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Journal of Foot and Ankle Research May 2020It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid...
BACKGROUND
It is estimated that 2% of the global childhood population is living with some form of mobility impairment. Although footwear interventions are proposed to aid ambulation, there appears to be a paucity in the understanding of the effects of therapeutic footwear. This review aims to explore the effectiveness of footwear as an intervention for mobility impairment in children.
METHODS
A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus and Scopus databases were performed. Studies which focused on children with some form of mobility impairment, age of 9 months to 18 years, therapeutic footwear that allowed walking, and outcome measures that had explored biomechanical or skeletal geometry or psychosocial aspects were included in this review. Modified Downs and Black quality assessment index of randomised and non-randomised studies were used to assess the methodologies of included papers.
RESULTS
Out of 5003 articles sourced, 13 met the inclusion criteria for this review. These were grouped into two titled "corrective and "functional" based on the types of footwear used for intervention. Studies within the corrective footwear group included participants aged 11 months to 5 years with moderate congenital talipes equino varus or mobile pes planus. While using skeletal geometry as an outcome, there was a limited fair quality (level II) evidence that corrective footwear has no significant effect on the development of pes planus but may assist in the reduction of deformity in congenital talipes equino varus. The functional footwear group included participants aged 3 to 17 years, predominantly with mobile pes planus or cerebral palsy. Based on biomechanical measures as an outcome, there was a limited fair quality (level III) evidence that functional footwear alters biomechanical parameters in mobile pes planus (spatiotemporal) and cerebral palsy (spatiotemporal, kinematic). Although psychosocial outcomes were considered within two studies, the analysis was limited.
CONCLUSION
Only a limited number of studies have explored the effects of therapeutic footwear and only in a narrow range of mobility impairments. Further high-quality research is required to improve the evidence base for the effectiveness of therapeutic footwear. This should include a wide range of mobility impairments and should focus both on physical and psychosocial outcomes.
Topics: Adolescent; Biomechanical Phenomena; Child; Child, Preschool; Female; Foot Orthoses; Humans; Infant; Male; Mobility Limitation; Shoes; Treatment Outcome
PubMed: 32404124
DOI: 10.1186/s13047-020-00390-3 -
Disability and Health Journal Jul 2020Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their...
BACKGROUND
Women with disabilities experience significant health disparities. A barrier to progress in addressing these disparities is the lack of population-based data on their health outcomes, which are needed to plan health care delivery systems. Administrative health data are increasingly being used to measure the health of entire populations, but these data may only capture impairment and not activity and participation restrictions.
OBJECTIVE
We conducted a systematic review to identify and appraise existing literature on the development and validation of algorithms to identify reproductive-aged women with physical and sensory disabilities in administrative health data.
METHODS
We searched Medline, EMBASE, CINAHL, PsycINFO, and Scopus from inception to April 2019 for studies of the development and/or validation of algorithms using diagnostic, procedural, or prescription codes to identify physical and sensory disabilities in administrative health data. Study and algorithm characteristics were extracted and quality was assessed using standardized instruments.
RESULTS
Of 14,073 articles initially identified, we reviewed 6 articles representing 2 unique algorithms. One algorithm aimed to correlate diagnoses, procedure codes, and prescriptions with ability to access routine care as an indicator of functional limitation. The other algorithm used diagnostic and procedure codes to identify use of mobility-assistive devices to measure functional limitation. Only one algorithm was validated against self-reported disability.
CONCLUSIONS
Our findings underscore the need to strengthen current methods to identify disability in administrative health data, including linkage with other sources of information on functional limitations, so that population-based data can be used to optimize health care for women with disabilities.
Topics: Adult; Algorithms; Disabled Persons; Female; Health Status; Healthcare Disparities; Humans; Movement Disorders; Self Report; Sensation Disorders; United States
PubMed: 32139320
DOI: 10.1016/j.dhjo.2020.100909 -
BMJ Open Feb 2020To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
OBJECTIVE
To evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.
DESIGN
Systematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.
RESULTS
28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.
CONCLUSIONS
There is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.
PROSPERO REGISTRATION NUMBER
CRD42017077737.
Topics: Activities of Daily Living; Aged; Early Ambulation; Female; Gait; Humans; Male; Mobility Limitation; Stroke Rehabilitation; Walking Speed
PubMed: 32029489
DOI: 10.1136/bmjopen-2019-033642 -
Annals of Physical and Rehabilitation... Mar 2020Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle...
BACKGROUND
Lower-limb functional capacity is impaired in most people with multiple sclerosis (PwMS). Reductions in lower-extremity muscle mechanical function (e.g., muscle strength) appear to have critical implications for lower-limb functional capacity. However, no review has summarized the current knowledge about the importance of muscle strength for functional tasks in PwMS. Expanding the current knowledge would advance the design of both clinical and research interventions aiming to improve functional capacity in PwMS.
OBJECTIVES
(1) To identify studies that measured lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS, and (2) to map associations between muscle strength and functional capacity.
METHODS
This review was based on a literature search (databases: PubMed, Embase). Included studies had to report data on lower-extremity muscle mechanical function and lower-limb functional capacity outcomes in PwMS. The associations between muscle strength and functional capacity were analyzed by using the reported correlation coefficients (R) recalculated to the determination coefficient R. Randomized trials and observational studies were included.
RESULTS
A total of 59 articles were reviewed; 17 (773 participants) reported associations between muscle strength and functional capacity. Lower-extremity muscle mechanical function explained a significant part of the variance in most lower-limb functional capacity tests (approximately 20-30%). This was particularly evident in muscle strength from the weakest leg. Muscle strength was predominantly tested on knee extensors and knee flexors by using isokinetic dynamometry during maximal isometric (0°/s) and dynamic (30-60°/s) contractions. Walking tests such as the timed 25-Foot Walk Test and 10-Min, 2-Min and 6-Min Walk Test were the most frequently performed functional capacity tests.
CONCLUSIONS
In PwMS, muscle strength of particularly the weakest limb explains 20% to 30% of the variance across a number of lower-limb functional capacity tests. Thus, exercise programs should focus on increasing lower-extremity muscle mechanical function in PwMS and minimizing strength asymmetry between limbs.
Topics: Biomechanical Phenomena; Humans; Isometric Contraction; Leg; Mobility Limitation; Multiple Sclerosis; Muscle Strength; Muscle Strength Dynamometer; Muscle, Skeletal; Walking
PubMed: 31816449
DOI: 10.1016/j.rehab.2019.11.005 -
NeuroImage. Clinical 2019Freezing of gait (FOG) is a paroxysmal gait disorder that often occurs at advanced stages of Parkinson's disease (PD). FOG consists of abrupt walking interruption and... (Review)
Review
Freezing of gait (FOG) is a paroxysmal gait disorder that often occurs at advanced stages of Parkinson's disease (PD). FOG consists of abrupt walking interruption and severe difficulty in locomotion with an increased risk of falling. Pathophysiological mechanisms underpinning FOG in PD are still unclear. However, advanced MRI and nuclear medicine studies have gained relevant insights into the pathophysiology of FOG in PD. Neuroimaging studies have demonstrated structural and functional abnormalities in a number of cortical and subcortical brain regions in PD patients with FOG. In this paper, we systematically review existing neuroimaging literature on the structural and functional brain changes described in PD patients with FOG, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We evaluate previous studies using various MRI techniques to estimate grey matter loss and white matter degeneration. Moreover, we review functional brain changes by examining functional MRI and nuclear medicine imaging studies. The current review provides up-to-date knowledge in this field and summarizes the possible mechanisms responsible for FOG in PD.
Topics: Brain; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Neuroimaging; Parkinson Disease; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon
PubMed: 31795038
DOI: 10.1016/j.nicl.2019.102059 -
PloS One 2019Systematic Review was used to evaluate the efficacy and safety of Dalfampridine (DAP) in the treatment of Mobility Disability (MS) in patients with Multiple Sclerosis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic Review was used to evaluate the efficacy and safety of Dalfampridine (DAP) in the treatment of Mobility Disability (MS) in patients with Multiple Sclerosis.
METHODS
Clinical randomized controlled studies about DAP and placebo in the treatment of Mobility Disability in patients with Multiple Sclerosis until March 2019 were explored by searching Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Literature screening, data extraction, quality assessment, and statistical analysis were performed by using Stata 14.0.
RESULTS
10 papers were included in the meta-analysis, and the number of patients was 2100. In conclusion, the application of DAP in clinical can significantly improve the Mobility Disability of patients [OR = 2.73, 95%CI (1.66, 4.50), P<0.001, I2 = 74.1%] and boost the mobility speed of patients in Timing 24 Minute Walk Test (T24FW) [SMD = 3,08, 95%CI(1,58, 4.58), P<0.001, I2 = 98.7%]. There are no significant differences of the incidence of adverse events [RR = 1.06, 95%CI (0.99, 1.14), P = 0.928, I2 = 0.0%] and urinary tract infection [RR = 1.21, 95%CI(0.91, 1.60), P = 0.145, I2 = 37.2%] between the DAP test group (Doses≤10 mg) and the placebo control group, and the incidence of adverse events [RR = 1.14, 95%CI(1.02, 1.28), P = 0.793, I2 = 0.0%] and urinary tract infection[RR = 3.05, 95%CI(1.04, 8.99), P = 0.680, I2 = 0.0%] for the DAP test group (Doses>10 mg) is a litter higher than the placebo control group.
CONCLUSION
DAP can effectively improve Mobility Disability in patients with Multiple Sclerosis, which is safe and reliable in specific DAP usage doses.
Topics: 4-Aminopyridine; Disabled Persons; Humans; Immunosuppressive Agents; Mobility Limitation; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Range of Motion, Articular
PubMed: 31513613
DOI: 10.1371/journal.pone.0222288 -
Journal of Vascular Surgery Jan 2020Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on...
BACKGROUND
Frailty has been associated with postoperative complications and mortality across surgical specialties, including vascular surgery. However, the influence of frailty on postoperative functional outcomes is unclear. We sought to determine the influence of frailty on functional outcomes after open or endovascular vascular procedures in patients with peripheral arterial disease.
METHODS
This systematic review was conducted according to the PRISMA guidelines. Eligible articles were identified through database searches of Pubmed and EMBASE in April 2017. Studies reporting on frailty and functional outcomes after vascular interventions for peripheral artery disease (PAD) were included. Outcomes of interest were dependency in activities of daily living (ADL), dependent mobility, discharge destination, disability-free survival, and quality of life. Individual studies were assessed for quality and risk of bias using the Quality in Prognosis Studies tool.
RESULTS
Eight studies met the eligibility criteria and were included. The risk of bias was low in two studies, intermediate in three studies, and high in three studies. Methods for frailty assessment were different for each study. Frailty was a predictor for discharge to a higher level of care, dependent mobility, and dependency in ADL after vascular procedures for PAD. Both frailty models and individual frailty characteristics seem to be associated with these adverse functional outcomes.
CONCLUSIONS
Despite a limited amount of literature and an overall intermediate quality of the included studies, this systematic review shows an association between frailty and adverse functional outcomes after peripheral arterial procedures for PAD, including discharge to a care facility, dependent mobility, and a decline in ADL functioning.
Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Comorbidity; Endovascular Procedures; Female; Frail Elderly; Frailty; Health Status; Humans; Male; Middle Aged; Mobility Limitation; Patient Discharge; Peripheral Arterial Disease; Polypharmacy; Quality of Life; Recovery of Function; Risk Assessment; Risk Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 31331651
DOI: 10.1016/j.jvs.2018.12.060 -
Archives of Rehabilitation Research and... Jun 2019To systematically review and quantitatively synthesize gait and balance impairments in breast cancer survivors compared with age-matched controls or normative values for... (Review)
Review
OBJECTIVE
To systematically review and quantitatively synthesize gait and balance impairments in breast cancer survivors compared with age-matched controls or normative values for adults who never had breast cancer.
DATA SOURCES
PubMed, Cumulative Index of Nursing and Allied Health, and Web of Science was searched using terms associated with , , and until November 2018.
STUDY SELECTION
Studies were included if they were randomized control trials, cross-sectional, prospective, pre-post, or case-control by design, included adult breast cancer survivors, reported gait and/or balance metrics as primary or secondary outcomes, were peer-reviewed publications, and were written in English. The search yielded 2117 results with 29 studies meeting the inclusion criteria.
DATA EXTRACTION
Two reviewers assessed study quality by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to determine the strength of evidence for each study that met the inclusion criteria. Basic descriptors of each study, study protocol, and balance and gait measures were extracted. Meta-analysis was performed for the single leg stance, functional reach, center of pressure velocity, gait speed, and timed up and go.
DATA SYNTHESIS
For quality assessment, 3 studies were rated good, 16 fair, and 10 poor. The meta-analysis indicated that there were no significant differences in single leg stance between breast cancer survivors and those who never had breast cancer (=.33). Pooled values of the functional reach task (22.16cm; 95% CI, 8.98-35.33) and center of pressure velocity (1.2cm/s; 95% CI, 0.87-1.55) suggest balance impairment in breast cancer survivors when compared with normative values. Breast cancer survivors also performed worse than those who never had breast cancer in challenging balance conditions that reduced sensory information or altered base of support. Pooled gait speed at a usual speed (0.91m/s; 95% CI, 0.2-1.6), fast speed across a short distance (1.2m/s; 95% CI, 0.31-2.1), and fast gait speed across a long distance (1.65m/s; 95% CI, 1.64-1.66) suggest gait impairments when compared with normative values.
CONCLUSIONS
Breast cancer survivors may demonstrate gait and balance impairments compared with normative values. Clinicians should consider assessing changes in balance and gait in breast cancer survivors to improve functional independence and prevent fall-related injuries.
PubMed: 33570512
DOI: 10.1016/j.arrct.2018.12.001 -
Journal of Foot and Ankle Research 2019Ankle-foot orthoses (AFO) are prescribed to manage difficulty walking due to foot drop, bony foot deformities and poor balance. Traditional AFOs are handmade using...
BACKGROUND
Ankle-foot orthoses (AFO) are prescribed to manage difficulty walking due to foot drop, bony foot deformities and poor balance. Traditional AFOs are handmade using thermoplastic vacuum forming which provides limited design options, is labour-intensive and associated with long wait times. 3D printing has the potential to transform AFO production and health service delivery. The aim of this systematic review was to determine the feasibility of designing, manufacturing and delivering customised 3D printed AFOs by evaluating the biomechanical outcomes, mechanical properties and fit of 3D printed compared to traditionally manufactured AFOs.
METHOD
Electronic databases were searched from January 1985 to June 2018 according to terms related to 3D printing and AFOs. Studies of any design from healthy or pathological populations of any age were eligible for inclusion. Studies must have investigated the effect of customised 3D printed AFOs using any 3D printing technique on outcomes related to walking ability, biomechanical function, mechanical properties, patient comfort, pain and disability. Any other orthotic type or AFOs without a 3D printed calf and foot section were excluded. The quality of evidence was assessed using the GRADE process.
RESULTS
Eleven studies met the eligibility criteria evaluating 3D printed AFOs in healthy adults, and adults and children with unilateral foot drop from a variety of conditions. 3D printing was used to replicate traditional AFOs and develop novel designs to optimise the stiffness properties or reduce the weight and improve the ease of use of the AFO. 3D printed custom AFOs were found to be comparable to traditional custom AFOs and prefabricated AFOs in terms of temporal-spatial parameters. The mechanical stiffness and energy dissipation of 3D printed AFOs were found to be similar to prefabricated carbon-fibre AFOs. However, the sample sizes were small ( = 1 to 8) and study quality was generally low.
CONCLUSION
The biomechanical effects and mechanical properties of 3D printed AFOs were comparable to traditionally manufactured AFOs. Developing novel AFO designs using 3D printing has many potential benefits including stiffness and weight optimisation to improve biomechanical function and comfort.
Topics: Ankle Joint; Biomechanical Phenomena; Equipment Design; Feasibility Studies; Foot Orthoses; Gait; Humans; Patient-Specific Modeling; Printing, Three-Dimensional
PubMed: 30774718
DOI: 10.1186/s13047-019-0321-6 -
PloS One 2018Previous systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous systematic reviews have reported positive associations between Modic changes (MCs) and low back pain (LBP), but due to their narrow scope and new primary studies, there is a need for a comprehensive systematic review. Our objectives were to investigate if MCs are associated with non-specific LBP and/or activity limitation and if such associations are modified by other factors.
METHODS
A protocol for this review was registered at PROSPERO prior to commencing the work (PROSPERO record: CRD42015017350). The MEDLINE, CINAHL and EMBASE databases were searched for relevant studies from first record to June 15th 2016. Prospective or retrospective cross-sectional cohort studies and case-control studies including people of all ages from general, working and clinical study populations were eligible for inclusion. Risk of bias assessment and data extraction for associations and potential modifiers were completed independently by pairs of reviewers. Meta-analysis was performed for homogeneous studies and presented as odds ratios (OR) with 95% CI.
RESULTS
In all, 5210 citations were identified and 31 studies were included. One study had low risk of bias. Fifteen studies (48%) reported statistically significant positive associations between MCs and LBP and one study found a statistically significant negative association. Meta-analysis performed for studies using concordant pain with provocative discography as the clinical outcome resulted in an OR of 4.01 (1.52-10.61). One of seven studies reported a statistically significant positive association between MCs and activity limitation. Lumbar disc level and disc degeneration were found to modify the association between MCs and LBP.
CONCLUSIONS
The results from this comprehensive systematic review indicate that the associations between MCs and LBP-related outcomes are inconsistent. The high risk of bias and the heterogeneity in terms of study samples, clinical outcomes and prevalence estimates of MCs and LBP may explain these findings. It is likely that new studies with low risk of bias will affect the direction and strength of these associations.
Topics: Humans; Intervertebral Disc; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Mobility Limitation; Odds Ratio; Spinal Diseases
PubMed: 30067777
DOI: 10.1371/journal.pone.0200677