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BMC Musculoskeletal Disorders Feb 2024Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed...
Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed light on such exciting developments, exploring how they are addressing the challenges faced by individuals with limb impairments and musculoskeletal conditions.
Topics: Humans; Artificial Limbs; Prosthesis Implantation; Orthotic Devices; Extremities
PubMed: 38347514
DOI: 10.1186/s12891-024-07246-y -
Journal of Neurology, Neurosurgery, and... Apr 2024Shoe inserts, orthopaedic shoes, ankle-foot orthoses (AFOs) are important devices in Charcot-Marie-Tooth disease (CMT) management, but data about use, benefits and...
BACKGROUND
Shoe inserts, orthopaedic shoes, ankle-foot orthoses (AFOs) are important devices in Charcot-Marie-Tooth disease (CMT) management, but data about use, benefits and tolerance are scanty.
METHODS
We administered to Italian CMT Registry patients an online ad hoc questionnaire investigating use, complications and perceived benefit/tolerability/emotional distress of shoe inserts, orthopaedic shoes, AFOs and other orthoses/aids. Patients were also asked to fill in the Quebec User Evaluation of Satisfaction with assistive Technology questionnaire, rating satisfaction with currently used AFO and related services.
RESULTS
We analysed answers from 266 CMT patients. Seventy per cent of subjects were prescribed lower limb orthoses, but 19% did not used them. Overall, 39% of subjects wore shoe inserts, 18% orthopaedic shoes and 23% AFOs. Frequency of abandonment was high: 24% for shoe inserts, 28% for orthopaedic shoes and 31% for AFOs. Complications were reported by 59% of patients and were more frequently related to AFOs (69%). AFO users experienced greater emotional distress and reduced tolerability as compared with shoe inserts (p<0.001) and orthopaedic shoes (p=0.003 and p=0.045, respectively). Disease severity, degree of foot weakness, customisation and timing for customisation were determinant factors in AFOs' tolerability. Quality of professional and follow-up services were perceived issues.
CONCLUSIONS
The majority of CMT patients is prescribed shoe inserts, orthopaedic shoes and/or AFOs. Although perceived benefits and tolerability are rather good, there is a high rate of complications, potentially inappropriate prescriptions and considerable emotional distress, which reduce the use of AFOs. A rational, patient-oriented and multidisciplinary approach to orthoses prescription must be encouraged.
Topics: Humans; Charcot-Marie-Tooth Disease; Orthotic Devices; Lower Extremity; Shoes; Patient Acuity
PubMed: 37918904
DOI: 10.1136/jnnp-2023-332422 -
Journal of Orthopaedic Surgery and... Dec 2023To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive... (Review)
Review
OBJECTIVES
To identify the existing assessment methods used to measure the spinal flexibility of adolescents with idiopathic scoliosis before bracing and to evaluate the predictive effect of spinal flexibility on bracing outcomes.
METHODS
A broad literature search was performed in the PubMed, Web of Science, EMBASE, CINAHL, Scopus, and Cochrane Library databases to obtain relevant information about spinal flexibility and bracing outcomes. All literature was retrieved by October 14, 2023. The inclusion and exclusion criteria were meticulously determined. The quality of each included study and the level of evidence were evaluated by the Quality in Prognosis Studies (QUIPS) method and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively.
RESULTS
After screening 1863 articles retrieved from databases, a total of 14 studies with 2261 subjects were eligible for the final analysis in this review. Overall, nine methods of flexibility assessment were identified, including supine radiographs, supine lateral bending radiographs, lateral bending radiographs but without clear positions, hanging radiographs, fulcrum bending physical method, and ultrasound imaging in the positions of supine, prone, sitting with side bending and prone with side bending. In addition, five studies demonstrated that flexibility had a strong correlation with in-brace correction, and eleven studies illustrated that spinal flexibility was a predictive factor of the bracing outcomes of initial in-brace Cobb angle, initial in-brace correction rate, curve progression, and curve regression. The results of GRADE demonstrated a moderate-evidence rating for the predictive value of spinal flexibility.
CONCLUSION
Supine radiography was the most prevalent method for measuring spinal flexibility at the pre-brace stage. Spinal flexibility was strongly correlated with the in-brace Cobb angle or correction rate, and moderate evidence supported that spinal flexibility could predict bracing outcomes.
Topics: Adolescent; Humans; Braces; Prognosis; Radiography; Scoliosis; Spine
PubMed: 38082366
DOI: 10.1186/s13018-023-04430-z -
Human Resources For Health Jan 2024Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always...
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.
Topics: Humans; Medicine; Allied Health Personnel; England; Health Facilities; Workforce
PubMed: 38191415
DOI: 10.1186/s12960-023-00882-w -
Research in Veterinary Science Sep 2023Orthoses and socket prostheses are rarely used orthopaedic devices in veterinary medicine. Recently, more pet owners have sought these treatments for pets with...
Orthoses and socket prostheses are rarely used orthopaedic devices in veterinary medicine. Recently, more pet owners have sought these treatments for pets with orthopaedic conditions. However, veterinarians often lack substantial scientific evidence on device outcomes and may expect high costs, the main limiting factor, if human orthopaedic market prices are assumed. This discrepancy creates an imbalance between pet owners' expectations, veterinarians' recommendations, and actual patient benefits. To address economic constraints and enhance knowledge about these devices, this study used 3D technology-namely 3D scanning and printing via fused deposition modelling-to design, modify, and manufacture orthoses and socket prostheses for ten patients, including nine dogs and one calf. An equation was devised and applied to all printed devices to streamline the resizing process for sockets and orthoses. The 3D-printed devices were fitted to the patients, and their adaptation was assessed using three novel scales based on prior scientific literature in the small animal orthopaedic field. The orthoses were well-tolerated, with successful and straightforward adaptation. Although socket prostheses were tolerated, the dogs' adaptation was suboptimal, while the calf demonstrated excellent and immediate adaptation.
Topics: Humans; Animals; Dogs; Prostheses and Implants; Orthotic Devices; Printing, Three-Dimensional; Orthopedics; Seizures; Dog Diseases
PubMed: 37480718
DOI: 10.1016/j.rvsc.2023.104960 -
Sensors (Basel, Switzerland) Sep 2023Adolescent idiopathic scoliosis (AIS) is a common disease that, in many cases, can be conservatively treated through bracing. High adherence to brace prescription is... (Review)
Review
Adolescent idiopathic scoliosis (AIS) is a common disease that, in many cases, can be conservatively treated through bracing. High adherence to brace prescription is fundamental to gaining the maximum benefit from this treatment approach. Wearable sensors are available that objectively monitor the brace-wearing time, but their use, combined with other interventions, is poorly investigated. The aims of the current review are as follows: (i) to summarize the real compliance with bracing reported by studies using sensors; (ii) to find out the real brace wearing rate through objective electronic monitoring; (iii) to verify if interventions made to increase adherence to bracing can be effective according to the published literature. We conducted a systematic review of the literature published on Medline, EMBASE, CINAHL, Scopus, CENTRAL, and Web of Science. We identified 466 articles and included examples articles, which had a low to good methodological quality. We found that compliance a greatly varied between 21.8 and 93.9% (weighted average: 58.8%), real brace wearing time varied between 5.7 and 21 h per day (weighted average 13.3), and specific interventions seemed to improve both outcomes, with compliance increasing from 58.5 to 66% and brace wearing increasing from 11.9 to 15.1 h per day. Two comparative studies showed positive effects of stand-alone counseling and information on the sensors' presence when added to counseling. Sensors proved to be useful tools for objectively and continuously monitoring adherence to therapy in everyday clinical practice. Specific interventions, like the use of sensors, counseling, education, and exercises, could increase compliance. However, further studies using high-quality designs should be conducted in this field.
Topics: Adolescent; Humans; Scoliosis; Exercise; Exercise Therapy
PubMed: 37688117
DOI: 10.3390/s23177660 -
Injury Oct 2023Fractures in the thoracolumbar region have a bimodal distribution, with an increasing number of older people presenting with acute vertebral fractures after atraumatic... (Review)
Review
Fractures in the thoracolumbar region have a bimodal distribution, with an increasing number of older people presenting with acute vertebral fractures after atraumatic or low energy mechanisms of injury. In the absence of neurological compromise and significant vertebral instability, thoracolumbar fractures are often managed conservatively and bracing is widely recommended. However, in older cohorts, bracing is often ill fitting and poorly tolerated with non-compliance leading to prolonged immobilization. Systematic reviews and meta-analyses have challenged the motive of bracing, but as evidence quality is low, the role of exploratory analysis has been limited. This descriptive review summarises and examines the current evidence that underpins the use of spinal orthoses, specific to older patients, in an effort to streamline its judicious use in clinical practice and identify scope to direct further research.
Topics: Humans; Aged; Lumbar Vertebrae; Thoracic Vertebrae; Orthotic Devices; Braces; Spinal Fractures
PubMed: 37579687
DOI: 10.1016/j.injury.2023.110986 -
BMC Musculoskeletal Disorders Jul 2023Individuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional...
BACKGROUND
Individuals with myelomeningocele (MMC) exhibit neurological deficits below the lesion level involving both motor and sensory functions. Ambulation and functional outcomes in patients offered orthotic management since childhood were investigated.
METHODS
Physical function, physical activity, pain, and health status were assessed in a descriptive study.
RESULTS
Of 59 adults with MMC, aged 18-33 years, 12 were in the community ambulation (Ca), 19 in the household ambulation (Ha), six in the non-functional (N-f), and 22 in the non-ambulation (N-a) groups. Orthoses were used by 78% (n = 46), i.e., by 10/12 in the Ca, 17/19 in the Ha, 6/6 in the N-f, and 13/22 in the N-a groups. In the ten-metre walking test, the non-orthosis group (NO) walked faster than those wearing ankle-foot orthoses (AFOs) or free-articulated knee-ankle-foot orthoses (KAFO-Fs), the Ca group faster than the Ha and N-f groups, and the Ha group faster than the N-f group. In the six-minute walking test, the Ca group walked farther than the Ha group. In the five times sit-to-stand test, the AFO and KAFO-F groups required longer than the NO group, and the KAFO-F group longer than the foot orthosis (FO) group. Lower extremity function with orthoses was higher in the FO than the AFO and KAFO-F groups, higher in the KAFO-F than the AFO group, and higher in the AFO group than in those using trunk-hip-knee-ankle-foot orthoses. Functional independence increased with ambulatory function. Time spent in physical recreation was higher in the Ha than the Ca and N-a groups. There were no differences between the ambulation groups in rated pain or reported health status.
CONCLUSION
The physical function results in persons with MMC improve our understanding of this population's heterogeneity and shed light on the importance of individualized orthotic management. The similarities between the various ambulatory levels in physical activity, pain, and health status may mirror opportunities to achieve equal results regardless of disability level. A clinical implication of the study is that orthotic management is likely to be beneficial for the patient with MMC of which the majority used their orthoses for most time of the day.
Topics: Humans; Adult; Child; Meningomyelocele; Walking; Orthotic Devices; Foot Orthoses; Pain; Health Status; Gait
PubMed: 37400860
DOI: 10.1186/s12891-023-06673-7 -
Sensors (Basel, Switzerland) Aug 2023Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many... (Review)
Review
Orthoses are commonly prescribed to relieve symptoms for musculoskeletal and neurological conditions; however, patients stop wearing orthoses as recommended for many reasons. When considering the effectiveness of orthoses, there needs to be an objective way to monitor whether participants wear the orthosis as instructed, because if this is not followed, the orthoses will not work as intended. This review aimed to identify, summarise, and compare objective methods used to measure compliance with orthoses applied to the extremities. Databases (Scopus, Web of Science, Embase, CINAHL, and MEDLINE) were searched for eligible studies. Twenty-three studies were accepted in the final review, including five studies that employed upper limb orthoses, two that employed hip orthoses, and fifteen that employed lower limb orthoses. To measure compliance objectively, studies utilised temperature sensors, pressure sensors, accelerometers, a step counter, or a combination of sensors. All sensor types have their own advantages and disadvantages and should be chosen based on study-specific parameters. Sensor-derived monitoring provides quantitative, objective data that are beneficial in both clinical and research settings. The ideal solution to monitoring compliance would consist of both objective and user-reported aspects that, in combination, would provide an all-encompassing picture of the orthotic treatment prescribed.
Topics: Humans; Orthotic Devices; Lower Extremity; Databases, Factual
PubMed: 37687876
DOI: 10.3390/s23177420