Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle

Inter-assessor reliability of practice based biomechanical assessment of the foot and ankle

Hannah L Jarvis1

Christopher J Nester

Richard K Jones

Anita Williams

Peter D Bowden

Abstract

Background

There is no consensus on which protocols should be used to assess foot and lower limb

biomechanics in clinical practice. The reliability of many assessments has been questioned by

previous research. The aim of this investigation was to (i) identify (through consensus) what

biomechanical examinations are used in clinical practice and (ii) evaluate the inter-assessor

reliability of some of these examinations.

Methods

Part1: Using a modified Delphi technique 12 podiatrists derived consensus on the

biomechanical examinations used in clinical practice. Part 2: Eleven podiatrists assessed 6

participants using a subset of the assessment protocol derived in Part 1. Examinations were

compared between assessors.

Results

Clinicians choose to estimate rather than quantitatively measure foot position and motion.

Poor inter-assessor reliability was recorded for all examinations. Intra-class correlation

coefficient values (ICC) for relaxed calcaneal stance position were less than 0.23 and were

less than 0.14 for neutral calcaneal stance position. For the examination of ankle joint

dorsiflexion, ICC values suggest moderate reliability (less than 0.61). The results of a random

effects ANOVA highlight that participant (up to 5.7°), assessor (up to 5.8°) and random (up

to 5.7°) error all contribute to the total error (up to 9.5° for relaxed calcaneal stance position,

up to 10.7° for the examination of ankle joint dorsiflexion). Kappa Fleiss values for

categorisation of first ray position and mobility were less than 0.05 and for limb length

assessment less than 0.02, indicating slight agreement.

Conclusion

Static biomechanical assessment of the foot, leg and lower limb is an important protocol in

clinical practice, but the key examinations used to make inferences about dynamic foot

function and to determine orthotic prescription are unreliable.

http://www.jfootankleres.com/content/pdf/1757-1146-5-14.pdf

NICE Venous Thromboembolic Diseases Clinical Guideline

NICE have published and update on the Venous thromboembolic diseases (144) clinical guideline on

27/06/12 and is now available at the NICE website at:

http://guidance.nice.org.uk/CG144

Guidance aims to improve procurement across healthcare system

Guidance aimed at improving procurement across the healthcare system has been published by the Department of Health.

'NHS procurement: raising our game' sets out proposed actions for NHS trusts and the Department and focuses on taking immediate action to start tackling six key areas for improvements:

• levers for change
• transparency and data management
• NHS standards of procurement
• leadership, clinical engagement and reducing variation
• collaboration and use of procurement partners
• suppliers, innovation and growth

Read NHS Procurement: raising our game

This guidance is launched in advance of a procurement strategy planned for later in 2012 that will be developed following a wider call for evidence. It aims to start the journey to world class procurement by identifying those issues and actions that require immediate attention in order to lay the foundations for a fuller and further-reaching strategy later in the year.

In support, we are also publishing NHS Standards of Procurement, which will support trusts in understanding what good procurement looks like and in planning their improvements at a local level.

The standards can be used to identify what a trust's areas of strengths and weakness are in their procurement and suggest ways in which they can start to monitor and measure improvements.

Read NHS Standards of Procurement

Racial differences in foot disorders and foot type: The Johnston County Osteoarthritis Project

Golightly, Yvonne M, Hannan, Marian T, Dufour, Alyssa B, Jordan, Joanne M (2012); Racial differences in foot disorders and foot type: The Johnston County Osteoarthritis Project'; Arthritis Care & Research; Arthritis Care Res; John Wiley & Sons, Inc.; 2151-4658; http://dx.doi.org/10.1002/acr.21752

Objective.

To describe racial differences in the frequency of structural foot disorders and pes planus, and cavus foot types in a large cohort of African American and Caucasian men and women 50+ years old. 

Methods.

Of 1,695 Johnston County Osteoarthritis Project participants evaluated for foot disorders/type in 2006-2010, four with lower extremity amputation were excluded, leaving 1,691 available for analyses (mean age 69 years, mean body mass index [BMI] 31.5 kg/m2, 68% women, 31% African American). The most common foot disorders/types were identified using a validated foot examination. Each foot disorder/type was compared by race using logistic regression, controlling for age, BMI, and gender. Effect modification between race (African American versus Caucasian) and age, BMI (categorized as ≥30 [obese] or <30 kg/m2 [non-obese]), gender, and education were examined. 

Results.

Hallux valgus (64%), hammer toes (35%), overlapping toes (34%), and pes planus (23%) were common. Compared to Caucasians, African Americans were almost 3 times more likely to have pes planus and were nearly 5 times less likely to have Tailor's bunions or pes cavus. Among the non-obese, African Americans were more likely than Caucasians to have hallux valgus (adjusted odds ratio [aOR] =2.01, 95% confidence interval [CI] = 1.39-2.92), hammer toes (aOR=2.64, 95% CI=1.88-3.70), and overlapping toes (aOR=1.53, 95% CI=1.09-2.13). 

Conclusions.

Foot disorders are common among adults 50 years of age or older and differ by race. Future research is needed to determine the etiology of foot problems, especially those with racial differences, in order to inform prevention approaches.

New rules applicable to students for NHS Bursary Scheme from September

There are two different sets of rules applicable to students depending on when their course first started. These document published today sets out the new rules which will apply to students who started their course on or after 1 September 2012. The rules for students who started their course before 1 September 2012 are set out in the thirteenth edition of The NHS Bursary Scheme old rules. In each case the rules apply in relation to the academic year starting on or after 1 September 2012 but before 31 August 2013.

The NHS Bursary Scheme new rules first edition outlines the student support arrangements for students who start their course on or after 1 September 2012.

The NHS Bursary Scheme old rules thirteenth edition outlines the student support arrangements for students who started their courses before 1 September 2012.

Disclaimer

Students and prospective students should not rely on the current NHS Bursary rules and allowances when planning for subsequent academic years, these may be subject to review in the future and as a result may be liable to change. Further information about the NHS bursary will be posted on the NHS Student Bursaries website as and when it is made available. Students are advised to check the website on a regular basis. The Department of Health and NHS Student Bursaries will accept no responsibility for loss of any type however suffered by students who have relied on current rules and allowances in altering their circumstances (including but not limited to financial circumstances) whether for the current academic year, academic year to begin or indeed for subsequent academic years.

Equality Statement 2012

The NHS Bursary Scheme has been around since the early 1990s and is usually updated annually to take into account changes to policy. The Department of Health has worked with its key partners to undertake a review of the NHS Bursary Scheme. A number of options for the future of NHS student support were developed and assessed against a number of criteria one of which was equality. The Department of Health ran a public consultation on the options to seek the views of others with an interest, including people who were currently considering entering healthcare training. Respondents were asked to consider how far the options met a number of equality aims. The review concluded that, in the future, eligible students will all have access to the same package of financial support from September 2012 irrespective of their course. A report of the consultation, an impact assessment and an equalities impact assessment at the link below was published alongside the outcome of the consultation which is reported in supporting our future NHS workforce: consultation report.

These documents supersede the twelfth edition of the NHS Bursary Scheme. These documents are not distributed in hard copy

Third edition of Long Term Conditions Compendium published

The Department of Health has published the third edition of the Long Term Conditions Compendium of Information. It is aimed at commissioners as well as health and social care professionals, to provide the evidence for improving care and outcomes for people with long term conditions (LTCs).  It updates the second edition of the compendium published in January 2008.

This document contains the latest statistical data on long term conditions, links to the LTC QIPP (quality, innovation, productivity and prevention) workstream and provides data from the ongoing evaluation of the Whole System Demonstrator Programme on telehealth and telecare, which supports the delivery of 3 Million Lives. It also showcases examples of innovative projects across the country where organisations and communities are pushing the boundaries to deliver improvements in LTC care.

The information and evidence captured in this third edition of the compendium continues to reinforce why a focus on LTCs should be a priority.

Long Term Conditions Compendium of Information – third edition

Find out about the long term conditions strategy.

Procurement call for evidence

A call for evidence on how procurement in the NHS can be transformed is issued. Views and contributions are being sought from the NHS, industry, other government departments, the academic, scientific and third sectors and social care. This could include actions for the Department of Health, wider government, industry, the NHS Commissioning Board, other National bodies, the NHS, or other sectors.

Sir Ian Curruthers letter said:

' Whilst some improvements in NHS procurement are evident, the pace of change is not sufficient to meet the financial challenge facing the NHS.

We need more innovative procurement processes and more widespread procurement of innovation. By harnessing relationships with suppliers, the NHS can adopt existing innovations and stimulate new innovation to deliver quality and value, for both NHS patients and taxpayers.'

Read the call for evidence and ideas document and the letter from Sir Ian Curruthers. To contribute to the call for evidence please see our online form.

Guidance published today provides the first steps that NHS trusts need to takenow. Read further information on Innovation Health and Wealth.

The National Audit Office has issued a report examining whether the NHS in England is providing recommended standards of care to people with diabetes

The report finds that, despite some improvements since 2006-07, there is poor performance against expected levels of care, low achievement of treatment standards and high numbers of avoidable deaths, and concludes that diabetes services in England are not delivering value for money.

http://www.nao.org.uk/publications/1213/adult_diabetes_services.aspx

Have your say on long term conditions strategy

The Department of Health is asking people to comment on what should be covered by the cross-government long term conditions strategy.

We are drafting the strategy at the moment and plan to publish it towards the end of this year. The strategy will be a high level vision, describing how we want to see improvements in the lives of people with long term conditions. It will apply to England only.

We would like to hear from people with long term conditions, carers, health professionals, commissioners, local authorities and the voluntary sector. People's experiences, both positive and negative, and their ideas about what could be done differently, are vital to make the strategy as relevant as possible.

The content of the strategy will not be confined to health issues. It will also cover other aspects of people's lives that can be affected by long term conditions and bring together departments across central government to sign up to shared aims.

Find out more about the long term conditions strategy.

NHS Corporate plan 2012-13

The Department of Health's Corporate plan sets out our priorities for the year ahead. The Department's enduring purpose is to achieve better health, better care, better value: working to help people live better for longer.

Now that the Health and Social Care Bill has become law, the Department has a firm platform on which to build clarity about the future direction of the health and social care system as a whole.

The plan groups the Department's activity into six priority areas:

• Better health; Better care; Better value relate directly to DH's enduring purpose and capture the key business priorities for the Department for this year to April 2013
• Successful change, delivering the transition to the new system – picks up the work the DH does and its accountability for making this happen
• Working with our partners – builds on what the DH does now and recognises that in the new system the Department will be working differently
• Transforming the DH itself – is about the DH's journey to develop its capability.

The plan is also built around how the Department will support the Secretary of State to deliver his five strategic objectives:

• a patient-led NHS
• delivering better health outcomes
• a more autonomous and accountable NHS
• improved public health
• reforming long-term and social care.

Take a look at the corporate plan 

Information strategy to give people more control over their care

The Department has published its information strategy – The power of information – which sets a ten-year framework for transforming information for the NHS, public health and social care.

The focus of the strategy is on improving access to information, including a commitment that people will be able to access their GP records online by 2015.

Other ambitions are for test results to be available electronically and that people will be able to book or re-arrange their medical appointments online.

This one-page visual guide helps demonstrate the key benefits to people of having better access to their health and care records and to services online.

Within the strategy the Department has identified dozens of case studies from across the country where GPs, hospital trusts or suppliers are ahead of the game in delivering services in this new way. Examples include:

• a GP surgery that encourages patients to access their records online
• a new information service for parents from NHS Choices
• care homes in Bristol using barcodes to avoid medication errors

The strategy also commits to creating a new website, or portal, that will act as a single trusted source of information across the NHS, public health and social care.

To find out more go to the information strategy website where you'll find a summary of what the strategy will mean for you, and the full publication as a download.

 

Diabet Med. 2012 Apr 30. doi: 10.1111/j.1464-5491.2012.03700.x. [Epub ahead of print]

Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration.

Waaijman R, Arts ML, Haspels R, Busch-Westbroek TE, Nollet F, Bus SA.

Source

Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands.

Abstract

Aims  To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes. Methods  Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis. Results  At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24-28%, compared with pressures in the control group. Conclusion  The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers. 

http://www.ncbi.nlm.nih.gov/pubmed/22540919?dopt=Abstract

Reebok to craft custom-built shoes for nation’s tallest man - BostonHerald.com

Reebok to craft custom-built shoes for nation’s tallest man - BostonHerald.com

Some expensive Bespoke Footwear!

Department seeks three non-executive directors for the NHS Commissioning Board Authority

The Secretary of State for Health is seeking to appoint up to three non-executive directors to the NHS Commissioning Board Authority. The board will lead a commissioning system to improve the health outcomes achieved by the NHS in England while securing value from budgets totalling around £80 billion. This is a unique opportunity to take a leading role in helping to design, develop and deliver the NHS of the future.

Non-executive directors will support the chair by contributing to the wider governance and leadership of the board and will develop and maintain excellent relationships with a range of key partners. They will have a track record of prominence and excellence in their field, and have the stature, intellect and strategic ability to contribute actively to the board of a large, complex organisation whose role is to serve the public.

Primary location: Leeds

Appointments are for a term of up to four years.

Renumeration

Remuneration: £7,882 for around two days a month.

The closing date for applications is 12 noon on 10 May 2012. Interviews are due to take place on 22 May 2012.

Further information

http://www.dh.gov.uk/health/2012/04/nhs-commissioning-board-authority/

Health Secretary sets out objectives for NHS Commissioning Board Authority

Health Secretary Andrew Lansley has set out the Government's strategic objectives for the NHS Commissioning Board Authority and the basis against which the Authority will be held to account.

The Department of Health will hold the Authority to account for its performance against four strategic objectives, relating to:

• transferring power to local organisations
• establishing the commissioning landscape
• developing specific commissioning and financial management capabilities
• developing excellent relationships.

These objectives flow from the Authority's role to prepare for the establishment and operation of the NHS Commissioning Board.

The objectives will need to be delivered in the context of the Board's responsibility to contribute to the achievement of:

• improvements in health for the whole population
• better quality of care and outcomes for all patients
• increased value for the taxpayer through robust financial management and improved efficiency and productivity.

The objectives are relevant to the period when the Authority is operating (until October 2012), and also to the full NHS Commissioning Board when it is established, in its preparatory phase from October 2012 until March 2013.

From April 2013, when the Board takes on its full statutory powers, Ministers will set their objectives, on behalf of the Government as a whole, through the mandate.

Proposals for the mandate are currently being developed with the aim of consulting on them this summer.

Accuracy Verification of Magnetic Resonance Imaging (MRI) Technology for Lower-Limb Prosthetic Research: Utilising Animal Soft Tissue Specimen and Common Socket Casting Materials

Mohammad Reza Safari, Philip Rowe, and Arjan Buis

Abstract

Lower limb prosthetic socket shape and volume consistency can be quantified using MRI technology. Additionally, MRI images of the residual limb could be used as an input data for CAD-CAM technology and finite element studies. However, the accuracy of MRI when socket casting materials are used has to be defined. A number of six, 46 mm thick, cross-sections of an animal leg were used. Three specimens were wrapped with Plaster of Paris (POP) and the other three with commercially available silicone interface liner. Data was obtained by utilising MRI technology and then the segmented images compared to corresponding calliper measurement, photographic imaging, and water suspension techniques. The MRI measurement results were strongly correlated with actual diameter, surface area, and volume measurements. The results show that the selected scanning parameters and the semiautomatic segmentation method are adequate enough, considering the limit of clinical meaningful shape and volume fluctuation, for residual limb volume and the cross-sectional surface area measurements.

http://www.tswj.com/2012/156186/

Alternatives for pressure relief of neuropathic ulcer in the diabetic foot

R. Gallego Estévez, A. Camp Faulí, C. Viel i Blasco, N. Chaqués Salcedo, H. Peñarrocha Fernández
Diabetic Foot Unit. Clínica Virgen del Consuelo. Instituto Valenciano del Pie. Valencia


Abstract
Among the chronic complications associated with diabetes mellitus, foot ulcers
are present in 15% of patients sometimes in the course of their disease,
and often leads to amputation. These ulcers are usually neuropatic and have
a poor response to mechanical stress that causes high plantar pressures. Using
offloading is an integral part of the healing process, which causes favorable
histologic changes in the ulcer, from a chronic inflammatory state to a
better evolutionary condition. There are many strategies for reducing plantar
pressure which have to be used in a protocol manner to obtain favorable results.
This article presents different methods of pressure reduction underling
the importance for professionals of their use in the management of diabetic
foot ulcers.




http://www.sediabetes.org/gestor/upload/revistaAvances/26-6-14-en.pdf

NEW Enhanced Insurance cover for BAPO members Reminder

The BAPO Executive committee is delighted to announce an extensively enhanced insurance cover for all UK Full, Associate Technician, Associate Assistant and Retired members at no increase in cost to you.

Insurance cover has been extended to provide cover for all members who undertake private practice which now gives an annual saving of over £500 for members who previously purchased an extension to their main BAPO policy to cover private income of over £1000. 

BAPO provides four policies as a benefit of membership:

Public Liability

Product Liability

Medical Malpractice Insurance

Professional Indemnity Insurance **NEW** This policy will also provide cover for Medico Legal Report writing and Expert Witness work.

Policy limits for all of the above are £5,000,000 per policy for any claims and in the annual aggregate. 

Full BAPO membership provides this and a host of other benefits for only £360.67 annually. Please feel free to advise your colleagues who work in private practice or Locum work who may not be aware of the fantastic saving available through BAPO membership.

If you have any further questions regarding your new BAPO insurance cover please contact the Secretariat on 0141 561 7217 or email enquiries@bapo.com

HPC Renewal Audit

Last September our profession was audited by HPC and 23 Prosthetists and Orthotists were selected. The results of the audit on 13 March 2012 were:

• 16 (70%)were accepted first time
• 1 (5%) was accepted after further information
• 1 (5%) was deferred
• 1 (5%)person lapsed and did not renew
• 4 (15%) are still under scrutiny

Have you previously been selected for HPC Audit and would like to share your experience with your fellow Prosthetists and Orthotists?

If so please contact the Secretariat on enquiries@bapo.com

Assessment of talipes equinovarus treated by Ponseti technique: Three-year preliminary report

Abstract

Background

The Ponseti method has become increasingly popular in the treatment of congenital talipes equinovarus (CTEV). Current methods of assessment focus on clinical, functional and radiological outcomes which are subjective and often difficult to repeat. However, integration of biomechanical evaluation can provide objective and quantifiable analysis. This study aims to evaluate the treatment outcome of CTEV patients on the basis of long-term clinical, functional and biomechanical assessment.

Methods

Following treatment, five children with CTEV were reviewed annually for the period 2008–2010. Clinical and functional outcomes were graded using parental questionnaires and clinical examination. Biomechanical parameters were evaluated using digital foot pressure studies.

Results

The study group recorded good clinical and functional outcomes. However, biomechanical studies have been able to identify subtle abnormalities that would be unapparent otherwise on clinical examination.

Conclusions

It is recommended that biomechanical assessment be integrated into the overall evaluation of the outcome of CTEV after treatment.

http://www.sciencedirect.com/science/article/pii/S0958259212000120