The British Association of Prosthetists and Orthotists (BAPO) was established to encourage high standards of prosthetic and orthotic practice. It is committed to Continued Professional Development and education to enhance standards of prosthetic and orthotic care. BAPO is the only UK body that represents the interests of prosthetic and orthotic professionals and associate members to their employers, BAPO enjoys the support of a high majority of the profession as members.
Tuesday 30 December 2014
Wednesday 24 December 2014
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.
Tuesday 23 December 2014
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 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.
Monday 22 December 2014
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.
Friday 19 December 2014
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.
Tuesday 16 December 2014
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.
Saturday 6 December 2014
Biomechanical Effects of Valgus Knee Bracing: A Systematic Review and Meta-Analysis
- Rebecca F. Moyer, PT, PhDa,
- Trevor B. Birmingham, PT, PhDa, , (Dr.),
- Dianne M. Bryant, PhDa,
- J.Robert Giffin, MD, FRCS(C)b,
- Kendal A. Marriott, BScKinc,
- Kristyn M. Leitch, PhDd
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
Thursday 4 December 2014
Guy's and St Thomas' NHS Foundation Trust, x2 Orthotists, London
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Friday 28 November 2014
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.
Tuesday 25 November 2014
BAPO Conference & Exhibition - Register Now Using Early Bird Discount
ONLY 6 DAYS REMAINING FOR EARLY BIRD DISCOUNT
BOOK NOW!
Monday 24 November 2014
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.
Friday 21 November 2014
Webinar - Making Rehabilitation Work Better for People - Save the Date 1 December 2014
Save the date - 1 December 12.45- 1.30
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 19th January, 5th February, 2nd 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.
Thursday 20 November 2014
Thursday 6 November 2014
Friday 31 October 2014
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.
Wednesday 22 October 2014
Prosthetist Vacancies - Opcare - Roehampton, Newcastle & Cambridge
Click here to view job advertisement
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