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Chatzistergos P, Chockalingam N. Diabetic ulcer alert: Time to rethink our approach to patient adherence. Diabet Med 2024; 41:e15276. [PMID: 38140765 DOI: 10.1111/dme.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technology, Staffordshire University, Stoke on Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technology, Staffordshire University, Stoke on Trent, UK
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Andrikopoulou E, Chatzistergos P, Chockalingam N. Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e54852. [PMID: 38656782 DOI: 10.2196/54852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. OBJECTIVE This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. METHODS This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. RESULTS The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. CONCLUSIONS This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54852.
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Affiliation(s)
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
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Naemi R, Chockalingam N, Lutale JK, Abbas ZG. What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration? J Diabetes Investig 2024. [PMID: 38571302 DOI: 10.1111/jdi.14193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
AIMS/INTRODUCTION This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications. MATERIALS AND METHODS A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two-step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics. RESULTS Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly-decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1. CONCLUSIONS Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5-fold risk of future foot ulceration compared to the other.
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Affiliation(s)
- Roozbeh Naemi
- School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK
- School of Health and Society, University of Salford, Manchester, UK
| | | | - Janet K Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Zulfiqarali G Abbas
- School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Abbas Medical Centre, Dar es Salaam, Tanzania
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Chatzistergos PE, Eddison N, Ganniari-Papageorgiou E, Chockalingam N. A quantitative analysis of optimum design for rigid ankle foot orthoses: The effect of thickness and reinforcement design on stiffness. Prosthet Orthot Int 2024; 48:204-212. [PMID: 37314325 DOI: 10.1097/pxr.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/23/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND An ankle foot orthosis (AFO) which is prescribed to be rigid should only deform a small amount to achieve its clinical goals. Material thickness and the design of reinforcing features can significantly affect AFO rigidity, but their selection remains based on anecdotal evidence. OBJECTIVES To quantify the effect of these parameters on AFO stiffness and to set the basis for quantitative guidelines for the design optimisation of rigid AFOs. STUDY DESIGN Experimental and computational study. METHODS A polypropylene AFO was produced according to UK standard practice and its stiffness was experimentally measured for 30Nm of dorsiflexion. Its geometry and mechanical characteristics were utilised to create a finite element (FE) model of a typical AFO prescribed to be rigid. Following validation, the model was used to quantify the effect of material thickness and reinforcement design (i.e., reinforcement placement, length) on stiffness. A final set of AFO samples was produced to experimentally confirm key findings. RESULTS AND CONCLUSIONS For a specific AFO geometry and loading magnitude, there is a thickness threshold below which the AFO cannot effectively resist flexion and buckles. FE modelling showed that stiffness is maximised when reinforcements are placed at the anterior-most position possible. This key finding was also experimentally confirmed. The stiffness of an AFO reinforced according to standard practice with lateral and medial ribbing was 4.4 ± 0.1 Nm/degree. Instructing the orthotic technician to move the ribbings anteriorly increased stiffness by 22%. Further stiffening is achieved by ensuring the reinforcements extend from the footplate to at least two-thirds of the AFO's total height.
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Affiliation(s)
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Testing protocols and measurement techniques when using pressure sensors for sport and health applications: A comparative review. Foot (Edinb) 2024; 59:102094. [PMID: 38579518 DOI: 10.1016/j.foot.2024.102094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024]
Abstract
Plantar pressure measurement systems are routinely used in sports and health applications to assess locomotion. The purpose of this review is to describe and critically discuss: (a) applications of the pressure measurement systems in sport and healthcare, (b) testing protocols and considerations for clinical gait analysis, (c) clinical recommendations for interpreting plantar pressure data, (d) calibration procedures and their accuracy, and (e) the future of pressure sensor data analysis. Rigid pressure platforms are typically used to measure plantar pressures for the assessment of foot function during standing and walking, particularly when barefoot, and are the most accurate for measuring plantar pressures. For reliable data, two step protocol prior to contacting the pressure plate is recommended. In-shoe systems are most suitable for measuring plantar pressures in the field during daily living or dynamic sporting movements as they are often wireless and can measure multiple steps. They are the most suitable equipment to assess the effects of footwear and orthotics on plantar pressures. However, they typically have lower spatial resolution and sampling frequency than platform systems. Users of pressure measurement systems need to consider the suitability of the calibration procedures for their chosen application when selecting and using a pressure measurement system. For some applications, a bespoke calibration procedure is required to improve validity and reliability of the pressure measurement system. The testing machines that are commonly used for dynamic calibration of pressure measurement systems frequently have loading rates of less than even those found in walking, so the development of testing protocols that truly measure the loading rates found in many sporting movements are required. There is clear potential for AI techniques to assist in the analysis and interpretation of plantar pressure data to enable the more complete use of pressure system data in clinical diagnoses and monitoring.
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Affiliation(s)
- Louise Burnie
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2RU, UK
| | | | - Tim Claypole
- Welsh Centre for Printing and Coating (WCPC), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam Kilduff
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Neil Bezodis
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
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Gidlow CJ, Sams L, Buckless K, Ellis NJ, Duffy HC, Lambley-Burke R, Campbell P, Cooke A, Dziedzic K, Brookes M, Chockalingam N, Devall P, Mallen C. "We have to change our mindsets": a qualitative study of barriers and facilitators in research collaboration across integrated care system organisations. BMC Health Serv Res 2024; 24:264. [PMID: 38429760 PMCID: PMC10908113 DOI: 10.1186/s12913-024-10760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
The introduction of Integrated Care Systems (ICS) in England aimed to increase joint planning and delivery of health and social care, and other services, to better meet the needs of local communities. There is an associated duty to undertake collaborative research across ICS partners to inform this new integrated approach, which might be challenging given that organisations span health, local authority, voluntary and community sector, and research. This study aimed to explore the appetite for collaborative Research and Innovation (R&I) across ICSs, potential barriers and solutions. This qualitative study involved semi-structured interviews with 24 stakeholders who held senior positions within organisations across two ICS areas (Staffordshire and Stoke-on-Trent; Shropshire, Telford and Wrekin). Interview transcripts were analysed using inductive and deductive analysis, first mapping to the Theoretical Domains Framework (TDF), then considering key influences on organisational behaviour in terms of Capability, Opportunity and Motivation from the COM-B Behaviour Change Wheel. There were fundamental limitations on organisational opportunities for collaborative R&I: a historical culture of competition (rather than collaboration), a lack of research culture and prioritisation, compounded by a challenging adverse economic environment. However, organisations were motivated to undertake collaborative R&I. They recognised the potential benefits (e.g., skill-sharing, staff development, attracting large studies and funding), the need for collaborative research that mirrors integrated care, and subsequent benefits for care recipients. Related barriers included negative experiences of collaboration, fear of failing and low confidence. Capability varied across organisations in terms of research skills and confidence, which reflected the range of partners (from local authorities to NHS Trusts, primary care, and academic institutions). These findings indicate a need to shift from a culture of competition to collaboration, and to help organisations across ICS to prioritise research, and share resources and skills to mitigate the limiting effects of a constrained economic environment. This could be further explored using a systems change approach, to develop the collaborative research efforts alongside the overarching move towards integrated care.
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Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK.
| | - Lorna Sams
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Kim Buckless
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Helen C Duffy
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Ruth Lambley-Burke
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
| | - Paul Campbell
- Midlands Partnership University NHS Foundation Trust, St George's Hospital, Corporation Street, ST16 3AG, Stafford, UK
- Keele University, ST5 5BG, Keele, Staffordshire, UK
| | - Alison Cooke
- Keele University, ST5 5BG, Keele, Staffordshire, UK
- University Hospitals of North Midlands NHS Trust, Newcastle Road, ST4 6QG, Stoke-on-Trent, UK
| | | | - Matthew Brookes
- University of Wolverhampton, Wolverhampton, UK
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Nachiappan Chockalingam
- Centre for Health and Development (CHAD), Staffordshire University, Ashley Building, Leek Road, ST4 2DF, Stoke-on-Trent, UK
| | - Pam Devall
- NIHR Clinical Research Network West Midlands, New Cross Hospital, WV10 0QP, Wolverhampton, UK
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Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Arienti C, Negrini S. Therapeutic exercises for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2024; 2:CD007837. [PMID: 38415871 PMCID: PMC10900302 DOI: 10.1002/14651858.cd007837.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a pathology that changes the three-dimensional shape of the spine and trunk. While AIS can progress during growth and cause cosmetic issues, it is usually asymptomatic. However, a final spinal curvature above the critical threshold of 30° increases the risk of health problems and curve progression in adulthood. The use of therapeutic exercises (TEs) to reduce the progression of AIS and delay or avoid other, more invasive treatments is still controversial. OBJECTIVES To evaluate the effectiveness of TE, including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two clinical trials registers to 17 November 2022. We also screened reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing TE with no treatment, other non-surgical treatments (braces, electrical stimulation, manual therapy), and different types of exercises. In the previous version of the review, we also included observational studies. We did not include observational studies in this update since we found sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Our major outcomes were progression of scoliosis (measured by Cobb angle, trunk rotation, progression, bracing, surgery), cosmetic issues (measured by surface measurements and perception), and quality of life (QoL). Our minor outcomes were back pain, mental health, and adverse effects. MAIN RESULTS We included 13 RCTs (583 participants). The percentage of females ranged from 50% to 100%; mean age ranged from 12 to 15 years. Studies included participants with Cobb angles from low to severe. We judged 61% of the studies at low risk for random sequence generation and 46% at low risk for allocation concealment. None of the studies could blind participants and personnel. We judged the subjective outcomes at high risk of performance and detection bias, and the objective outcomes at high risk of detection bias in six studies and at low risk of bias in the other six studies. One study did not assess any objective outcomes. Comparing TE versus no treatment, we are very uncertain whether TE reduces the Cobb angle (mean difference (MD) -3.6°, 95% confidence interval (CI) -5.6 to -1.7; 2 studies, 52 participants). Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR) (MD -0.8°, 95% CI -3.8 to 2.1; 1 study, 45 participants), may reduce the waist asymmetry slightly (MD -0.5 cm, 95% CI -0.8 to -0.3; 1 study, 45 participants), and may result in little to no difference in the score of cosmetic issues measured by the Spinal Appearance Questionnaire (SAQ) General (MD 0.7 points, 95% CI -0.1 to 1.4; 1 study, 16 participants). PSSE may result in little to no difference in self-image measured by the Scoliosis Research Society - 22 Patient Questionnaire (SRS-22) (MD 0.3 points, 95% CI -0.3 to 0.9; 1 study, 16 participants) and improve QoL slightly measured by SRS-22 Total score (MD 0.3 points, 95% CI 0.1 to 0.4; 2 studies, 61 participants). Only Cobb angle results were clinically meaningful. Comparing PSSE plus bracing versus bracing, low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle (-2.2°, 95% CI -3.8 to -0.7; 2 studies, 84 participants). Comparing GTE plus other non-surgical interventions versus other non-surgical interventions, low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle (MD -8.0°, 95% CI -11.5 to -4.5; 1 study, 80 participants). We are uncertain whether PSSE plus other non-surgical interventions versus other non-surgical interventions reduces Cobb angle (MD -7.8°, 95% CI -12.5 to -3.1; 1 study, 18 participants) and ATR (MD -8.0°, 95% CI -12.7 to -3.3; 1 study, 18 participants). PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues as measured by SAQ General (-0.2 points, 95% CI -0.9 to 0.5; 1 study, 34 participants), self-image score as measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -0.3 to 0.5; 1 study, 34 participants), and QoL measured by SRS-22 Total score (MD 0.2 points, 95% CI -0.1 to 0.5; 1 study, 34 participants). None of these results were clinically meaningful. Comparing TE versus bracing, we are very uncertain whether PSSE allows progression of Cobb angle (MD 2.7°, 95% CI 0.3 to 5.0; 1 study, 60 participants), changes self-image measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -1.0 to 1.1; 1 study, 60 participants), and QoL measured by SRS-22 Total score (MD 3.2 points, 95% CI 2.1 to 4.2; 1 study, 60 participants). None of these results were clinically meaningful. Comparing PSSE with GTE, we are uncertain whether PSSE makes little or no difference in Cobb angle (MD -3.0°, 95% CI -8.2 to 2.1; 4 studies, 192 participants; very low-certainty evidence). PSSE probably reduces ATR (clinically meaningful) (-MD 3.0°, 95% CI -3.4 to -2.5; 2 studies, 138 participants). We are uncertain about the effect of PSSE on QoL measured by SRS-22 Total score (MD 0.26 points, 95% CI 0.11 to 0.62; 3 studies, 168 participants) and on self-image measured by SRS-22 Self-Image and Walter Reed Visual Assessment Scale (standardised mean difference (SMD) 0.77, 95% CI -0.61 to 2.14; 3 studies, 168 participants). Further, low-certainty evidence indicates that 38/100 people receiving GTE may progress more than 5° Cobb versus 7/100 receiving PSSE (risk ratio (RR) 0.19, 95% CI 0.67 to 0.52; 1 study, 110 participants). None of the included studies assessed adverse effects. AUTHORS' CONCLUSIONS The evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and many different comparisons. We found only one study following participants to the end of growth showing the efficacy of PSSE over TE. This result was weakened by adding studies with short-term results and unclear preparation of treating physiotherapists. More RCTs are needed to strengthen the current evidence and study other highly clinically relevant outcomes such as QoL, psychological and cosmetic issues, and back pain.
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Affiliation(s)
- Michele Romano
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Formosa C, Chockalingam N, Papanas N, Gatt A. Diabetic Foot Screening Guidelines and the Role of Artificial Intelligence: Time to Turn the Tide! INT J LOW EXTR WOUND 2024:15347346241234421. [PMID: 38387871 DOI: 10.1177/15347346241234421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Despite medical and technological advancements, foot amputations continue to rise. Thus, the effort of diabetic foot management should be toward prevention and early diagnosis. Healthcare professionals need to be trained, equipped, and supported with adequate resources to be able to identify and deliver appropriate foot care. Every effort should be made to minimize the impact of complications and to ensure prompt access to care for everyone. Artificial intelligence and smart technology could provide a significant opportunity to improve efficiency in diabetes care, which may reduce diabetic foot complications. The possible potential of the new technologies which are emerging together with their current developing applications for diabetic foot care are suggested. A call for immediate change in diabetes foot screening guidelines is imperative to save limbs and lives.
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Affiliation(s)
- Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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Eddison N, Healy A, Darke N, Jones M, Leask M, Roberts GL, Chockalingam N. Exploration of the representation of the allied health professions in senior leadership positions in the UK National Health Service. BMJ Lead 2024:leader-2023-000737. [PMID: 37620124 DOI: 10.1136/leader-2023-000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Allied health professionals (AHPs) are an important group within the National Health Service (NHS) in the UK and make up a large portion of the workforce. Investment in AHP leadership is believed to lead to improvements in patient care, resource use, collaboration and innovation. This study aims to assess the current state of AHP strategic leadership within the NHS. METHODS A freedom of information (FOI) request was sent to all NHS Trusts and health boards (HBs) within the UK NHS. The questions focused on the AHP workforce, with a particular interest in the chief AHPs (or equivalent roles) working in an NHS setting. Analysis of the FOI used a range of descriptive statistics. RESULTS Of the 217 Trusts/HBs contacted, responses were received from 160 (74%). The majority (81%) reported that they employed a Chief AHP or equivalent role, with only 14% of these having a position on the Trust/HB executive board. There were 50 different job titles reported as the titles for the chief AHP or equivalent roles: with director of AHPs (18.6%), lead AHP (13.9%) and chief AHP (11.6%) being the most reported titles. The results identified an inequity of representation of AHP professions within senior AHP leadership; with most of these roles (70%) held by physiotherapists and occupational therapists. CONCLUSION Changes in AHP strategic leadership are needed to address the inequities identified in this study. Addressing these issues is required to enable inclusive leadership, which is crucial to improve the contribution of AHPs to healthcare.
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Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nina Darke
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Mary Jones
- Royal Berkshire Foundation Trust, Reading, UK
| | - Millar Leask
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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Mansi MK, Chockalingam N, Chatzistergos PE. The enhanced paper grip test can substantially improve community screening for the risk of falling. Gait Posture 2024; 108:157-163. [PMID: 38091629 DOI: 10.1016/j.gaitpost.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Lower-limb strength measures can enhance falls risk assessment but due to the lack of clinically applicable methods, such measures are not included in current screening. The enhanced paper grip test (EPGT) is a simple-to-use and cost-effective test that could fill this gap. However, its outcome measure (EPGT force) has not yet been directly linked to the risk of falling. RESEARCH QUESTION Is the EPGT a good candidate for falls risk screening in older people in the community? METHODS Seventy-one older people living independently in the community were recruited for this prospective observational study (median age 69 y, range 65y-79y). Lower-limb and whole-body strength were assessed at baseline using the EPGT and a standardised hand-grip method respectively. Incident falls were recorded monthly for a year through follow-up telephone conversations. The capacity of individual strength measures to predict falls and to enhance an established falls risk assessment tool (FRAT) commonly used by UK's national health service (NHS) was assessed using binomial logistic regression. The analysis was repeated for the subset of participants without history of falling at baseline (prediction of first-ever falls). RESULTS Increased EPGT force and increased symmetry in strength between limbs were significantly associated with reduced risk of falling. Compared to the NHS-FRAT, the EPGT correctly classified more people (73% vs 69%), it achieved higher sensitivity (56% vs 26%) and higher negative predictive value (76% vs 68%). Complementing the NHS-FRAT with the EPGT produced a more comprehensive model that correctly classified 91% of participants and achieved 98% specificity, 81% sensitivity, 89% negative and 96% positive predictive value. Replacing the EPGT with hand-grip strength consistently undermined prediction accuracy. The EPGT remained highly accurate when focused on the prediction of first-ever falls. SIGNIFICANCE The EPGT can substantially enhance falls screening in the community. These results can also inform effective personalised strength exercise interventions.
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Affiliation(s)
- Mahmoud K Mansi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
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11
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Leone E, Eddison N, Healy A, Jackson C, Pluckrose B, Chockalingam N. The national profile of the prosthetic and orthotic workforce in the UK: Sociodemographics and employment characteristics. Prosthet Orthot Int 2024:00006479-990000000-00217. [PMID: 38306308 DOI: 10.1097/pxr.0000000000000331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Prosthetists and orthotists (POs) are essential members of the health care workforce and one of the United Kingdom's (UK's) allied health professions. There is a paucity of information on their demographics, which is essential for the development of the profession. To fill this void, this study has attempted to comprehensively explore the sociodemographics and work-related characteristics of the entire workforce. METHODS Data were collected in 2022 through multiple sources, including surveys of POs, private companies employing POs, and freedom of information requests to National Health Service Trusts/Health Boards and higher education institutes offering programs leading to registration as a prosthetist/orthotist. RESULTS The workforce survey had 641 respondents (74% response rate). The estimated national ratio of POs per million population was 13, with all bar of the 12 regions below the World Health Organization minimum recommendation of 15 POs per million population. Most of the survey respondents were female (47.6%) and younger than male respondents, were British (75.8%), and in the White ethnic group (74.3%). Most of them were employed by private companies (59.9% vs. 31.4% employed by the National Health Service) and had clinical duties (94%), permanent contracts (90%), worked full-time (75%), and treated a wide range of clinical conditions. CONCLUSIONS The national UK prosthetist and orthotist ratio falls below the recommended international standards. The versatility and broad skill set of POs highlight their crucial role in multidisciplinary teams. Establishing a centralized prosthetist and orthotist workforce database system is recommended for data-driven strategic planning.
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Affiliation(s)
- Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
- Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
| | | | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, United Kingdom
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12
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Tonna R, Chatzistergos PE, Wyatt O, Chockalingam N. Reliability and Validity of Shore Hardness in Plantar Soft Tissue Biomechanics. Sensors (Basel) 2024; 24:539. [PMID: 38257632 PMCID: PMC10818800 DOI: 10.3390/s24020539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study. Validity and reliability were assessed across six different plantar sites. The validity was assessed against shear wave (SW) elastography (the gold standard). SH was measured by two examiners to assess inter-rater reliability. Testing was repeated following a test/retest study design to assess intra-rater reliability. SH was significantly correlated with SW speed measured in the skin or in the microchamber layer of the first metatarsal head (MetHead), third MetHead and rearfoot. Intraclass correlation coefficients and Bland-Altman plots of limits of agreement indicated satisfactory levels of reliability for these sites. No significant correlation between SH and SW elastography was found for the hallux, 5th MetHead or midfoot. Reliability for these sites was also compromised. SH is a valid and reliable measurement for plantar soft tissue biomechanics in the first MetHead, the third MetHead and the rearfoot. Our results do not support the use of SH for the hallux, 5th MetHead or midfoot.
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Affiliation(s)
- Redent Tonna
- Department of Engineering, School of Digital, Technologies and Arts, Staffordshire University, Stoke-on-Trent ST4 2DE, UK;
| | - Panagiotis E. Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Otis Wyatt
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
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13
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Eddison N, Healy A, Leone E, Jackson C, Pluckrose B, Chockalingam N. The UK prosthetic and orthotic workforce: current status and implications for the future. Hum Resour Health 2024; 22:3. [PMID: 38191415 PMCID: PMC10773099 DOI: 10.1186/s12960-023-00882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. METHODS To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. RESULTS The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they "definitely" planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation's (WHO) recommendation. CONCLUSIONS The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.
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Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF, United Kingdom
- Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, United Kingdom
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF, United Kingdom
| | - Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF, United Kingdom
| | - Caroline Jackson
- DM Orthotics Ltd, Unit 2, Cardrew Way, Cardew Industrial Estate, Redruth, Cornwall, TR15 1SS, United Kingdom
| | - Bracken Pluckrose
- Blatchford Clinic, Unit D, Antura, Kingsland Business Park, Basingstoke, RG24 9PZ, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Science Centre, Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF, United Kingdom.
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14
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Vas P, Chockalingam N. Improving Physical, Physiological, and Psychological Health Outcomes in Patients with Diabetic Foot Ulcers - State of the Art. Clin Cosmet Investig Dermatol 2023; 16:3547-3560. [PMID: 38107668 PMCID: PMC10725647 DOI: 10.2147/ccid.s333660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.
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Affiliation(s)
- Prashanth Vas
- Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, London, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
- Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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15
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Mansi MK, Chockalingam N, Chatzistergos PE. An exploration of the mechanistic link between the enhanced paper grip test and the risk of falling. Foot (Edinb) 2023; 57:102059. [PMID: 37926054 DOI: 10.1016/j.foot.2023.102059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
The enhanced paper grip test (EPGT) offers an easy-to-use measure of hallux plantar-flexion strength that does not need expensive specialised equipment. Literature suggests that it could be a useful screening tool to assess the risk of falling in older people. However, research on a specific mechanistic link to the risk of falling is lacking. It is hypothesised here that muscle weakening (assessed by the EPGT) is indicative of impaired ability to recover balance after a slip or a trip. To get an initial assessment of validity of the above hypothesis, the EPGT is compared against an established lab-based measure of lower-limb strength that is capable of assessing a person's ability to recover balance after a slip or a trip: maximum isometric leg press push-off force (leg press force). A gender-balanced sample of twenty people (median age=34 y) was recruited. Two different but equaly valid techniques of administering the EPGT were included regarding whether the participants' ankle was supported by the examiner or not. Results for the two EPGT techniques differed susbtantialy but they were both significantly associated with leg press force and therefore linked to better ability to maintain balance after a slip or a trip. The "ankle not held" EPGT technique was more strongly correlated to leg press force (r(18) = 0.652, p = 0.002) than the "ankle held" (r(18) = 0.623, p = 0.003) and appears to be the more favourable technique to administer the EPGT. These findings offer new insight on a potential mechanistic link between the EPGT and the risk of falling and support its optimal use in future research involving older people.
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Affiliation(s)
- Mahmoud K Mansi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
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16
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Stojmanovski Mercieca LA, Formosa C, Chockalingam N. Considerations for a Sustainable Podiatric Telemedicine Service. Stud Health Technol Inform 2023; 309:292-293. [PMID: 37869860 DOI: 10.3233/shti230799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Presently telemedicine in podiatry is in its nascent development phase. Current exploratory work indicates that a comprehensive set of guidelines regarding telemedicine in podiatry is necessary. Stakeholders have put forward multiple factors to be considered while developing guidelines to devise a sustainable service.
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Affiliation(s)
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Faculty of Health Sciences, University of Malta
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17
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Mehta B, Chockalingam N, Shannon T, Jevtic N, Lazic F, Jasani V, Eddison N, Healy A, Needham R. Non-Invasive Assessment of Back Surface Topography: Technologies, Techniques and Clinical Utility. Sensors (Basel) 2023; 23:8485. [PMID: 37896577 PMCID: PMC10610923 DOI: 10.3390/s23208485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.
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Affiliation(s)
- Bhavna Mehta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Thomas Shannon
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Nikola Jevtic
- ScolioCentar, Novisad, 403916 Novi Sad, Serbia; (N.J.); (F.L.)
| | - Filip Lazic
- ScolioCentar, Novisad, 403916 Novi Sad, Serbia; (N.J.); (F.L.)
| | - Vinay Jasani
- Centre for Biomechanics, University Hospitals of North Midlands NHS Trust, Stoke on Trent ST4 6QG, UK;
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
| | - Robert Needham
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK; (B.M.); (T.S.); (N.E.); (A.H.); (R.N.)
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18
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Taylor B, Scott TE, Shaw J, Chockalingam N. Renal safety of critical care sedation with sevoflurane: a systematic review and meta-analysis. J Anesth 2023; 37:794-805. [PMID: 37498387 DOI: 10.1007/s00540-023-03227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
Volatile anesthetic agents are increasingly widely used for critical care sedation. There are concerns that sevoflurane presents a risk of renal injury when used in this role. RCTs comparing the use of critical care sevoflurane sedation with any control in humans were systematically identified using MEDLINE, Cochrane CENTRAL, web of Science, and CINAHL (until May 2022), if they presented comparative data on renal function or serum inorganic fluoride levels. Pooled SMDs (95% CI) were calculated where possible after assessment of quality with GRADE and risk of bias with ROB-2. Eight studies analyzing 793 patients were included. The median duration of use of critical care sevoflurane sedation was 4.8 [IQR 3.5-9.2] hours; however, most trials also included a period of prior intraoperative use. No significant difference was found in serum creatinine at 1 day (SMD 0.05, 95% CI - 0.12 to 0.21), 48 h (SMD = - 0.04; 95% Cl - 0.25 to 0.17), 72 h (SMD = - 0.15; 95% CI - 0.45 to 0.15), and at discharge (SMD = - 0.1; 95% CI - 0.3 to 0.13) between the sevoflurane group and the control groups. Creatinine clearance was measured in two studies at 48 h with no significant difference (SMD = - 0.13; 95% Cl - 0.38 to 0.11). Levels of serum inorganic fluoride were significantly elevated in patients where sevoflurane was used. Sevoflurane was not associated with renal failure when used for critical care sedation of fewer than 72-h duration, despite the elevation of serum fluoride. Longer-term studies are currently inadequate, including in patients with compromised renal function, to further evaluate the role of sevoflurane in this setting.Trial registration PROSPERO (CRD42022333099).
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Affiliation(s)
- Ben Taylor
- Department of Anaesthesia and Critical Care, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
- Academic Department of Military Anaesthesia and Critical Care, Birmingham, UK.
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
| | - Timothy E Scott
- Department of Anaesthesia and Critical Care, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Academic Department of Military Anaesthesia and Critical Care, Birmingham, UK
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - James Shaw
- Academic Department of Military Anaesthesia and Critical Care, Birmingham, UK
- Emergency Medical Retrieval and Transport Service Cymru, Llanelli, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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19
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Chatzistergos PE, Gatt A, Formosa C, Sinclair JK, Chockalingam N. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Res Clin Pract 2023; 204:110914. [PMID: 37742803 DOI: 10.1016/j.diabres.2023.110914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. METHODS Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. RESULTS People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. CONCLUSIONS Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.
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Affiliation(s)
- Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jonathan K Sinclair
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom; Faculty of Health Sciences, University of Malta, Msida, Malta
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Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Commercially available pressure sensors for sport and health applications: A comparative review. Foot (Edinb) 2023; 56:102046. [PMID: 37597352 DOI: 10.1016/j.foot.2023.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Pressure measurement systems have numerous applications in healthcare and sport. The purpose of this review is to: (a) describe the brief history of the development of pressure sensors for clinical and sport applications, (b) discuss the design requirements for pressure measurement systems for different applications, (c) critique the suitability, reliability, and validity of commercial pressure measurement systems, and (d) suggest future directions for the development of pressure measurements systems in this area. Commercial pressure measurement systems generally use capacitive or resistive sensors, and typically capacitive sensors have been reported to be more valid and reliable than resistive sensors for prolonged use. It is important to acknowledge, however, that the selection of sensors is contingent upon the specific application requirements. Recent improvements in sensor and wireless technology and computational power have resulted in systems that have higher sensor density and sampling frequency with improved usability - thinner, lighter platforms, some of which are wireless, and reduced the obtrusiveness of in-shoe systems due to wireless data transmission and smaller data-logger and control units. Future developments of pressure sensors should focus on the design of systems that can measure or accurately predict shear stresses in conjunction with pressure, as it is thought the combination of both contributes to the development of pressure ulcers and diabetic plantar ulcers. The focus for the development of in-shoe pressure measurement systems is to minimise any potential interference to the patient or athlete, and to reduce power consumption of the wireless systems to improve the battery life, so these systems can be used to monitor daily activity. A potential solution to reduce the obtrusiveness of in-shoe systems include thin flexible pressure sensors which can be incorporated into socks. Although some experimental systems are available further work is needed to improve their validity and reliability.
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Affiliation(s)
- Louise Burnie
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2RU, UK
| | | | - Tim Claypole
- Welsh Centre for Printing and Coating (WCPC), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam Kilduff
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Neil Bezodis
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
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21
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Naemi R, Balasubramanian G, Darvel T, Chockalingam N. Predicting diabetic foot ulceration using routinely collected data in a foot clinic. What level of prognostic accuracy can be achieved? Diabetes Metab Res Rev 2023; 39:e3674. [PMID: 37350019 DOI: 10.1002/dmrr.3674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/26/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
This study aimed to investigate the efficacy of using routinely collected clinical data in predicting the risk of diabetic foot ulcer (DFU). The first objective was to develop a prognostic model based on the most important risk factors objectively selected from a set of 39 clinical measures. The second objective was to compare the prediction accuracy of the developed model against that of a model based on only the 3 risk factors that were suggested in the systematic review and meta-analyses study (PODUS). In a cohort study, a set of 12 continuous and 27 categorical data from patients (n = 203 M/F:99/104) who attended a specialised diabetic foot clinic were collected at baseline. These patients were then followed-up for 24 months during which 24 (M/F:17/7) patients had DFU. Multivariate logistic regression was used to develop a prognostic model using the identified risk factors that achieved p < 0.2 based on univariate logistic regression. The final prognostic model included 4 risk factors (Adjusted-OR [95% CI]; p) in total. Impaired sensation (116.082 [12.06-1117.287]; p = 0.000) and presence of callus (6.257 [1.312-29.836]; p = 0.021) were significant (p < 0.05), while having dry skin (5.497 [0.866-34.89]; p = 0.071) and Onychomycosis (6.386 [0.856-47.670]; p = 0.071) that stayed in the model were not significant. The accuracy of the model with these 4 risk factors was 92.3%, where sensitivity and specificity were 78.9%, and 94.0% respectively. The 78.9% sensitivity of our prognostic 4-risk factor model was superior to the 50% sensitivity that was achieved when the three risk factors proposed by PODUS were used. Also our proposed model based on the above 4 risk factors showed to predict the DFU with higher overall prognostic accuracy. These findings have implications for developing prognostic models and clinical prediction rules in specific patient populations to more accurately predict DFU.
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Affiliation(s)
- Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Gayathri Balasubramanian
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Tracey Darvel
- The Hillingdon Hospital, Central and North West London NHS Foundation Trust, Uxbridge, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
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22
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Agius TP, Cerasola D, Gauci M, Sciriha A, Sillato D, Formosa C, Gatt A, Xerri de Caro J, Needham R, Chockalingam N, Grima JN. The Kinematics of Fixed-Seat Rowing: A Structured Synthesis. Bioengineering (Basel) 2023; 10:774. [PMID: 37508801 PMCID: PMC10376464 DOI: 10.3390/bioengineering10070774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Olympic-style sliding-seat rowing is a sport that has been extensively researched, with studies investigating aspects related to the physiology, biomechanics, kinematics, and the performance of rowers. In contrast, studies on the more classic form of fixed-seat rowing are sparse. The aim of this study is to address this lacuna by analysing for the first time the specific kinematics of fixed-seat rowing as practised by able-bodied athletes, thus (i) documenting how this technique is performed in a manner that is replicable by others and (ii) showing how this technique compares and contrasts with the more standard sliding-seat technique. Fixed-seat rowing was replicated in a biomechanics laboratory where experienced fixed-seat rowers, marked with reflective markers following the modified Helen-Hayes model, were asked to row in a manner that mimics rowing on a fixed-seat boat. The findings from this study, complimented with data gathered through the observation of athletes rowing on water, were compared to sliding-seat ergometer rowing and other control experiments. The results show that, in fixed-seat rowing, there is more forward and backward thoracic movement than in sliding-seat rowing (75-77° vs. 44-52°, p < 0.0005). Tilting of the upper body stems was noted to result from rotations around the pelvis, as in sliding-seat rowing, rather than from spinal movements. The results also confirmed knee flexion in fixed-seat rowing with a range of motion of 30-35°. This is less pronounced than in standard-seat rowing, but not insignificant. These findings provide a biomechanical explanation as to why fixed-seat rowers do not have an increased risk of back injuries when compared with their sliding-seat counterparts. They also provide athletes, coaches, and related personnel with precise and detailed information of how fixed-seat rowing is performed so that they may formulate better and more specific evidence-based training programs to meliorate technique and performance.
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Affiliation(s)
- Tonio P Agius
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Dario Cerasola
- Italian Rowing Federation, Viale Tiziano, 74, 00196 Rome, Italy
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90100 Palermo, Italy
| | - Michael Gauci
- Metamaterials Unit, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
| | - Anabel Sciriha
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Darren Sillato
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Cynthia Formosa
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Alfred Gatt
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - John Xerri de Caro
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Robert Needham
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Nachiappan Chockalingam
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Joseph N Grima
- Metamaterials Unit, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
- Siġġiewi Rowing Club, 181, Melita Street, VLT 1129 Valletta, Malta
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23
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Chatzistergos PE, Kumar S, Sumathi CS, Mahadevan S, Vas P, Chockalingam N. Screening for the loss of protective sensation in people without a history of diabetic foot ulceration: validation of two simple tests in India. Diabetes Res Clin Pract 2023; 202:110810. [PMID: 37391033 DOI: 10.1016/j.diabres.2023.110810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
The ability of the Ipswich touch test (IpTT) and VibratipTM to detect loss of protective sensation (LOPS) was tested against a neurothesiometer in an outpatient diabetic population without a history for ulceration. Our results support the use of the IpTT as a screening tool for LOPS, but not of VibratipTM.
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Affiliation(s)
- P E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Life Sciences and Education, Staffordshire University, Stoke-On-Trent, United Kingdom.
| | - S Kumar
- Sri Ramachandra University, Chennai, India
| | | | | | - P Vas
- King's College Hospital NHS Foundation Trust, United Kingdom; Centre for Biomechanics and Rehabilitation Technologies, School of Life Sciences and Education, Staffordshire University, Stoke-On-Trent, United Kingdom
| | - N Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Life Sciences and Education, Staffordshire University, Stoke-On-Trent, United Kingdom; Sri Ramachandra University, Chennai, India
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Mifsud T, Chatzistergos P, Maganaris C, Chockalingam N, Padhiar N, Stafrace KM, Gatt A. Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains. J Biomech 2023; 152:111558. [PMID: 37004390 DOI: 10.1016/j.jbiomech.2023.111558] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Supersonic shear wave (SW) elastography has emerged as a useful imaging modality offering researchers and clinicians a fast, non-invasive, quantitative assessment of tendon biomechanics. However, the exact relationship between SW speed and in vivo tendon stiffness is not intuitively obvious and needs to be verified. This study aimed to explore the validity of supersonic SW elastography against a gold standard method to measure the Achilles tendon's in vivo tensile stiffness by combining conventional ultrasound imaging with dynamometry. Twelve healthy participants performed maximal voluntary isometric plantarflexion contractions (MVC) on a dynamometer with simultaneous ultrasonographic recording of the medial gastrocnemius musculotendinous junction for dynamometry-based measurement of stiffness. The tendon's force-elongation relationship and stress-strain behaviour were assessed. Tendon stiffness at different levels of tension was calculated as the slope of the stress-strain graph. SW speed was measured at the midportion of the free tendon and tendon Young's modulus was estimated. A correlation analysis between the two techniques revealed a statistically significant correlation for small strains (r(10) = 0.604, p =.038). SW-based assessments of in vivo tendon stiffness were not correlated to the gold standard method for strains in the tendon>10 % of the maximum strain during MVC. The absolute values of SW-based Young's modulus estimations were approximately-three orders of magnitude lower than dynamometry-based measurements. Supersonic SW elastography should be only used to assess SW speed for the detection and study of differences between tissue regions, differences between people or groups of people or changes over time in tendon initial stiffness (i.e., stiffness for small strains).
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Affiliation(s)
- Tiziana Mifsud
- Faculty of Health Sciences, University of Malta, Msida, Malta; Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, Malta
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Constantinos Maganaris
- John Moores University, School of Sport and Exercise Sciences, Liverpool, United Kingdom
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Nat Padhiar
- Centre for Sports & Exercise Medicine, Queen Mary University of London, United Kingdom
| | | | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
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25
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Mifsud T, Gatt A, Micallef-Stafrace K, Chockalingam N, Padhiar N. Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties. J Foot Ankle Res 2023; 16:23. [PMID: 37101290 PMCID: PMC10134611 DOI: 10.1186/s13047-023-00623-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology. RESULTS Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded. CONCLUSIONS A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness.
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Affiliation(s)
- Tiziana Mifsud
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Kirill Micallef-Stafrace
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, L-Imsida, Malta
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke On Trent, Staffordshire, UK
| | - Nat Padhiar
- Centre for Sports &Exercise Medicine, St Bartholomew's & The London School of Medicine & Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
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26
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Formosa C, Chockalingam N, Gatt A, Papanas N. Diabetic Amputations in 2023 are Still More Frightening Than Death-Act Now Before it is Too Late. INT J LOW EXTR WOUND 2023:15347346231171439. [PMID: 37081813 DOI: 10.1177/15347346231171439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Despite huge medical and technological advances to date for the diagnosis, monitoring, and management of diabetic foot complications, their prevalence is still alarmingly high. Patients' quality of life may be severely compromised. Patients may fear amputations more than death. An effort to minimize the impact of these complications and to ensure prompt access to care for everyone is still required. Urgent therapeutic measures should become possible when needed. Improved physician training in and management of peripheral arterial disease are also vital. We need to act now before it is too late. This will definitely be one of the greatest challenges for 2023 and the years to come.
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Affiliation(s)
- Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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27
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Eddison N, Scott DA, Pankhurst C, Chockalingam N. The challenge of service planning and development without adequate data: The case for orthotic services. J Eval Clin Pract 2023; 29:525-528. [PMID: 36433887 DOI: 10.1111/jep.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/12/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
The UK National Health Service (NHS) employs a group of 14 separate allied health professions. Prosthetics and orthotics are the smallest of these professions. Although small, orthotics is integral to many clinical care pathways and has shown to provide an essential impact on a range of clinical conditions in the health service priority lists. Previous reports acknowledged the lack of data on the UK prosthetic and orthotic workforce, appointment outcomes and cost and the service users accessing such services and thus the challenges that it poses for effective service delivery. There is still a paucity of relevant data or initiatives to support the service provision. The work within this paper has taken the first step to address this gap, presenting a summary of the information relating to appointments and costs, and provides a discussion on the implications of variations across the NHS orthotic services within England in terms of spend, staffing and skill mix for orthotic services and service users and the need for further data on service users and the UK prosthetic and orthotic workforce.
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Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK.,Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David A Scott
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.,Exceed Research Network, Exceed Worldwide, London, UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK.,Exceed Research Network, Exceed Worldwide, London, UK
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28
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Nachiappan N, Ward S, Chockalingam N, Chambers R. Can simple household assistive products enhance the self-care of health and well-being? JICA 2023. [DOI: 10.1108/jica-08-2022-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
PurposeThe ageing population is a global phenomenon that is occurring in many countries around the world, including the UK. According to the Office for National Statistics (ONS), the proportion of the UK population aged 65 years and over is projected to increase, reaching 25% by 2045. This increase will have a significant impact on a range of social and economic issues. One of the ways to reduce this impact is to improve self-care.Design/methodology/approachThe availability of simple assistive devices can facilitate physical activity and help complete daily living activities. These devices can also help in the self-management of long-term health and well-being. To encourage self-care, it is essential to create awareness about these assistive products. Simple assistive products such as shoe horns, magnifying glasses or a sphygmomanometer that are readily available to buy from shops were grouped into four boxes or kits. The authors provided these simple devices to 175 community-dwelling older adults in deprived areas and followed them up via a phone survey after 4–6 weeks.FindingsThe authors recorded overall positive feedback on individual products and the kit. The results indicate that there was a sense of empowerment and ability by the recipients to take control of their health and well-being and management of their health condition using items contained in the kit provided.Practical implicationsThe study results show that simple assistive products empower older adults to self-care and can provide a positive impact on their activities of daily living.Originality/valuePrevious studies have shown that regular exercise can enhance both physical and mental abilities and reverse certain chronic health issues. Simple household devices can aid in increasing physical activity. This work highlights how these devices enable older adults to take care of themselves, with a focus on capturing their personal perspectives and experiences.
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29
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Grima JN, Cerasola D, Sciriha A, Sillato D, Formosa C, Gatt A, Gauci M, Xerri de Caro J, Needham R, Chockalingam N, Agius TP. On the Kinematics of the Forward-Facing Venetian-Style Rowing Technique. Bioengineering (Basel) 2023; 10:bioengineering10030310. [PMID: 36978701 PMCID: PMC10045323 DOI: 10.3390/bioengineering10030310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/11/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
This work presents a qualitative and quantitative pilot study which explores the kinematics of Venetian style forward-facing standing rowing as practised by able-bodied competitive athletes. The technique, made famous by the gondoliers, was replicated in a biomechanics laboratory by a cohort of four experienced rowers who compete in this style at National Level events in Malta. Athletes were marked with reflective markers following the modified Helen Hayes model and asked to row in a manner which mimics their on-water practise and recorded using a Vicon optoelectronic motion capture system. Data collected were compared to its equivalent using a standard sliding-seat ergometer as well as data collated from observations of athletes rowing on water, thus permitting the documentation of the manner of how this technique is performed. It was shown that this rowing style is characterised by rather asymmetric and complex kinematics, particularly upper-body movements which provides the athlete with a total-body workout involving all major muscle groups working either isometrically, to provide stability, or actively.
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Affiliation(s)
- Joseph N. Grima
- Metamaterials Unit, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
- Siġġiewi Rowing Club, 181, Melita Street, VLT 1129 Valletta, Malta
- Correspondence: (J.N.G.); (T.P.A.)
| | - Dario Cerasola
- Italian Rowing Federation, Viale Tiziano, 74, 00196 Rome, Italy
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90100 Palermo, Italy
| | - Anabel Sciriha
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Darren Sillato
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Cynthia Formosa
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Alfred Gatt
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Michael Gauci
- Metamaterials Unit, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
| | - John Xerri de Caro
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
| | - Robert Needham
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Nachiappan Chockalingam
- Department of Podiatry, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Tonio P. Agius
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2080 Msida, Malta
- Correspondence: (J.N.G.); (T.P.A.)
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30
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Chatzistergos P, E Scott T, Thorburn M, Chockalingam N. Understanding occipital pressure sores in UK military casualties: a pilot study in healthy military personnel. BMJ Mil Health 2023:e002305. [PMID: 36725104 DOI: 10.1136/military-2022-002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The high prevalence of occipital ulcers in UK military casualties observed during the conflict in Afghanistan is a multifactorial phenomenon. However, the consensus is that ulceration is triggered by excessive pressure that is maintained for too long during the use of the general service military stretcher. Thresholds for capillary occlusion are accepted benchmarks to define excessive pressure, but similar thresholds for safe/excessive duration of pressure application do not exist. To address this gap in knowledge, we propose to use the time it takes for a healthy person to feel pain at the back of the head as an initial indication of safe exposure to pressure. METHODS Healthy military personnel (16 male/10 female) were asked to lie motionless on a typical general service stretcher until they felt pain. Time-to-pain and the location of pain were recorded. To support the interpretation of results, baseline sensitivity to pain and pressure distribution at the back of the head were also measured. Independent samples t-test was used to assess differences between genders. RESULTS Twenty participants felt pressure-induced soft-tissue pain at the back of the head. The remaining six participants terminated the test due to musculoskeletal pain caused by poor ergonomic positioning. On average, pain at the occiput developed after 31 min (±14 min). Female participants were significantly more sensitive to pain (t(24)=3.038,p=0.006), but time-to-pain did not differ significantly between genders (p>0.05). CONCLUSIONS When people lie motionless on a typical military stretcher, the back of the head is the first area of the body that becomes painful due to pressure. The fact that pain develops in ≈30 min can help healthcare providers decide how frequently to reposition their patients who are unable to do this on their own. More research is still needed to directly link time-to-pain with time-to-injury.
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Affiliation(s)
- Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - T E Scott
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Intensive Care Unit, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - M Thorburn
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - N Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Faculty of Health Sciences, University of Malta, Msida, Malta
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31
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Stojmanovski Mercieca LA, Formosa C, Chockalingam N. A scoping review of foot and ankle telemedicine guidelines. Health Sci Rep 2023; 6:e1076. [PMID: 36698701 PMCID: PMC9860371 DOI: 10.1002/hsr2.1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
Background and Aims The COVID-19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting. Methods The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free-text terms for the keywords "telemedicine" "foot health" and "guidelines" with appropriate Boolean operators. Results The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available. Conclusion This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand-on-one but also reachable virtually, where applicable.
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Affiliation(s)
| | - Cynthia Formosa
- Faculty of Health SciencesUniversity of MaltaMsidaMalta,Centre for Biomechanics and Rehabilitation TechnologiesStaffordshire UniversityStoke‐on‐TrentUK
| | - Nachiappan Chockalingam
- Faculty of Health SciencesUniversity of MaltaMsidaMalta,Centre for Biomechanics and Rehabilitation TechnologiesStaffordshire UniversityStoke‐on‐TrentUK
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Sinclair J, Lynch H, Chockalingam N, Taylor PJ. Effects of Obesity on Medial Tibiofemoral Cartilage Mechanics in Females-An Exploration Using Musculoskeletal Simulation and Probabilistic Cartilage Failure Modelling. Life (Basel) 2023; 13:life13020270. [PMID: 36836627 PMCID: PMC9964246 DOI: 10.3390/life13020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/01/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023] Open
Abstract
This study examined the effects of obesity on cartilage mechanics and longitudinal failure probability at the medial tibiofemoral compartment, using combined musculoskeletal simulation and probabilistic failure modelling approaches. The current investigation examined twenty obese females (BMI > 30.0 kg/m2) and 20 healthy weight (BMI < 25.0 kg/m2) females. Walking kinematics were obtained via an 8-camera optoelectric system, and a force plate was used to collect ground reaction forces. Musculoskeletal simulation and probabilistic failure modelling were utilized to explore medial tibiofemoral forces and cartilage probability. Comparisons between groups were undertaken using linear mixed-effects models. Net peak cartilage forces, stress and strain were significantly larger in the obese group (force = 2013.92 N, stress = 3.03 MPa & strain = 0.25), compared to health weight (force = 1493.21 N, stress 2.26 MPa & strain = 0.19). In addition, medial tibiofemoral cartilage failure probability was also significantly larger in the obese group (42.98%) compared to healthy weight (11.63%). The findings from the current investigation show that obesity has a profoundly negative influence on longitudinal medial knee cartilage health and strongly advocates for the implementation of effective weight management programs into long-term musculoskeletal management strategies.
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Affiliation(s)
- Jonathan Sinclair
- School of Sport & Health Sciences, Faculty of Allied Health & Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
- Correspondence:
| | - Holly Lynch
- School of Sport & Health Sciences, Faculty of Allied Health & Wellbeing, University of Central Lancashire, Preston PR1 2HE, UK
| | | | - Paul John Taylor
- School of Psychology & Computer Sciences, Faculty of Science & Technology, University of Central Lancashire, Preston PR1 2HE, UK
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Healy A, Eddison N, Chockalingam N. Breaking barriers: telehealth to improve access to assistive technology. Assist Technol 2023; 35:1-2. [PMID: 36946986 DOI: 10.1080/10400435.2022.2160613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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Olarewaju T, Healy A, Chockalingam N. Barriers to accessing assistive technology in Africa. Assist Technol 2023; 35:116-117. [PMID: 34554890 DOI: 10.1080/10400435.2021.1985011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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Ramaskandhan J, Kakwani R, Kometa S, Hewart P, Rawlings D, Chockalingam N, Siddique M. Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement. J Foot Ankle Surg 2023:S1067-2516(22)00370-2. [PMID: 36710141 DOI: 10.1053/j.jfas.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/09/2021] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.
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Affiliation(s)
- Jayasree Ramaskandhan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
| | - Rajesh Kakwani
- Department of Orthopaedics, Northumbria Healthcare NHS Trust, North Shields, UK
| | - Simon Kometa
- Newcastle University IT (NUIT) Service, Newcastle upon Tyne, UK
| | - Penny Hewart
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - David Rawlings
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Malik Siddique
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
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Eddison N, Royse C, Healy A, Leone E, Chockalingam N. Telehealth provision across allied health professions (AHP): An investigation of reimbursement considerations for its successful implementation in England. Health Sci Rep 2023; 6:e991. [PMCID: PMC9748490 DOI: 10.1002/hsr2.991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke on Trent UK
- Royal Wolverhampton NHS Trust Wolverhampton UK
| | - Carolyn Royse
- Dorset County Hospital NHS Foundation Trust, Dorchester Dorset UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke on Trent UK
| | - Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke on Trent UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies Staffordshire University Stoke on Trent UK
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Dimitrijević V, Šćepanović T, Jevtić N, Rašković B, Milankov V, Milosević Z, Ninković SS, Chockalingam N, Obradović B, Drid P. Application of the Schroth Method in the Treatment of Idiopathic Scoliosis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:16730. [PMID: 36554613 PMCID: PMC9779560 DOI: 10.3390/ijerph192416730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Idiopathic scoliosis can be defined as a complex three-dimensional deformity of the spine and trunk, which occurs in basically healthy children. Schroth scoliosis-specific exercises have shown good results in reducing idiopathic scoliosis progression. This study aimed to critically evaluate the effect size of Schroth's method through a systematic review and meta-analysis. (2) Methods: Four databases were included in the search: PubMed, Cochrane Library, Web of Science, and Google Scholar. The following keywords were used: "Schroth exercise", "idiopathic scoliosis", "Cobb angle", "angle of trunk rotation", and "quality of life". Only articles written in English that met the following criteria were included in our study: subjects who had idiopathic scoliosis, the Schroth method was applied, and Cobb angle or angle of trunk rotation or quality of life as outcomes. (3) Results: Ten randomized controlled trials were included in this study. The effect size of the Schroth exercise ranged from almost moderate to large, for the outcomes used: Cobb angle (ES = -0.492, p ˂ 0.005); ATR (ES = -0.471, p = 0.013); QoL (ES = 1.087, p ˂ 0.001). (4) Conclusions: The current meta-analysis indicates that the Schroth method has a positive effect on subjects with idiopathic scoliosis.
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Affiliation(s)
- Vanja Dimitrijević
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Tijana Šćepanović
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | | | - Bojan Rašković
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Vukadin Milankov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute for Children and Youth Health Care of Vojvodina, 21000 Novi Sad, Serbia
| | - Zoran Milosević
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Srđan S. Ninković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Department of Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2DF, UK
| | - Borislav Obradović
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sports and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia
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Sinclair J, Huang G, Taylor PJ, Chockalingam N, Fan Y. Effects of Running in Minimal and Conventional Footwear on Medial Tibiofemoral Cartilage Failure Probability in Habitual and Non-Habitual Users. J Clin Med 2022; 11:jcm11247335. [PMID: 36555951 PMCID: PMC9788348 DOI: 10.3390/jcm11247335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
This study examined the effects of minimal and conventional running footwear on medial tibiofemoral cartilage mechanics and longitudinal failure probability. The current investigation examined twenty males who habitually ran in minimal footwear and 20 males who habitually ran in conventional footwear. Kinematic data during overground running were collected using a motion-capture system and ground reaction forces using a force plate. Medial tibiofemoral loading was examined using musculoskeletal simulation and cartilage failure probability via probabilistic modelling. In habitual minimal footwear users, peak medial tibiofemoral cartilage force, stress and strain were significantly greater in conventional (force = 7.43 BW, stress = 5.12 MPa and strain = 0.30), compared to minimal footwear (force = 7.11 BW, stress 4.65 MPa and strain = 0.28), though no significant differences in these parameters were evident in non-habitual minimal footwear users (conventional: force = 7.50 BW, stress = 5.05 MPa and strain = 0.30; minimal: force = 7.40 BW, stress = 4.77 MPa and strain = 0.29). However, in both habitual and non-habitual minimal footwear users, the probability of medial tibiofemoral cartilage failure was significantly greater in conventional (habitual = 47.19% and non-habitual = 50.00%) compared to minimal footwear (habitual = 33.18% and non-habitual = 32.81%) users. The observations from this investigation show that compared to minimal footwear, conventional footwear appears to have a negative influence on medial tibiofemoral cartilage health.
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Affiliation(s)
- Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport & Health Sciences, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston PR1 2HE, Lancashire, UK
- Correspondence: (J.S.); (G.H.)
| | - Guohao Huang
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou 350117, China
- Correspondence: (J.S.); (G.H.)
| | - Paul John Taylor
- School of Psychology & Computer Sciences, Faculty of Science and Technology, University of Central Lancashire, Preston PR1 2HE, Lancashire, UK
| | | | - Yifang Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou 350117, China
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Leone E, Eddison N, Healy A, Royse C, Chockalingam N. Do UK Allied Health Professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations? Hum Resour Health 2022; 20:82. [PMID: 36471340 PMCID: PMC9721053 DOI: 10.1186/s12960-022-00778-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The COVID-19 pandemic caused a rapid shift to remote consultations. United Kingdom (UK) NHS Allied Health Professional (AHP) services may have been unprepared for telehealth implementation. This study explored these services' organisational readiness regarding telehealth guidelines implementation and staff training. METHODS A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK AHPs and AHP service managers between May and June 2021. RESULTS 658 participants answered the survey (119 managers and 539 clinicians). Most services, in which telehealth was in place, had implemented telehealth guidelines (clinicians, 64%; managers, 82%), with most guidelines produced by the NHS staff who use them for their consultations. Most clinicians reported that guidelines had ambiguous areas (e.g., regarding protection from litigation and dealing with emergencies), whereas most managers reported the opposite opinion. Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients, while recommended consultation length and how to conduct telehealth with certain population groups were least reported. Clinicians lacked training in most telehealth aspects, while managers reported that staff training focused on telehealth software and hardware. For both clinicians and managers, training is needed on how to deal with emergencies during telehealth. CONCLUSIONS UK NHS AHP services are not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities and hinder the success of the NHS digital transformation. The absence of national guidelines highlights the need for uniform AHP telehealth guidelines.
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Affiliation(s)
- Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF, United Kingdom
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF, United Kingdom
- Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, United Kingdom
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF, United Kingdom
| | - Carolyn Royse
- Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, DT1 2JY, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, Stoke-on-Trent, ST4 2DF, United Kingdom.
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Eddison N, Gandy M, Charlton P, Chockalingam N. Prescription practices for rigid ankle-foot orthoses among UK orthotists. Prosthet Orthot Int 2022; 46:566-568. [PMID: 35511438 DOI: 10.1097/pxr.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate rigid ankle-foot orthosis (AFO) prescription practices for adult men among UK orthotists. DESIGN A cross-sectional study using a survey was distributed online to UK orthotists by the British Association of Prosthetists and Orthotists to its members and through social media and orthotic networks. The survey was completed between November 1, 2020, and November 29, 2020. MAIN OUTCOME MEASURES Descriptive statistics of survey results include information related to the material used, the thickness of the material, positive cast rectification, AFO reinforcement, footplate design, padding, strapping system, and height of AFO. RESULTS One hundred participants completed the survey, which equates to a response rate of 30.5% of the British Association of Prosthetists and Orthotists members targeted. A clear consensus emerged on the design of a bespoke rigid AFO for the hypothetical patient in this study, which is detailed as follows: 1) 4.5 mm copolymer polypropylene, 2) no additional reinforcement, 3) full-length footplate with mediolateral trimlines terminating behind the metatarsal heads, 4) 3-point correction with parallel sides, 5) padded VELCRO straps with D-rings at the calf and heel, 6) no forefoot or other additional strapping, 7) 3-mm PORON (international Ltd) padding at the malleoli, and 8) AFO height that finishes 2 cm below the fibular head. CONCLUSIONS This study has highlighted a consensus on AFO prescription/design among UK orthotists surveyed, based on the hypothetical patient described in this study.
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Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, United Kingdom
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, United Kingdom
| | - Michael Gandy
- The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, United Kingdom
| | - Paul Charlton
- Peacocks Medical Group, Benfield Business Park, Newcastle upon Tyne, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, United Kingdom
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Ramu SM, Chatzistergos P, Chockalingam N, Arampatzis A, Maganaris C. Automated Method for Tracking Human Muscle Architecture on Ultrasound Scans during Dynamic Tasks. Sensors (Basel) 2022; 22:6498. [PMID: 36080955 PMCID: PMC9459806 DOI: 10.3390/s22176498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Existing approaches for automated tracking of fascicle length (FL) and pennation angle (PA) rely on the presence of a single, user-defined fascicle (feature tracking) or on the presence of a specific intensity pattern (feature detection) across all the recorded ultrasound images. These prerequisites are seldom met during large dynamic muscle movements or for deeper muscles that are difficult to image. Deep-learning approaches are not affected by these issues, but their applicability is restricted by their need for large, manually analyzed training data sets. To address these limitations, the present study proposes a novel approach that tracks changes in FL and PA based on the distortion pattern within the fascicle band. The results indicated a satisfactory level of agreement between manual and automated measurements made with the proposed method. When compared against feature tracking and feature detection methods, the proposed method achieved the lowest average root mean squared error for FL and the second lowest for PA. The strength of the proposed approach is that the quantification process does not require a training data set and it can take place even when it is not possible to track a single fascicle or observe a specific intensity pattern on the ultrasound recording.
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Affiliation(s)
- Saru Meena Ramu
- School of Computing, SASTRA Deemed University, Thanjavur 613401, India
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
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Ghosh R, Healy A, Prabhune A, Mallavaram A, Raju S, Chockalingam N. Provision of rehabilitation and assistive technology services in a low resource setting during the COVID-19 pandemic and introduction of telehealth: service users' and providers' perspectives. Assist Technol 2022:1-7. [PMID: 35857654 DOI: 10.1080/10400435.2022.2095582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
Abstract
The COVID-19 pandemic created a challenge for providing assistive technology (AT) and rehabilitation services, with many service providers implementing telehealth service provision for the first time. The objective of this study was to explore the experiences of people accessing and providing AT and rehabilitation services during the pandemic and to assess the implementation of telehealth service delivery at an assistive technology and rehabilitation center in India. A mixed-methods design, combining analysis of clinical data and semi-structured interviews, was utilized. A descriptive analysis of demographics and clinical characteristics of service users accessing services through telehealth, or in-person mode was completed. In addition, service users were interviewed to explore their experiences of accessing services during the pandemic. Service providers were also interviewed to gather their opinions on telehealth service delivery during the pandemic. Findings showed that telehealth was an alternative tool in the pandemic for continuing to deliver services in a low-resource setting. However, not all types of services could be successfully delivered via telehealth. There are barriers to the delivery of telehealth services that need to be considered and addressed to allow successful implementation, and it is important to consider that telehealth consultations are not suitable for all service users.
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Affiliation(s)
- Ritu Ghosh
- Mobility India Rehabilitation Research & Training Centre, Bangalore, Karnataka, India
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
| | - Akash Prabhune
- Institute of Health Management Research Bangalore, Bengaluru, Karnataka, India
| | | | - Sama Raju
- Mobility India Rehabilitation Research & Training Centre, Bangalore, Karnataka, India
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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Eddison N, Leone E, Healy A, Royse C, Chockalingam N. The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment. Int J Equity Health 2022; 21:91. [PMID: 35773695 PMCID: PMC9245876 DOI: 10.1186/s12939-022-01689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. METHODS Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May - June 2021. RESULTS 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient's ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. CONCLUSIONS The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment.
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Affiliation(s)
- Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Technologies Leek Road, ST4 2DF, Stoke on Trent, UK. .,Royal Wolverhampton NHS Trust, WV10 0QP, Wolverhampton, UK.
| | - Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Technologies Leek Road, ST4 2DF, Stoke on Trent, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Technologies Leek Road, ST4 2DF, Stoke on Trent, UK
| | - Carolyn Royse
- Dorset County Hospital NHS Foundation Trust, DT1 2JY, Dorchester, Dorset, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Technologies Leek Road, ST4 2DF, Stoke on Trent, UK
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44
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Patwari M, Chatzistergos P, Sundar L, Chockalingam N, Ramachandran A, Naemi R. A quantitative comparison of plantar soft tissue strainability distribution and homogeneity between ulcerated and non-ulcerated patients using ultrasound strain elastography. Proc Inst Mech Eng H 2022; 236:722-729. [PMID: 35199619 DOI: 10.1177/09544119221074786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The primary objective of this study was to develop a method that allows accurate quantification of plantar soft tissue stiffness distribution and homogeneity. The secondary aim of this study was to investigate if the differences in soft tissue stiffness distribution and homogeneity can be detected between ulcerated and non-ulcerated foot. Novel measures of individual pixel stiffness, named as quantitative strainability (QS) and relative strainability (RS) were developed. Strain Elastography data obtained from 39 (nine with active diabetic foot ulcers) patients with diabetic neuropathy. The patients with active diabetic foot ulcer had wound in parts of the foot other than the first metatarsal head and the heel where the elastography measures were conducted. RS was used to measure changes and gradients in the stiffness distribution of plantar soft tissues in participants with and without active diabetic foot ulcer. The plantar soft tissue homogeneity in superior-inferior direction in the left forefoot was found to be significantly (p < 0.05) higher in ulcerated group compared to non-ulcerated group. The assessment of homogeneity showed potentials to further explain the nature of the change in tissue that can increase internal stress. This can have implications in assessing the vulnerability to plantar soft tissue damage and ulceration in diabetes.
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Affiliation(s)
- Mayank Patwari
- Computer Aided Medical Procedures, Technische Universität München, Munich, Garching, Germany
| | - Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke on Trent, Staffordshire, UK
| | | | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke on Trent, Staffordshire, UK
| | | | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke on Trent, Staffordshire, UK
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Allan D, Chatzistergos PE, Mahadevan S, Healy A, Sundar L, Ramachandran A, Kumar S, Punnoose A, Chockalingam N, Naemi R. Increased exposure to loading is associated with decreased plantar soft tissue hardness in people with diabetes and neuropathy. Diabetes Res Clin Pract 2022; 187:109865. [PMID: 35398144 DOI: 10.1016/j.diabres.2022.109865] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
Abstract
AIMS Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness. METHODS Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy. RESULTS Spearman correlation analysis revealed that increased pressure time integral at the 1st metatarsal-head region (r = -0.354, n = 39, P = 0.027) or at the heel (r = -0.378, n = 39, P = 0.018) was associated with reduced hardness in the same regions. After accounting for confounding parameters, generalised estimating equations analysis also showed that 10% increase in pressure time integral at the heel was associated with ≈ 1 unit reduction in hardness in the same region. CONCLUSIONS For the first time, this study reveals that people with diabetes and neuropathy who tend to load their feet more heavily also tend to have plantar soft tissues with lower hardness. The observed difference in tissue hardness is likely to affect the tissue's vulnerability to overload injury. More research will be needed to explore the implications of the observed association for the risk of ulceration.
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Affiliation(s)
- D Allan
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-On-Trent, United Kingdom
| | - P E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-On-Trent, United Kingdom.
| | | | - A Healy
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-On-Trent, United Kingdom
| | - L Sundar
- India Diabetes Research Foundation, Chennai, India
| | | | - S Kumar
- Sri Ramachandra University, Chennai, India
| | - A Punnoose
- Sri Ramachandra University, Chennai, India
| | - N Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-On-Trent, United Kingdom
| | - R Naemi
- Centre for Biomechanics and Rehabilitation Technologies, School of Health, Science and Wellbeing, Staffordshire University, Stoke-On-Trent, United Kingdom
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Abbas ZG, Chockalingam N, Lutale JK, Naemi R. Predicting the risk of amputation and death in patients with diabetic foot ulcer. A long‐term prospective cohort study of patients in Tanzania. Endocrinol Diabetes Metab 2022; 5:e00336. [PMID: 35388642 PMCID: PMC9094473 DOI: 10.1002/edm2.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/12/2022] [Accepted: 03/20/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Zulfiqarali G. Abbas
- Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
- Abbas Medical Centre Dar es Salaam Tanzania
| | - Nachiappan Chockalingam
- Centre for Biomechancis and Rehabilitation Technologies, School of Health, Science and Wellbeing Science Centre Staffordshire University Stoke on Trent UK
| | - Janet K. Lutale
- Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Roozbeh Naemi
- Centre for Biomechancis and Rehabilitation Technologies, School of Health, Science and Wellbeing Science Centre Staffordshire University Stoke on Trent UK
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Ellis S, Branthwaite H, Chockalingam N. Evaluation and optimisation of a footwear assessment tool for use within a clinical environment. J Foot Ankle Res 2022; 15:12. [PMID: 35144665 PMCID: PMC8829975 DOI: 10.1186/s13047-022-00519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
Footwear has been documented as a significant factor in the aetiology of foot pain in the general population. Assessing footwear in a clinical setting continues to be practitioner specific and there is limited guidance to direct advice. Health professionals must have access to clinically appropriate and reliable footwear assessment tools to educate patients on healthier footwear choices. The primary aim of this study was to critique what elements should be in a footwear assessment tool with a secondary aim of testing the agreed tool for validity. A combined Nominal Group Technique and then a Delphi technique from purposively sampled experts of foot health professions were employed to critique elements of footwear assessment. The agreed tool was then tested by practising podiatrists on 5 different shoes to assess the validity and reliability of the measures. Twelve test evaluation criteria were identified receiving significant ratings to form the final footwear assessment tool consisting of five footwear themes. Application of the tool in a clinical setting validated the themes of footwear characteristics, footwear structure, motion control and wear patterns. However, the assessment of footwear fit was not reliable. The footwear tool was refined based on the collective consensus achieved from the rounds creating a more clinically appropriate tool. The validity of this tool was assessed as high in some of the themes but for those that were lower, a training need was identified.
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Affiliation(s)
- Stephen Ellis
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK
| | - Helen Branthwaite
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Leek Road, ST4 2DF, Stoke on Trent, UK
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Leone E, Eddison N, Healy A, Royse C, Chockalingam N. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies' guidance. BMJ Open 2021; 11:e055823. [PMID: 34969656 PMCID: PMC8718347 DOI: 10.1136/bmjopen-2021-055823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies' guidelines. DESIGN Scoping review following Aksey and O' Malley methodological framework. DATA SOURCES CINHAL and MEDLINE were searched from inception to March 2021 using terms related to 'telehealth', 'guidelines' and 'AHPs'. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. STUDY SELECTION Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review. DATA EXTRACTION One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. RESULTS 2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family's and caregiver's roles and the costs. There was lack of clarity on the AHPs' registration requirements, costs and coverage, and legal aspects. CONCLUSION This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world's leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.
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Affiliation(s)
- Enza Leone
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Nicola Eddison
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
- Orthotic Service, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Aoife Healy
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
| | - Carolyn Royse
- Dorset County Hospital NHS Foundation Trust, Dorchester, Dorset, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK
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Abbas ZG, Lutale JK, Formosa C, Gatt A, Chockalingam N. The Charcot Foot: An Emerging Public Health Problem for African Diabetes Patients. INT J LOW EXTR WOUND 2021:15347346211066684. [PMID: 34881679 DOI: 10.1177/15347346211066684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim: To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. Methods: This was a prospective analytic cohort study conducted between January 2013 through December 2015. Following informed consent, patients were followed at the outpatient clinic. Detailed clinical assessments and documented presence of diabetic peripheral neuropathy (DPN), macrovascular disease and microvascular disease were recorded. Education and counseling were part of the follow-up program. Results: 3271 ulcerations were presented at the clinic during the 3-year study period. 571 (18%) met the case definition for CN; all patients had Type 2 diabetes. The prevalence for each of the years 2013, 2014, and 2015 was 19/1192 (1.6%), 209/1044 (20%), and 343/1035 (34%), respectively; the increases in the slope of the trendline was statistically significant (P < .001). Conclusion: The prevalence of CN is increasing in the Tanzanian diabetes patient population, and is strongly associated with neuropathy. CN can lead to severe deformity, disability, and amputation. Due to the risk of limb amputation, patients with diabetes must seek immediate care if signs or symptoms appear and avoid delay in seeking medical attention. Early diagnosis of CN by caregivers is extremely important for successful outcomes.
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Affiliation(s)
- Zulfiqarali G Abbas
- 92976Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Abbas Medical Centre, Dar es Salaam, Tanzania
| | - J K Lutale
- 92976Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - C Formosa
- 37563University of Malta, Msida, Malta
- 7703Staffordshire University, Stoke on Trent, UK
| | - A Gatt
- 37563University of Malta, Msida, Malta
- 7703Staffordshire University, Stoke on Trent, UK
| | - N Chockalingam
- 37563University of Malta, Msida, Malta
- 7703Staffordshire University, Stoke on Trent, UK
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Byrne M, Scott TE, Sinclair J, Chockalingam N. COVID-19 and critical care capacity: Can we mitigate demand? Respirology 2021; 27:107-108. [PMID: 34865289 DOI: 10.1111/resp.14193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Matthew Byrne
- Intensive Care Medicine, New Cross Hospital, Wolverhampton, UK
| | - Timothy E Scott
- Adult Intensive Care Unit, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Jonathan Sinclair
- Faculty of Health & Wellbeing, University of Central Lancashire, Preston, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK
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