Freedom to Speak Up Guardian
• A new Independent National Whistleblowing Officer who will provide national leadership; and
• Standards for professionals on raising concerns.

The consultation closes on 4 June 2015.

Read the consultation and take part.

Source: http://compassionatecare.dh.gov.uk/2015/03/12/freedom-to-speak-up-give-your-views-on-supporting-nhs-staff-to-raise-concerns-about-care/

HCPC - Prosthetist/Orthotist Visitors

For full details please click here

Short Course Timetable2015

The Education Committee are delighted to unveil the short course timetable for the first half of the year.  The committee have worked hard to bring you courses which are not only excellent value but which offer diversity in topics and locations. 

Click the link below for detailed information on the courses now available and look out for updates detailing additional course dates and topics in the comings months!

Course Information

Prosthetists and Orthotists on Shortage of Occupation List (SOL) for a minimum of 4 years

BAPO have managed to get recognition that there is a shortage of Prosthetists and Orthotists. We're now on the shortage of occupation list (SOL) for a minimum of 4 years.

http://www.cfwi.org.uk/publications/migration-advisory-committee-mac-healthcare-occupation-submission-main-report-for-the-2014-shortage-occupation-list-sol

Webinar 4 - Managing Relationships for Transition - Save the date Monday 2 March 2015

Monday 2 March 2015 – 13:00-13:50

This fourth and final webinar, provided by the NHS Clinical Soft Intelligence Service in partnership with the Royal College of Speech and Language Therapists and supported by the Chartered Society of Physiotherapists, will explore two examples of how rehabilitation service providers have carried out service improvements across a pathway.  In particular the webinar will discuss how they are improving transition for people who use the service.
 
The speakers will discuss the issues around:

·        enablers and obstacles to improving transition for people at different points in a pathway

·        issues pertinent to working in partnership to improve transitions between rehabilitation services in different organisations

·        ensuring the sharing of skills and expertise across providers to ensure effective transition

 

To find out more and register, go to http://www.tinyurl.com/NHS4a for a place at this webinar and to submit any initial questions around this topic. You are also able to submit questions during the webinar.

Buchanan Orthotics - Orthotist

Please click here to view job advertisement.

The Influence of Foot Orthoses on Patellofemoral Pain Syndrome: A Systematic Analysis of the Literature

Ahlhelm A, Alfuth M

Abstract

Background: The patellofemoral pain syndrome (PFPS) is one of the most commonly encountered disorders involving the knee. The symptoms often lead to a reduction of physical activities resulting in sport- and job-related disabilities and the potential occurrence of severe disorders. Different theories for the development of the syndrome exist which result in different therapy modalities. A change in foot posture and its effect on lower limb kinematics seem to be one potential risk factor for the development of the syndrome. This leads to the assumption that foot orthoses might be a potential therapy device. Objectives: The aims of this study were to outline the state of evidence for the treatment of PFPS with foot orthoses and to identify the effect of foot orthoses on PFPS. Study Design: A systematic review of clinical (CT) and randomized controlled trials (RCT) was undertaken. Methods: A systematic search for studies (CT, RCT) was conducted using the databases of Medline (PubMed), Cochrane library, and PEDro. The relevance for further analysis of studies was reviewed on the basis of title and abstract. An additional search was undertaken using the reference lists of the included studies and additional literature as well as the PubMed function "related articles". Results: 11 studies were included in this analysis. The effect of different types of foot orthoses on pain, function and kinematics of the lower limb and muscle activation of selected lower limb muscles was analysed. Significant effects on pain and function were determined. A slight effect on kinematics of the lower limb and muscle activation of selected lower limb muscles was identified. Conclusion: Foot orthoses seem to be an effective treatment device in the therapy for PFPS. An immediate and long-term reduction in pain and an improvement of function occurred following the intervention. There was just a slight change in lower limb kinematics and muscle activation of selected lower limb muscles. The relationship between biomechanical effects of orthoses and pain still seems to be unclear.

Source: http://www.ncbi.nlm.nih.gov/pubmed/25675398 

NHS Lothian - Head of Technical Services

For full details of this post please click here

BAPO Conference 2015 Accommodation Bookings

Please note that  the online link for Conference 2015 accommodation bookings is due for release on 16 February, after which time there will be just a limited choice of hotels available via Reservation Highway and the rate will not be guaranteed.

Therefore if you haven’t already secured your accommodation for Conference 2015 please book as soon as possible via www.reservation-highway.co.uk/bapo15

Kent and Medway NHS - Prosthetic Team Leader

Click here to view Job Advertisement.

CSP - Improving Adult Rehabilitation Services Community of Practice – Soft intelligence Summary Bulletin

Following up on our requests for snapshots of good practice, we wanted you to share with you the first bulletin capturing the thoughts or 'soft intelligence' of the Improving Rehabilitation Services Community of Practice (IRSCOP).

Members are encouraged to enter the debate by adding comments to what people are saying about improving rehabilitation services and are invited to:

• Feedback on the themes within the bulletin that are either missing or upon which you have a different perspective
• Share what action you are taking in relation to these themes (however big or small)

How to submit feedback & comments
I would be very happy to receive feedback from members. Alternatively, comments can either be emailed to katherine.andrews@nhs-commissioning.net or posted on the discussion forum (making these anonymous if requested)

Feedback will be used to enrich the emergent themes and populate the next Soft intelligence Bulletin. We are grateful for your assistance.

Webinar 3 - Integration in Action: Breaking down Boundaries - Save the date 5 February 2015

Save the date - 5 February 2015 - 1:00-1:50 

 

Webinar 3 - Integration in Action:  Breaking down Boundaries  

 

We are delighted to announce a third webinar, provided by NHS Clinical Soft Intelligence Service in partnership with the Royal College of Speech and Language Therapists and supported by the Chartered Society of Physiotherapy to the Improving Rehabilitation Services Community of Practice.

 

This webinar will explore two examples of how service providers have carried out service improvements across health, social care and the voluntary sector.

 

Following the webinar, participants will be aware of:

·        alternative ways of engaging with partner organisations to deliver good rehabilitation

·        how these services overcame barriers and be able to consider ways in which they are applicable to their own circumstances

 

Speakers will include

Dr Karen Robb – Regional Lead for Rehabilitation - London

Bernadette Kennedy - St. George's Healthcare NHS Trust

Dr Joanne Fillingham – Regional Lead for Rehabilitation – Midlands and East

Alison Shortman - Staffordshire and Stoke On Trent Partnership Trust

 

To find out more and to register for this webinar, please go to:

http://tinyurl.com/CSIweb3a

 

Participants have the opportunity to submit questions on this topic to our speakers before and during the webinar. 

Please note places are limited.  Unfortunately webinar content currently cannot be viewed on mobile devices.

Please refer to the RCSLT’s webinar guide for participants for more information on participating in a webinar, and technical requirements

 

If you have any relevant examples of great services, guidelines or resources which you have produced or know of, we would be delighted to hear about them on the NHSCSI on line forum. 

Trulife - Senior Orthotist Opportunities

For full details please click here

HCPC - Chair of Council Role

For full details of this advert and how to apply please click here

Lancashire Teaching Hospitals - Senior Orthotist

Click here for full details of the advert

Dorset Hospitals, Orthotist, Dorset

Click here to view job advertisement

Peacocks - Experienced Orthotists

For full details of this job advert click here

National Institute for Health Research (NIHR) funded Masters in Clinical Research

The University of Brighton are now recruiting for NIHR fully funded (SUBJECT TO AGREEMENT BY NIHR) places for the MRes (Clinical Research) course, starting in September 2015. Funding includes salary costs and course fees for full time over one year or part time route over two years.

Click here to view more information.

Prosthetic developments worth watching

http://www.onlinetmd.com/medical-device-design-prosthetic-developments-emerson-1315.aspx#.VKxm2IqsWhZ

Pledge reinforces NHS leaders commitment to a healthy engaged workforce

http://www.nhsemployers.org/news/2014/12/pledge-reinforces-nhs-leaders-commitment-to-a-healthy-engaged-workforce

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.

Source: http://m.poi.sagepub.com/content/38/6/467.full

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 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.

Source: http://www.japmaonline.org/doi/abs/10.7547/8750-7315-104.6.555 

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.

Source: http://journals.lww.com/jpojournal/Abstract/2015/01000/Effects_of_Custom_Molded_and_Prefabricated_Hinged.8.aspx 

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.

Source: http://www.euro.who.int/en/countries/tajikistan/news/news/2014/12/rehabilitation-key-to-an-independent-future-for-children-with-poliomyelitis-in-tajikistan

Opcare - Junior Prosthetist Vacancies

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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.

Source: http://esciencecentral.org/journals/indicators-of-future-ulceration-in-diabetes-patients-of-lowmoderate-foot-risk-2329-910X-2-155.pdf

Biomechanical Effects of Valgus Knee Bracing: A Systematic Review and Meta-Analysis

• Rebecca F. Moyer, PT, PhD^a, 
• Trevor B. Birmingham, PT, PhD^a, ,  (Dr.), 
• Dianne M. Bryant, PhD^a,
• J.Robert Giffin, MD, FRCS(C)^b, 
• Kendal A. Marriott, BScKin^c, 
• Kristyn M. Leitch, PhD^d

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

Source: http://www.sciencedirect.com/science/article/pii/S1063458414013417

Guy's and St Thomas' NHS Foundation Trust, x2 Orthotists, London

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NHS England¹s clinician survey on patients taking a more active role in their healthcare

Patients with long term conditions self-manage their condition at home the majority of the time. They have different levels of knowledge, skills and confidence in managing their own health and care – we describe this as the patient's 'activation' level.

 

Clinicians have different training, orientations and views about a patient's role in their care which results in different approaches when working with people with long term conditions. NHS England is carrying out this survey with doctors, nurses and allied health professionals to understand these views and approaches. It will help us to develop a baseline of clinicians' attitudes across the range of professionals and understand their support needs in this area.

 

Your response is very important and the survey will take less than 10 minutes to complete. To complete the survey, please go tohttps://www.surveymonkey.com/s/CS-PAM_AHPs

 

The survey closes on 12 December. All responses are anonymous and not associated with any personally identifiable information. Aggregated results will be published and shared with stakeholders.

Snapshot of good practice - Rehabilitation Service Improvement

As part of the Improving Rehabilitation Services Community of Practice (IRS COP), NHS Clinical Soft Intelligence Service (NHSCSI) wishes to support BAPO members to raise the profile of local service improvements, no matter how big or small. Some of you have already identified examples good practice which can be shared.  Please download the snapshot of good practice proforma complete and return to katherine.andrews@nhs-commissioning.net. The responses will form a "snapshot" database composed of the succinct descriptions and contact details provided. This collation will be shared with the IRS community as well as the NHS England Improving Rehabilitation Services programme team. 

 

 

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Making rehabilitation work better for people - 1 December 2014 - Webinar Content for Comment

Dear Colleague

 

Further to our recent webinar invite, we would welcome your comments on the attached webinar draft outline in terms of the subject and areas you would wish to see covered in the presentations and question and answer session.

 

Please note that this webinar is not meant to highlight individual professions' best practice but focus on the overarching messages and themes for a very wide-ranging audience. There will be opportunities and we would encourage professional bodies to signpost these more specific examples via posting on the on line forum

 

If you would like to see your ideas reflected in the forthcoming webinar series, please email Carol Cahill at cahillc@csp.org.uk with your suggestions about the subject areas you would like discussed, as well as any questions for inclusion in the Q & A sessions.

New Evidence Update on Lower Limb Peripheral Arterial Disease

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