BAPO Bulletin 26 March 2014

Conference

The Conference this year was a huge success; we hope you all enjoyed it. We are already looking forward to next years conference and if you didn’t get a chance during the weekend to fill our a feedback sheet for what you would like to see in 2015 please email your feedback to the secretariat.

AHP Informatics - Telehealth, Telecare & Telemedicine

BAPO is assisting with some work by the National AHP Informatics Strategic Taskforce (NAHPIST) to look into how information is collected, managed and shared to support the delivery of healthcare and promote health.

We would really like your assistance in this matter so we can find out about current practices and establish your current knowledge, attitudes towards and understanding of Informatics, Telehealth, Telecare and Telemedicine.

This information will help greatly with the planning, training and communication of these key areas in order to enhance and drive patient care across this diverse professional group. 

It will take approx 10 minutes to complete and, apart from indicating which AHP group you are from, it is completely anonymous.

The survey will close at the end of March.

https://www.surveymonkey.com/s/NAHPISTFEB14

Career Structure Documents

The Prosthetics and Orthotics Career Framework is now complete and if you didn’t have a chance to see it at the conference it is available for download on the BAPO website

Prescription Charge Increase in England

The government are increasing prescription charges in England. Current price for a single dispensed prescription has been increased to £8.05 this year and will increase to £8.25 next year.  There are also new charges for fabric supports and wigs:

 

Wigs and Fabrics
Surgical brassiere	27.05
Abdominal or spinal support	40.85
Stock modacrylic wig	66.70
Partial human hair wig	176.65
Full bespoke human hair wig	258.35

 

 

AHPs and Information Technology

Following the link sent out in our previous bulletin, only 2.25% of Prosthetists and Orthotists have responded to the questionnaire on AHPs and the use of IT.  Here is that link again if you missed it:  https://www.surveymonkey.com/s/NAHPISTFEB14

Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial

Marco Monticone, Emilia Ambrosini, Daniele Cazzaniga, Barbara Rocca, Simona Ferrante

Abstract

Purpose

To evaluate the effect of a programme of active self-correction and task-oriented exercises on spinal deformities and health-related quality of life (HRQL) in patients with mild adolescent idiopathic scoliosis (AIS) (Cobb angle <25°).

Methods

This was a parallel-group, randomised, superiority-controlled study in which 110 patients were randomly assigned to a rehabilitation programme consisting of active self-correction, task-oriented spinal exercises and education (experimental group, 55 subjects) or traditional spinal exercises (control group, 55 subjects). Before treatment, at the end of treatment (analysis at skeletal maturity), and 12 months later (follow-up), all of the patients underwent radiological deformity (Cobb angle), surface deformity (angle of trunk rotation) and HRQL evaluations (SRS-22 questionnaire). A linear mixed model for repeated measures was used for each outcome measure.

Results

There were main effects of time (p < 0.001), group (p < 0.001) and time by group interaction (p < 0.001) on radiological deformity: training in the experimental group led to a significant improvement (decrease in Cobb angle of >5°), whereas the control group remained stable. Analysis of all of the secondary outcome measures revealed significant effects of time, group and time by group interaction in favour of the experimental group.

Conclusions

The programme of active self-correction and task-oriented exercises was superior to traditional exercises in reducing spinal deformities and enhancing the HRQL in patients with mild AIS. The effects lasted for at least 1 year after the intervention ended.

http://link.springer.com/article/10.1007/s00586-014-3241-y

Secretariat Opening Hours

To allow Association staff to attend conference 2014 the Secretariat will close at 5pm on Wednesday 12 March and will re-open on Monday 24 March at 8.45am.  Please direct any queries to enquiries@bapo.com

Trulife Job Advert - Orthotist, London

Please follow the link to view the job advertisement: Trulife Job Advert

Conference 2014

Less than two weeks to go till Conference! There is still time to get tickets for both the Weekend event and the Saturday Evening with guest speaker Dennis Taylor; just book online or speak to the

secretariat.

 

BAPO Bulletin March 2014

Conference

As you may know the organising and finalising of the conference which is happening at The Point, Lancashire cricket ground is now well underway. We look forward to seeing many of you there, and would like to thank both the Conference Committee and the Secretariat for helping to organise this; if you haven’t got your tickets yet there is still time to register online or by phoning the Secretariat. We are looking forward to celebrating BAPO’s 20th Anniversary throughout the weekend, looking at what BAPO has done and what BAPO is currently doing.

Professional Affairs

The Professional Affairs committee are currently working on some commissioning documents that will be championed by Linda Hindle, AHP lead at public health England. This will be a series of documents with case studies, which will advise commissioners allowing them to understand the role of Prosthetists and Orthotists and how they can help deliver suitable care in practice.  These documents will be publically available online.

AHP Informatics - Telehealth, Telecare & Telemedicine

BAPO is assisting with some work by the National AHP Informatics Strategic Taskforce (NAHPIST) to look into how information is collected, managed and shared to support the delivery of healthcare and promote health.

We would really like your assistance in this matter so we can find out about current practices and establish your current knowledge, attitudes towards and understanding of Informatics, Telehealth, Telecare and Telemedicine.

This information will help greatly with the planning, training and communication of these key areas in order to enhance and drive patient care across this diverse professional group. 

It will take approx 10 minutes to complete and, apart from indicating which AHP group you are from, it is completely anonymous.

The survey will close at the end of March.

https://www.surveymonkey.com/s/NAHPISTFEB14

Career Structure Documents

 

The Prosthetics and Orthotics Career Framework is now complete and available on the BAPO website.   Andrew Nicol worked on behalf of North West Education England and Salford University to produce these framework documents.  He will be available throughout the conference to talk about this work.  BAPO were one of the key stakeholders in producing these documents.

Saturday Night Ticket - BAPO Conference 2014 - **now available to buy online or by contacting the BAPO Secretariat**

KAFO - Stance Phase Control and Lower Limb Solutions

This course aims to:

Give an overview of conventional and non-conventional KAFO designs, trimlines and material choices.

Give an overview of stance phase control with the information on how to apply this clinically.

If you are interested in this course, please click below link for further details:

KAFO - Stance Phase Control and Lower Limb Solutions

BAPO Conference & Exhibition 2014

Have you seen the BAPO conference programme yet?
Take a look there are some fantastic speakers lined up including Andrew Andrews on the Friday with a mock court scene And Keynote Speakers Rory O'Connor; Peter Slijkhuis and Hayley Ginn on the Saturday. There are many other exciting speakers to listen to and of course you have got to see the exhibition.
And don't worry Its not to late to register if you've not yet done so.

Executive Committee Elections

Dear Member,

Executive Committee Elections

There are a number of seats available at this years’ AGM. Do you know someone who is motivated and has enthusiastic drive for their profession, if so please nominate them for election onto the EC where they may have the opportunity to influence their profession and its position within current affairs.

Further information is available from the BAPO Secretariat or to nominate please complete the attached Nomination form and return it to the address below:

BAPO Secretariat
Sir James Clark Building
Abbey Mill Business Centre
Paisley
Renfrewshire
PA1 1TJ

Nomination Form 2014

BAPO Conference

Only 5 weeks to go to the BAPO conference. Have you got your tickets yet? If not there is still time Register Now!

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

Kevin Deschamps, Giovanni Arnoldo Matricali, Philip Roosen, Kaat Desloovere, Herman Bruyninckx, Pieter Spaepen, Frank Nobels, Jos Tits, Mieke Flour, Filip Staes

Abstract

Background

The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics.

Methodology/Principal Findings

Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters.

Conclusion/s Significance

There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot.

Source: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0079924

BAPO CONFERENCE

Remember to book your tickets for this years BAPO conference. If you haven't done it yet you can Register Here.
And nominations for Technician of the Year are still open if you know someone who has gone the extra mile, or deserves recognition for an excellent piece of work. Nomination Forms available here.

New Council for the Health and Care Professions Council appointed

HCPC News release

Thursday 9 January 2014

New Council for the Health and Care Professions Council appointed

The Health and Care Professions Council (HCPC) is pleased to announce the appointment of its new Council.  There are twelve members in total, all of whom have taken office in January 2014.  This is in line with the government recommendation that all regulatory bodies should be overseen by smaller, more 'board like' Councils.

Each Council member has been appointed for the skills they will bring, including a strong mix of governance, management and financial abilities.  The new Council has also been drawn from the professions we regulate as well as lay backgrounds to bring a diverse mix of experience and knowledge. The full list of appointees, including biographies, is set out below.

Chair of the HCPC, Anna van der Gaag, commented:

"The last few years has seen tremendous growth and change for the HCPC.  I am pleased that we have recruited a Council with such a strong mix of skills, ability and experience drawn from all parts of the UK.  This is particularly important for us as we continue working with our stakeholders in order to ensure we carry out our primary purpose of public protection effectively.  I very much look forward to continuing this work with the restructured Council."

Chief Executive and Registrar of the HCPC, Marc Seale, commented;

"I very much welcome the newly appointed Council members and am looking forward to working with them to ensure the highest standards of public protection. Council members play a fundamental governance role in setting the strategy and policy and ensuring HCPC fulfils its statutory duty. They also ensure we maintain efficient regulatory processes and that the standards we set continue to be fit for purpose."

New Short Course - Saturday 12th April 2014 - Staffordshire University

Imaging Interpretation of the Foot and Ankle with a focus on Diabetic Foot

 

This course aims to:

Provide basic imaging (X-Ray) interpreting skills to allow Allied Health Professionals to be able to distinguish the differences between a normal foot and an abnormal foot and how one can use this information for treatment planning.

If you are interested on this course, please click below link for further details:
Imaging Interpretation of the Foot and Ankle with a focus on Diabetic Foot

Modification of midfoot bone stress with functional foot orthoses

Halstead-Rastrick, Jill (2013) Modification of midfoot bone stress with functional foot orthoses. PhD thesis, University of Leeds.

Abstract

Studies of foot orthoses suggest that they can improve foot pain and function, although the precise mode of action of foot orthoses is poorly understood. It is proposed that they may act through the modification of abnormal stresses or motions occurring within the foot. The central aim of this thesis is to explore whether functional foot orthoses can systematically modify bone stress in the midfoot as measured on magnetic resonance imaging. Bone marrow lesion patterns quantified on magnetic resonance imaging was proposed as a surrogate measure of bone stress in the foot. A reliable method of bone segmentation and BML volume measurement was developed and applied in this thesis. In the interventional study of this thesis, the effect of functional foot orthoses on mechanical medial midfoot pain, foot impairment, patterns of bone marrow lesions and foot kinematics were investigated. Thirty seven participants with mechanical midfoot pain and medial midfoot bone marrow lesions participated in the study and were allocated to wear either functional foot orthoses (n=21) or a cushioning insole (n=16). The effect of the orthosis intervention on foot pain, impairment and volumes of magnetic resonance bone marrow lesions was compared in each group. In addition, the gait parameters and foot kinematics were assessed in a subset of 20 participants (functional foot orthoses n=10 and cushioning insole n=10). Foot pain and foot impairment outcomes improved more in the functional foot orthoses group than the control group wearing cushioning insoles. The results suggest that the volumes of bone marrow lesions in the medial foot bones were reduced systematically in the functional foot orthoses group. In comparison, those wearing the cushioning insole showed no change greater than measurement error. There was no evidence in the small subset of 7 participants, that foot kinematics were systematically altered when wearing either the cushioning insole or functional foot orthoses compared to in-shoe only analyses. The results reported in this thesis suggest that the biomechanical mechanism of functional foot orthoses in treating foot pain could be the modification of internal forces rather than their systematically influencing magnitudes of foot motion. This new data indicates that functional foot orthoses appear to have the potential to reduce foot pain and alter patterns of bone marrow lesions (a surrogate measure of bone stress) in the medial midfoot bones and further work is now required to explore this formally in larger studies.

Source: http://etheses.whiterose.ac.uk/4849/

BAPO Insurance Additional Information

Please click here for additional information on BAPO insurance 2014

BAPO Conference & Exhibition 2014 - Delegate Registrations Now Open!

BAPO are pleased to announce the opening of delegate registrations for Conference & Exhibition 2014 please take advantage of the Early Bird discount which closes on 31 December 2013 BAPO members wishing to register should use their current login details to access BAPOnline - www.bapo.com Non-members should click on the link below, provide details requested, enter the Non Members activation in the box provided, in order to register and access BAPOnline - www.bapo.com http://www.bapo.com/Application/Member/SelfRegistration.aspx For further information or enquiries please contact the Secretariat on 0141 561 7217 or email conference@bapo.com

BAPO Conference & Exhibition 2014 - Call for Papers Reminder

BAPO are seeking presentations both Prosthetic and Orthotic of 12 minutes duration with up to 3 minutes for questions and answers.

 

For more details download submission instructions here

2014 Limbcare Technician of the Year Award

The BAPO Technician Committee are pleased to announce the launch of the Limbcare Technician of the Year Award.  For details on how to nominate please click here and for nomination forms download here

Effect of an ankle–foot orthosis on knee joint mechanics: A novel conservative treatment for knee osteoarthritis

Cynthia H Fantini Pagani; Steffen Willwacher; Rita Benker; Gert-Peter Brüggemann

Abstract

Background: Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success.

Objective: To analyze the effect of an ankle–foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment.

Study design: Controlled laboratory study, repeated measurements.

Methods: In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle–foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis.

Results: Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle–foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles.

Conclusion: The ankle–foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane.

Clinical relevance This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis.

Source: http://poi.sagepub.com/content/early/2013/12/10/0309364613513297.abstract

Speakeasy - BAPO Conference 14th-16th March 2014

Speakeasy Flyer (exclusively for recent graduates (2011-2013) and students) BAPO Conference 14th-16th March 2014

HCPC News Release 4/12/13

News release

Wednesday 4 December 2013

Outcomes of the consultation on the Health and Care Professions Council (HCPC) registration fees

At its most recent meeting, the HCPC Council agreed to proposals to increase the registration renewal fee to £80 per year.  The Council also agreed a similar level of increases to other registration fees.

The Council's decision to increase the fees was carefully considered and followed an in-depth analysis of the responses to the fees consultation which closed recently.

Marc Seale, Chief Executive and Registrar commented;

"We are very aware of the concerns raised by registrants about these increases and of the economic context in which we operate.  For this reason, we have consciously managed our costs as efficiently as we can whilst striving to improve our effectiveness.

"The fees we charge pay for all our operating costs.  However, these fees have not increased since 2009 despite rising costs. We have worked hard to limit the increases as much as possible, but it is crucial that we have sufficient funds to continue to operate efficiently and effectively in protecting the public.

"The new fee structure still means we have the lowest renewal fee of all the regulators overseen by the Professional Standards Authority.  It also allows us to manage increases in costs in an incremental way, preventing financial difficulties which might otherwise lead to substantial unplanned increases to the fees."

Subject to parliamentary approval, the new registration fee structure will come into effect on 1 April 2014.

A full summary of the responses to the consultation is available on our website at www.hcpc-uk.org/aboutus/consultations/closed/index.asp?id=160<file:///C:\Users\gaylee\AppData\Local\Temp\>. The report contains an analysis of the responses we received as well as our comments and decisions. We also have answers to a series of 'frequently asked questions' about the revised registration fees at www.hcpc-uk.org/registrants/fees/consultation<file:///C:\Users\gaylee\AppData\Local\Temp\>

BAPO Conference & Exhibition 2014 - OETT Technician Training Day

OETT sponsorship of this event has allowed us to once again offer the first 15 full paying Technicians to register the opportunity to bring along a colleague FREE OF CHARGE *!

 

Simply complete and return the attached registration forms or download from http://www.bapo.com/

 

*Offer applies to registrations received from full paying P&O Technicians only

*Only P&O Technicians can benefit from free registration offer

*Free registration applies to Friday 14 March only

*Access to Training Day and Trade Exhibition from 5pm

 

OETT Technician Training Day 2014 Flyer

 

Delegate Registration Form 2014

 

Technician Free Place Registration Form 2014

 

Studies examine ways to optimize OA bracing

Research continues to suggest that bracing has the ability to improve pain and function in patients with knee osteoarthritis.  This article offers some recent reviews of literature and tips on compliance.

http://lowerextremityreview.com/article/studies-examine-ways-to-optimize-oa-bracing

BAPO Conference & Exhibition 2014 - Call for Posters

In addition to the clinical programme BAPO will be running a poster competition, submissions will be divided into four groups: Prosthetists/Orthotists; Technicians/Assistants; Students and other.  The best poster in each group will be awarded £100 with a bottle of bubbly awarded to the runners up in each category. 

 

For full details please click here

HCPC News Release

Wednesday 20 November 2013

New research commissioned by the HCPC shows that one in five 'doubted fitness to practise' of a health or care professional

The Health and Care Professions Council (HCPC) is launching new research today which finds that a fifth of UK adults have encountered behaviour from a health or care professional that made them doubt their fitness to practise.

More than a quarter said the health or care professional in question seriously or persistently failed to meet standards whilst 16 per cent said they felt the professional failed to respect the rights of a patient to make their own choices.  Thirteen per cent felt they were 'hiding mistakes' and a further nine per cent felt they were exploiting vulnerable patients.  One in twenty said they had experienced or witnessed reckless or deliberately harmful acts.

Despite these figures, just three out of ten reported their concerns, with a further 73 per cent of adults who would not know where to go to report concerning behaviour.

The data, released today supports research commissioned by the HCPC earlier in the year into what the general public feel they need protection from most.  Findings from this report show that Illegal drug taking and shoplifting were far more likely to concern members of the public than convictions for drink driving. Dishonesty and fraud were also key concerns for most.

Brian James, Head of Assurance and Development said:

"The vast majority of HCPC registrants practise safely and effectively and within nationally agreed standards for professional skills and behaviour. However, on the rare occasion that a registrant does not meet HCPC standards, action can be taken including imposing sanctions or stopping them from practising in the most serious of cases. After looking at the key findings in this research it is reassuring to know that we are dealing with the issues that the public feel they need protecting from the most."

The HCPC's 2013 annual fitness to practise report<http://www.hcpc-uk.org/publications/reports/index.asp?id=709>, which has just been published, shows the action the HCPC is taking to protect the public.

Anyone can contact the HCPC to raise a concern about a registrant. This includes members of the public, employers, the police and other professionals.

Save the Date

Save the Date for the BAPO conference 2014.

 

When: 14^th-16^th March
Where: The Point, Lancashire County Cricket Club, Old Trafford, Manchester.

Its set to be a Fantastic Weekend with some great speakers so don't miss out Save the Date now!

BAPO Conference & Exhibition 2014 Call for Papers

BAPO are seeking presentations both Prosthetic and Orthotic of 12 minutes duration with up to 3 minutes for questions and answers.

 

For more details download submission instructions here

Physiotherapy to Complement Orthotic Treatment

Physiotherapy to Complement Orthotic Treatment

Saturday 12th October 2013

**last chance to book on this course**

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

 

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

 

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

 

Contact hours: 6 hours plus 2 hours of independent reading

 

 

Physiotherapy to Complement Orthotic Treatment Short Course

LimbPower Holding Primary & Junior Games at Stoke Mandeville Stadium

Following the huge success of last year's inaugural Junior Games, LimbPower are proud to be holding this fantastic event once again at Stoke Mandeville Stadium, birthplace of the Paralympics. The weekend will introduce young amputees and the young ambulant disabled to a range of sporting activities in a safe, friendly and inclusive environment.

Saturday 5th October will see those aged 5-11 able to try out a variety of sports including athletics, cycling, football, tennis and basketball in 'Have a Go' sessions under the guidance of experienced mentors and instructors from each sport's governing body. The emphasis is on fun while encouraging the children to have a go at sports and socialise with their peers.

On Sunday 6th October the older children aged between 11-18 will be able to have a go at key Paralympic sports, with instruction from qualified coaches and experienced athletes. They will be able to try out a wide range of sports including; athletics, Powerlifting, basketball, sitting volleyball, archery, football, cycling, swimming and tennis. They will be able to have fun and also perhaps find some hidden talents. We may even discover the Paralympians of the future!

"We're thrilled to be able to run this event again and offer the same opportunities to children that we have been offering to adults at the Amputee Games" said Kiera Roche, LimbPower Chairman. "Last year was such a great success, and we're hoping to reach even more young people and give them the chance to challenge what they think they are capable of."

Juliette Woolf, mother of Rio Woolf who took part last year, commented; "The 2012 LimbPower Primary Games were life-changing for Rio - he absolutely loved trying all the different para-sports on offer and making friendships with other "children with special arms and legs" which will last a lifetime - they had an instant bond!"

The Primary & Junior Games will help young amputees to learn new skills, have fun and importantly to discover their potential through sport. Anyone interested in taking part should contact Kiera Roche from LimbPower on: 07502 276858 or kiera@limbpower.com Alternatively registration forms can be downloaded from the website at www.limbpower.com/junior-games/

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

Surgical versus non‐surgical interventions in patients with adolescent idiopathic scoliosis

J Bettany‐Saltikov, HR Weiss, N Chockalingam… - The Cochrane Library, 2013

... Whilst scoliosis-specific exercises use internal corrective forces (ie muscles), braces use external
corrective forces ... However, some braces (called soft braces) are made of material similar to elas-
tic bands ... of the brace are used to straighten the spine and derotate the pelvis and ...

Retrospective Cohort Study ofthe Economic Value of Orthotic and Prosthetic Services

Medicare recipients given orthotic and prosthetic devices were more likely to remain active in the community and avoid facility-based care than similar Medicare patients who didn't receive such devices, a retrospective study found.

For example, patients receiving lower-extremity orthoses had fewer hospitalizations and emergency department (ED) admissions, and had about 10% lower Medicare costs after 18 months (P<0.05). Comparable Medicare savings were seen in patients with spinal orthoses and they also relied less on facility-based care (P<0.05).

The study results will be used to urge Medicare and other payers to make it easier for patients in need of prosthetics to receive them, the Amputee Coalition, a Manassas, Va.-based advocacy group that commissioned the study, said Tuesday.

The advocates said patients who receive orthoses and prosthetics will save Medicare money in the long run.

Although they relied less on facility-based care, patients receiving the orthotic and prosthetic devices did have more falls and fractures, and average Medicare episode payments weren't always lower. The increase in falls was most likely due to increased mobility because of the device, according to Allen Dobson, president of Dobson DaVanzo & Associates in Vienna, Va., the consulting firm that conducted the study.

"The increased physical therapy among O&P [orthoses and prosthetic] users allowed patients to become less bed-bound and more independent, which may be associated with higher rates of falls and fractures, but fewer emergency room admissions and acute care hospital admissions," the report concluded. "This reduction in health care utilization ultimately makes O&P services cost-effective for the Medicare program and increases the quality of life and independence of the patient."

Dobson, a former research director at the Centers for Medicare and Medicaid Services (CMS), and colleagues examined CMS data from 2007 to 2010 for patients who either had an amputation within the last year or who met predetermined etiological diagnoses. Patients who received a lower-extremity or spinal orthotic or prosthetic device were compared with those who hadn't received such devices.

The study compared healthcare utilization, Medicare payments, and negative outcomes such as fall and emergency department admissions for up to 18 months after receiving the device.

Generally, patients were found to be more mobile and therefore able to receive the physical therapy and rehabilitation required, and to avoid facility-based care.

With the data in hand, advocates hope it will be easier for patients to receive authorization for the devices.

"Insurers want to see the data that the healthcare system is better off if the service is provided," Susan Stout, interim president and chief executive of the Amputee Coalition, said in a call with reporters. "Now that the study is completed, we intend to use the information contained in the study to achieve fair insurance coverage for prosthetic devices."

Providers must prove the medical necessity of devices before insurers will pay for their use, a step which can be burdensome to patients and physicians. Insurers also have a tendency to provide the least expensive prostheses rather than one that maximizes a patient's mobility.

"For the first time, we can actually use the data ... that clearly demonstrates the efficiency and the efficacy of the services that we provide," Thomas Kirk, PhD, president of theAmerican Orthotic & Prosthetic Association, said in a call with reporters. "Not only are we providing services that can help out patients, we are also helping the American taxpayers save money."

While payers don't deny the devices, a number of patients are underserved by insurers, the advocates said on the call Tuesday. "Many payers have seen the cost of a prosthesis in a vacuum rather than seeing it as actually contributing to the overall improved health of the patient," Kirk said.

The authors hope to publish the results in a medical journal later.

Source: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/41260

Link to report: http://www.amputee-coalition.org/content/documents/dobson-davanzo-report.pdf

Effect of rocker shoes on pain, disability and activity limitation in patients with rheumatoid arthritis

Masumeh Bagherzadeh Cham, Mohammad Sadegh Ghasemi, Bijan Forough, Mohammad Ali Sanjari, Mozdeh Zabihi Yeganeh, Arezoo Eshraghi

Abstract

Background: Rheumatoid arthritis is a chronic inflammatory joint disease which affects the joints and soft tissues of the foot and ankle. Rocker shoes may be prescribed for the symptomatic foot in rheumatoid arthritis; however, there is a limited evidence base to support the use of rocker shoes in these patients.

Objectives: The aim of this study was to evaluate the effectiveness of heel-to-toe rocker shoes on pain, disability, and activity limitation in patients with rheumatoid arthritis.

Study design: Clinical trial.

Methods: Seventeen female patients with rheumatoid arthritis of 1 year or more duration, disease activity score of less than 2.6, and foot and ankle pain were recruited. Heel-to-toe rocker shoe was made according to each patient's foot size. All the patients were evaluated immediately, 7 and 30 days after their first visit. Foot Function Index values were recorded at each appointment.

Results: With the use of rocker shoes, Foot Function Index values decreased in all subscales. This reduction was noted in the first visit and was maintained throughout the trials.

Conclusion: Rocker shoe can improve pain, disability, and activity limitation in patients with rheumatoid foot pain. All the subjects reported improved comfort levels.

Clinical relevance The results of this study showed that high-top, heel-to-toe rocker shoe with wide toe box was effective at reducing foot and ankle pain. It was also regarded as comfortable and acceptable footwear by the patients with rheumatoid foot problems.

Suspended without pay

HCPC REGISTRATION RENEWAL REMINDER
DEADLINE:  30 SEPTEMBER 2013

Can you afford to be suspended without pay?  46% of P&O registrants still have not re-registered with HCPC.  All registrants must re-register by 30th September 2013 or you will be unable to practice as a Prosthetist or Orthotist.  Re-registration only takes 5 minutes and can be done simply online on the HCPC website.
 
http://www.hpc-uk.org/aboutregistration/theregister/

Paediatric Gait Analysis and Orthotic Management - BAPO Run Short Course - 8th & 9th November 2013

This Course Aims to: 

Explore a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders. The biomechanics of normal gait and standing, and the pathological gaits of disabling conditions will be extensively reviewed, with particular reference to orthotic management. Pre-gait analysis and orthotic management assessment will be demonstrated. The emphasis of patient cases will focus on cerebral palsy, myelomeningocoele and other neurological conditions. Participants will gain a knowledge of the aims of orthotic management and how to achieve them through: the biomechanics of ankle-foot orthoses, the influence of footwear, varieties of ‘AFO Footwear Combination’ design, tuning ‘AFO Footwear Combinations’ to optimise gait and extensive video examples. In addition live patient demonstrations will help participants refine their clinical decision making skills involved in gait analysis and orthotic design.

                                                          Paediatric Gait Analysis and Orthotic Management

Register as a stakeholder for a Clinical Reference Group

Registration is now open for anyone with an interest in the work of the Specialised Services Clinical Reference Groups (CRGs).  To become a stakeholder in a particular CRG you will most likely be a patient, carer, a member of the public, a member of a voluntary organisation, or a clinical or non-clinical professional.

Physiotherapy to Complement Orthotic Treatment

This course aims to:

Share how physiotherapists look at patients regarding an assessment and detail what elements of that assessment may lead to the involvement of orthotics.

Explore reasoning behind physiotherapy intervention, namely core stability, flexibility, strength, pathology, neurological involvement etc.

The event will be delivered by tutors who are also active clinicians using audio/visual aids as appropriate. We may call upon willing delegates to participate in the direct delivery of the syllabus. There will group discussions and case studies.

Contact hours: 6 hours plus 2 hours of independent reading

Physiotherapy to Complement Orthotic Treatment Short Course

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model

Matthias Höslemail, Harald Böhm, Christel Multerer, Leonhard Döderlein

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds.

http://www.gaitposture.com/article/S0966-6362(13)00251-8/abstract

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Jonathan 

Prosthetic finger out of Bicle Parts

Colin MacDuff invents prosthetic finger out of BICYCLE partsDaily Mail

Mr Macduff constructed the prosthetic device using leftover bike parts, ... but doctors told him that there were no prosthetics for finger amputees available.

NICE Stroke Rehabilitation Guideline

Stroke rehabilitation: long-term rehabilitation after stroke

Clinical guidelines, CG162 - Issued: June 2013

This guideline offers evidence-based advice on the care of adults and young people aged 16 years and older who have had a stroke with continuing impairment, activity limitation or participation restriction.

http://www.nice.org.uk/nicemedia/live/14182/64098/64098.pdf

NICE has published good practice guidance on patient group directions (PGDs)

The guidance has been developed to help individuals and organisations who are considering the need for, developing, authorising, using and/or updating PGDs to ensure they are appropriate, legal and that relevant governance arrangements are in place within commissioning and provider organisations.

The guidance underlines that supplying and/or administering medicines under PGD should be reserved for situations where this offers an advantage for patient care without compromising patient safety and where there are clear governance arrangements and accountability.

Physiotherapy to Complement Orthotic Treatment Saturday 12th October 2013

For further information on the 'Physiotherapy to Complement Orthotic Treatment' BAPO Short Course please follow the link below:

Further Information

Please note that the cancellation date of this course is 2 September 2013.  If you wish to book a place on the BAPO short course then please do so at your earliest convenience.

The clinical management of diabetic foot in the elderly and medico-legal implications

Claudio Terranova, Andrea Bruttocao

Abstract

Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.

http://msl.sagepub.com/content/early/2013/08/06/0025802412473595.abstract

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy

TL Lin, HM Sheen, CT Chung, SW Yang, SY Lin… - … of Foot and Ankle Research, 2013

... However, what the four insole conditions will be, the configurations, and possible biomechanical
effects, were not told. ... 18. Menz HB: Two feet, or one person? Problems associated with statistical
analysis of paired data in foot and ankle medicine. Foot 2004, 14(1):2–5. 19. ...