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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Webinar - Making Rehabilitation Work Better for People - Save the Date 1 December 2014

Save the date - 1 December 12.45- 1.30

Webinar - Making Rehabilitation Work Better for People

 

The webinar will be of relevance to everyone with an interest in improving rehabilitation services. It will consider how changes can be made that better support people to return to meaningful occupation, including education and work. It will also share information about NHS England's Improving Rehabilitation Services programme and how you can get involved.

 

This is the first of four webinars (other dates are 19^th January, 5^th February, 2^nd March) which 'The Improving Rehabilitation Services Community of Practice' will hold over the next few months that offer learning and an opportunity to interact and discuss ideas in a live format. Please click on the link to view a longer communication which includes more detail about the content of the webinar:  Webinar Information

 

To Register (and submit a question) click here

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 are new to webinars, please allow plenty of time prior to the start to familiarise yourself with the technical requirements.

If you can't join us live, a recording of the webinar will be made available after 1 December 2014 via the Community of Practice and the COP forum.

 

NHS Clinical Soft Intelligence Service has developed this webinar with NHS England and it is produced in collaboration with the Royal College of Speech and Language Therapists.

Sherwood Forest Hospitals - Band 5 Orthotist

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Sherwood Forest Hospital - Senior Orthotist - Nottinghamshire

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Exercise improves gait, reaction time and postural stability in older adults with type 2 diabetes and neuropathy

S. Morrison, S.R. Colberg, H.K. Parson, A.I. Vinik

Journal of Diabetes and its Complications

Abstract

Aims

For older adults with type 2 diabetes (T2DM), declines in balance and walking ability are risk factors for falls, and peripheral neuropathy magnifies this risk. Exercise training may improve balance, gait and reduce the risk of falling. This study investigated the effects of 12 weeks of aerobic exercise training on walking, balance, reaction time and falls risk metrics in older T2DM individuals with/without peripheral neuropathy.

Methods

Adults with T2DM, 21 without (DM; age 58.7 ± 1.7 yrs) and 16 with neuropathy (DM-PN; age 58.9 ± 1.9 yrs), engaged in either moderate or intense supervised exercise training thrice-weekly for 12 weeks. Pre/post-training assessments included falls risk (using the physiological profile assessment), standing balance, walking ability and hand/foot simple reaction time.

Results

Pre-training, the DM-PN group had higher falls risk, slower (hand) reaction times (232 vs.219 ms), walked at a slower speed (108 vs. 113 cm/s) with shorter strides compared to the DM group. Following training, improvements in hand/foot reaction times and faster walking speed were seen for both groups.

Conclusions

While falls risk was not significantly reduced, the observed changes in gait, reaction time and balance metrics suggest that aerobic exercise of varying intensities is beneficial for improving dynamic postural control in older T2DM adults with/without neuropathy.

http://www.sciencedirect.com/science/article/pii/S1056872714001226

Prosthetist Vacancies - Opcare - Roehampton, Newcastle & Cambridge

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Clinical Audit Awareness Week

HQIP is pleased to confirm details of this year's Clinical Audit Awareness Week(CAAW) webex sessions. The free, interactive lunchtime webinars have this year been designed around the classic Clinical Audit Cycle and will run everyday during CAAW from 20-24 October 2014 at 1-1.30pm. 

Further details can be found on the following link:

http://www.hqip.org.uk/clinical-audit-awareness-week-webinar-booking/?utm_medium=email&utm_campaign=eBulletin+2014-10-21&utm_content=eBulletin+2014-10-21+CID_b2634dcb0e3ad84bd86cd3c4cdc7527c&utm_source=ebulletin&utm_term=Its%20Clinical%20Audit%20Awareness%20Week

Trulife - Orthotist - North West London & The North West/Midlands

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BAPO Conference & Exhibition 2015 - SpeakEasy

Opcare Job Advertisement - 3 x Orthotist positions, England

To find out further information on the positions available please click on the following link:

Opcare Orthotist Positions, England

UNISON NHS Agenda for Change Action

UNISON is asking it's NHS employed members to take industrial action over NHS pay offer.  There will be strike action from 7am-11am on Monday 13 October 2014 followed by 4 days of action short of strike action from 14 October – 17 October. 

UNISON asks that if a member is employed directly by an NHS organisation on Agenda for Change terms and conditions then they are covered by the action and able to show support.  Members who choose to strike would lose pay as a result.

If a member is self employed, or employed under a contract for services, then they are not covered by the action. If this is the case we would ask that they do not cross picket lines or cover the work of striking workers. These BAPO members cannot be asked to strike or take action short of strike action. 

It is unlikely that any workplaces will close as a result of the strike however if so then any BAPO members should be informed by their employer and receive their full normal pay.
 
UNISON and other trade unions will likely be maintaining picket lines at entrances to workplaces. Pickets are allowed to peacefully persuade workers and others not to cross the picket line but anyone who decides to cross must be allowed. Anyone crossing the picket line will also likely be asked to not undertake any duties of to cover those who are on strike. 

Of course it is an individual decision and BAPO members can explain that they have not been balloted and are not on strike.  

The background to the strike is here http://www.unison.org.uk/at-work/health-care/key-issues/nhs-pay/home/ . 

BAPO Conference & Exhibition 2015 - Call for Posters

Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children

Ankle-foot orthosis (AFO) is the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs are designed either to improve function or to prevent or treat muscle contractures.

The purpose of the present study was to analyse the use of, the indications for, and the outcome of using AFO, relative to age and gross motor function in a total population of children with cerebral palsy. 

Methods: A cross-sectional study was performed of 2200 children (58% boys, 42% girls), 0-19 years old (median age 7 years), based on data from the national Swedish follow-up programme and registry for CP. To analyse the outcome of passive ankle dorsiflexion, data was compared between 2011 and 2012.

The Gross motor classification system (GMFCS) levels of included children was as follows: I (n = 879), II (n = 357), III (n = 230), IV (n = 374) and V (n = 355). 

Results: AFOs were used by 1127 (51%) of the children. In 215 children (10%), the indication was to improve function, in 251 (11%) to maintain or increase range of motion, and 661 of the children (30%) used AFOs for both purposes.

The use of AFOs was highest in 5-year-olds (67%) and was more frequent at lower levels of motor function with 70% at GMFCS IV-V. Physiotherapists reported achievement of functional goals in 73% of the children using AFOs and maintenance or improvement in range of ankle dorsiflexion in 70%. 

Conclusions: AFOs were used by half of the children with CP in Sweden.

The treatment goals were attained in almost three quarters of the children, equally at all GMFCS levels. AFOs to improve range of motion were more effective in children with a more significant decrease in dorsiflexion at baseline.

Author: Maria WingstrandGunnar HägglundElisabet Rodby-Bousquet
Credits/Source: BMC Musculoskeletal Disorders 2014, 15:327

http://7thspace.com/headlines/489888/ankle_foot_orthoses_in_children_with_cerebral_palsy_a_cross_sectional_population_based_study_of_2200_children.html