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 16 December 2014
Indicators of Future Ulceration in Diabetes Patients of 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
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
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
Tuesday 25 November 2014
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
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
Wednesday 22 October 2014
Prosthetist Vacancies - Opcare - Roehampton, Newcastle & Cambridge
Tuesday 21 October 2014
Clinical Audit Awareness Week
Trulife - Orthotist - North West London & The North West/Midlands
Monday 13 October 2014
Opcare Job Advertisement - 3 x Orthotist positions, England
Sunday 12 October 2014
UNISON NHS Agenda for Change Action
UNISON asks that if a member is employed directly by an NHS organisation on Agenda for Change terms and conditions then they are covered by the action and able to show support. Members who choose to strike would lose pay as a result.
If a member is self employed, or employed under a contract for services, then they are not covered by the action. If this is the case we would ask that they do not cross picket lines or cover the work of striking workers. These BAPO members cannot be asked to strike or take action short of strike action.
It is unlikely that any workplaces will close as a result of the strike however if so then any BAPO members should be informed by their employer and receive their full normal pay.
UNISON and other trade unions will likely be maintaining picket lines at entrances to workplaces. Pickets are allowed to peacefully persuade workers and others not to cross the picket line but anyone who decides to cross must be allowed. Anyone crossing the picket line will also likely be asked to not undertake any duties of to cover those who are on strike.
Of course it is an individual decision and BAPO members can explain that they have not been balloted and are not on strike.
The background to the strike is here http://www.unison.org.uk/at-work/health-care/key-issues/nhs-pay/home/ .
Friday 10 October 2014
Monday 6 October 2014
Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children
Ankle-foot orthosis (AFO) is the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs are designed either to improve function or to prevent or treat muscle contractures.
The purpose of the present study was to analyse the use of, the indications for, and the outcome of using AFO, relative to age and gross motor function in a total population of children with cerebral palsy.
Methods: A cross-sectional study was performed of 2200 children (58% boys, 42% girls), 0-19 years old (median age 7 years), based on data from the national Swedish follow-up programme and registry for CP. To analyse the outcome of passive ankle dorsiflexion, data was compared between 2011 and 2012.
The Gross motor classification system (GMFCS) levels of included children was as follows: I (n = 879), II (n = 357), III (n = 230), IV (n = 374) and V (n = 355).
Results: AFOs were used by 1127 (51%) of the children. In 215 children (10%), the indication was to improve function, in 251 (11%) to maintain or increase range of motion, and 661 of the children (30%) used AFOs for both purposes.
The use of AFOs was highest in 5-year-olds (67%) and was more frequent at lower levels of motor function with 70% at GMFCS IV-V. Physiotherapists reported achievement of functional goals in 73% of the children using AFOs and maintenance or improvement in range of ankle dorsiflexion in 70%.
Conclusions: AFOs were used by half of the children with CP in Sweden.
The treatment goals were attained in almost three quarters of the children, equally at all GMFCS levels. AFOs to improve range of motion were more effective in children with a more significant decrease in dorsiflexion at baseline.
Author: Maria WingstrandGunnar HägglundElisabet Rodby-Bousquet
Credits/Source: BMC Musculoskeletal Disorders 2014, 15:327
Wednesday 1 October 2014
Sunday 28 September 2014
AHP Healthy Conversations
Friday 19 September 2014
The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study
Even if the SRS criteria propose a prospective design, until now only one out of 6 published studies was prospective. Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria for AIS conservative treatment.
Methods: Study design/setting: prospective cohort study nested in a clinical database of all outpatients of a clinic specialized in scoliosis conservative treatment.Patient sample: seventy-three patients (60 females), age 12 years 10 months +/-17 months, 34.4+/-4.4 Cobb degrees, who satisfied SRS criteria were included out of 3,883 patients at first evaluation.Outcome measures: Cobb angle at the end of treatment according to SRS criteria : (unchanged; worsened 6[degree sign] or more, over 45[degree sign] and surgically treated, and rate of improvement of 6[degree sign] or more).Braces were prescribed for 18-23 hours/day according to curves magnitude and actual international guidelines.
Weaning was gradual after Risser 3. All patients performed exercises and were managed according to SOSORT criteria.
Results in all patients were analyzed according to intent-to-treat at the end of the treatment. Funding and Conflict of Interest: no.
Results: Overall 46 patients (49.3%) improved.
Seven patients (9.6%) worsened, of which 1 patient progressed beyond 45[degree sign] and was fused. Referred compliance was assessed during a mean period of 3 years 4 months+/-20 months; the median adherence was 99.1% (range 22.2-109.2%).
Employing intent-to-treat analysis, there were failures in 11 patients (15.1%). At start, these patients had statistically significant low BMI and kyphosis, high thoracic rotation and higher Cobb angles.
Drop-outs showed reduced compliance and years of treatment; their average scoliosis at discontinuation was low: 22.7[degree sign] (range 16-35[degree sign]) at Risser 1.3 +/- 1.
Conclusions: Bracing in patients with AIS who satisfy SRS criteria is effective. Combining bracing with exercise according to SOSORT criteria shows better results than the current literature.
Author: Stefano NegriniSabrina DonzelliMonia LusiniSalvatore MinnellaFabio Zaina
Credits/Source: BMC Musculoskeletal Disorders 2014, 15:263
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Tuesday 16 September 2014
BAPO Bulletin September 2014
16th-17th October, 2014, Venue- Mercure Goldthorn Hotel, Wolverhampton
Friday 14th November, 2014, Venue- Peacocks Medical, Newcastle
Following the success of Making Every Contact Count (MECC) initiative in supporting people to lead healthier lives in NHS settings, the Royal Society for Public Health is working in partnership with Public Health England to explore the potential for Allied Health Professionals (AHPs) to engage in “healthy conversations” with their clients in order to improve the health and wellbeing of their patients and clients.
requires all HCPC registrants, apart from social workers in England, to
hold appropriate professional indemnity cover as a condition of
registration with the HCPC.
This will not affect the majority of registrants as they will already be
indemnified either through their employer, BAPO Indemnity Insurance, directly
with an insurer or a combination of these. It is, however important that
each HCPC registrant has the appropriate level of cover for their practice.
HCPC have published guidance for registrants, -Professional indemnity and your registration, which is available on their website here:
http://www.hcpc-uk.org/assets/documents/10004776Professionalindemnityandyourregistration.pdf
HCPC have also put together some Frequently Asked Questions which are
available here: http://www.hcpc-uk.org/registrants/indemnity/
The government has announced legislation which introduces fundamental standards for health and social care providers. Subject to parliamentary approval, they will become law in April 2015.
The new measures are being introduced as part of the government’s response to the Francis Inquiry’s recommendations and are intended to help improve the quality of care and transparency of providers by insuring that those responsible for poor care can be held to account.
Monday 15 September 2014
HCPC CPD audit process webinars
This online event will focus on the Health and Care Professions Council's
audit process and how this links to your HCPC registration and CPD and will
provide detailed information on how to put your CPD profile together
The presentation will last around 40 minutes, followed by the opportunity
to ask representatives from the HCPC questions about the audit (via the
webinar portal).
We will be running two sessions on 25 September 2014:
1pm - 2.30pm
4pm - 5.30pm
If you would like to register for these events, please click here
Further details about the webinar, including the link to join on the
day and how to send in questions, will be sent to those registered 1 week
before the event.
You can find further details on CPD and registration on our webpage -
http://www.hcpc-uk.org/registrants/renew/
Friday 12 September 2014
Tuesday 9 September 2014
Monday 8 September 2014
Lancashire Teaching Hospitals - Senior Prosthetist & Senior Orthotist Positions
Wednesday 3 September 2014
Orthotic Treatment of Neurological Conditions
This event aims to:
Review orthotic principles of managing different types of neurological conditions
Provide up to date knowledge on orthotic prescription and interventions available to complement orthotic treatment.
Guidance Framework for personalised care and population health
Tuesday 2 September 2014
The effect of knee orthoses on gait parameters in medial knee compartment osteoarthritis: A literature review
Background: Knee osteoarthritis is a musculoskeletal condition which is most prevalent in the medial compartment. This injury causes considerable pain, disability, and negative changes in kinetic and kinematic parameters. The efficiency of unloader valgus brace as a conservative treatment for medial knee osteoarthritis is not well documented.
Objectives: The aim of this study was to review the previous research regarding the biomechanical effects of knee valgus braces on walking in medial compartment knee osteoarthritis patients.
Study design: Literature review
Methods: According to the population intervention comparison outcome measure methods and based on selected keywords, 12 studies were chosen according to (met) the inclusion criteria.
Results: The results indicated that treatment with knee braces was effective in decreasing pain, improving function, ameliorating improvement in range of motion, and increasing speed of walking and step length in conjunction with a reduction in the adduction moment applied to the knee.
Conclusion: Osteoarthritis knee braces may be considered for improvement of walking and treatment of medial compartment knee osteoarthritis.
Friday 29 August 2014
Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness
H.E. Ploeger, S.A. Bus, M.A. Brehm, F. Nollet
Wednesday 27 August 2014
Friday 15 August 2014
Sunday 10 August 2014
Personalized Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot
Maria Luz González Fernández, Rosario Morales Lozano, Carmen Martínez Rincón, and David MartínezHernández
Background: We sought to assess the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and to determine reulceration rates before and after personalized conservative orthotic treatment.
Methods: A longitudinal prospective study was performed in 35 patients with Charcot's foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph. Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first-ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received.
Results: In a 1-year period, 70 feet received orthotic treatment, of which 41 were Charcot's feet. Ulceration rates before the study were 73.2% in feet with Charcot's and 31.0% in those without. After 1 year of wearing the customized orthoses, rates fell significantly to 9.8% in the Charcot feet and 0% in the feet without this condition.
Conclusions: Conservative customized orthotic treatment was effective at preventing ulcers and the complications that often lead these patients to surgery.
Source: http://www.japmaonline.org/doi/abs/10.7547/0003-0538-104.4.375
Friday 8 August 2014
Paediatric Gait Analysis and Orthotic Management
This course explores a fresh approach to the observation and analysis of normal gait and standing, and the classification and management of gait disorders.
Wednesday 6 August 2014
Tuesday 5 August 2014
The Subtalar Joint Axis Palpation Technique Part 2: Reliability and Validity Results Using Cadaver Feet
Background: Clinically locating the point of no rotation to determine the subtalar joint axis location by applying pressure on the plantar surface of the foot was described by Kirby in 1987 but was never validated. We sought to extend a previously validated mechanical model to cadaver feet and to examine the intratester and intertester reliability.
Methods: Four testers with different levels of experience determined the subtalar joint axis location and moved the subtalar joint through its range of motion, capturing the movement using kinematic analysis. The comparison of the spatial subtalar joint axis location as determined by palpation between and within testers determined the intertester and intratester reliability. The helical axis method was performed to validate the model.
Results: The intrarater reliability varied from a high of α = 0.96 to a low of α = 0.26 for the slope and was, in general, high (α = 0.78–0.95) for the intersection. The interrater reliability scored moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method.
Conclusions: The palpation technique as part of the subtalar joint axis location and rotational equilibrium theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence-based practice, this technique could be a standard tool in the examination of patients with lower-limb–related pathologic disorders.
Source: http://www.japmaonline.org/doi/abs/10.7547/0003-0538-104.4.365
Thursday 31 July 2014
Tuesday 29 July 2014
Monday 28 July 2014
#hellomynameis
As a healthcare professional you know so much about your patient. You know their name, their personal details, their health conditions, who they live with and much more. What do we as patients know about our healthcare professionals? The answer is often absolutely nothing, sometimes it seems not even their names. The balance of power is very one-sided in favour of the healthcare professional.
Getting to know people's names is part of building good working relationships with both patients and other colleagues. It is the first rung on the ladder to providing compassionate care and often getting the simple things right, means the more complex things will follow more easily and naturally.
Dr Kate Granger created the #hellomynameis campaign. If you support this idea please download a #hellomynameis name card from the BAPO website, add your name and send in a photograph of yourself toenquiries@bapo.comor post to the Secretariat. BAPO would like to create a collage of images that will be put onto YouTube to promote this campaign and our profession.
Please share with your fellow Prosthetists and Orthotists to see how many pledges we can get!