USING FOOT PRESSURE ANALYSIS TO PREDICT REOCCURRENCE OF DEFORMITY FOR CHILDREN WITH UNILATERAL CLUBFOOT

Reoccurrence of deformity can affect upwards of 64% of children with clubfoot. The ability to use foot function as a measure of reoccurrence has not been previously assessed. The purpose of this investigation was to utilize foot pressure analysis to predict the probability of reoccurrence in children with unilateral clubfoot. Retrospective foot pressure data revealed predictive algorithms detecting the probability of experiencing any type of reoccurrence (overall reoccurrence) and for experiencing a tibialis anterior tendon transfer (TATT). The equation for overall reoccurrence reported sensitivity and specificity of 0.82 and 0.81 and the equation for TATT reported values of 0.81 and 0.84. These algorithms were then applied prospectively to a cohort of children with unilateral clubfoot. Interim sensitivity and specificity results at a 1.5-year follow-up demonstrate that the equations for overall reoccurrence and TATT were highly specific but not sensitive (0.84, 0.73 specificity; 0.11, 0 sensitivity). This is an indication that these algorithms were more accurate when identifying the absence of reoccurrence. However, these results may change as the prospective subjects continue to age. Overall, the results of this investigation show that foot pressure analysis can predict the presence/absence of reoccurrence. The algorithms developed herein have the potential to improve long and short-term outcomes for children with clubfoot. Providing clinicians with the probability of reoccurrence will improve their ability to be proactive during the treatment decision making process

Evaluating Capacity Building for Monitoring & Evaluation in Low- and Middle-Income Countries: A Performance Monitoring Plan

ABSTRACT Victoria Taffe: Evaluating Capacity Building for Monitoring & Evaluation in Low- and Middle-Income Countries: A Performance Monitoring Plan(Under the Direction of Lori Evarts)Background/Objectives:This paper will define and describe the benefits of monitoring and evaluation (M&E), explain capacity building for M&E in the context of global health interventions in low- and middle-income countries (LMICs), and propose a performance monitoring plan (PMP) for a case study of the capacity building provided by US-based non-governmental organization (NGO) MiracleFeet to their implementing partner (IP) in Tanzania. The paper will address the following objectives: 1. To provide a clear example of a PMP, a standard approach for outlining components of an M&E plan, to help global public health leaders think through evaluation approaches to clarify the value of capacity building for M&E2. To provide recommendations and key considerations for global public health leaders who are exploring evaluation of their own M&E capacity building efforts in LMICs3. To contribute to increased clarity and greater understanding within global health of how to assess the value of donor organizations’ capacity building provision for M&E to their in-country IPs.Methods:Before determining an evaluation approach for the PMP, it was essential to first understand the elements and activities that comprise capacity building for M&E. For the purposes of this paper, which focuses on work in global settings, this foundational knowledge was rooted mainly in the United Nations Development Programme (UNDP) Handbook on Planning, Monitoring and Evaluating for Development Results (2009). The UNDP approach to building and ensuring M&E capacity emphasizes a three-level, four-domain structure (UNDP, 2009). Another global resource was the 12 Joint United Nations Programme on HIV and AIDS (UNAIDS) component “capacity areas”, described by MEASURE Evaluation (2017) in their Monitoring and Evaluation Capacity Assessment Toolkit (MECAT) User Guide. The MEASURE Evaluation/UNAIDS model depicts rings of the organizational and human resources as part of the M&E processes as well as the necessary data tools (MEASURE Evaluation, 2017, p.2). At the core is analysis and use of data (i.e. informing decision making) (MEASURE Evaluation, 2017, p.2).Results:A PMP was developed to walk through the capacity building efforts for M&E currently being provided by the non-governmental organization MiracleFeet to their IP in Tanzania. (Several proposed capacity building activities were added to diversify the intervention for evaluation.) The PMP structure includes: ●Background/context●Description of the program/intervention (including the Conceptual Framework) ●Goals and Objectives●A Logic Model●An Indicators Matrix●A Table and Description of data sources for program monitoring●Overview of Outcome/Impact Evaluation design (time frame, sampling, strengths and limitations of evaluation design)●Overview of proposed Economic Evaluation●Overview of Stakeholder Engagement Plan●Plan for Results Dissemination and Use●Conclusions and Recommendations for global public health leaders.  Recommendations:Capacity building must begin with an assessment of the M&E knowledge and abilities of the IP organization and its staff. Additional activities support development of knowledge and abilities, all of which can be evaluated through qualitative and quantitative methods, telling a more detailed story of what’s happening on the ground. This paper provides resources that can help global health leaders organize their thinking about capacity building for M&E and how to best gauge whether their efforts are effective as a result of the activities undertaken.Conclusions:The evaluation of capacity building for M&E is necessary to ensure that an IP’s intervention activities, and the implementation approach, are as effective as possible. Increasing capacity improves organizational learning in real time from their activities through stronger data collection, reporting, and ultimate use to inform decisions; and evaluation ensures overarching organizational learning to improve and strengthen the planning and delivery of future capacity building interventions. The PMP suggests additional activities for inclusion into the current MiracleFeet approach to capacity building for M&E (the intervention). The addition of these activities could be a limitation if it overwhelms the IP and consequently negatively impacts their experience in the other activities or takes too much time away from conducting clinical protocols. Future work could expand the preliminary discussion on cost-effectiveness analysis, which can be conducted for each activity that comprises the capacity building for M&E approach.Master of Public Healt

Interventions for congenital talipes equinovarus

Congenital talipes equinovarus, or clubfoot, is a condition where the foot develops in equinus (pointing down), adductus (pointing in) and varus (twisting in). It occurs in 1 per 1000 births and without intervention leads to life-long disability and pain. This thesis examines several key areas in current research of clubfoot. Chapter 1 provides a broad overview of the definition, aetiology, assessment and management of clubfoot. Chapter 2 reports the findings of a 12 month prospective study comparing children with relapsing clubfoot requiring tibialis anterior tendon transfer to children with clubfoot not requiring tibialis anterior tendon transfer. Chapter 3 evaluates the differences in clinical severity between unilateral and bilateral cases of clubfoot and the statistical implications of examining data per foot rather than data per person. Chapter 4 examines the severity and correlation of right and left feet of bilateral cases of clubfoot and the unit of analysis error implications for future research in this sub-group. Chapter 5 presents a Cochrane Systematic Review examining all interventions for clubfoot utilising statistical models which account for the correlation in right and left feet of bilateral clubfoot cases. Chapter 6 summarises the results of Chapters 2-5 and discusses the implications for future research into the assessment, analysis and management of clubfoot deformity

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood

Biomechanical Evaluation of an Optical System for Quantitative Human Motion Analysis

An eight-camera Optitrack motion capture system was evaluated by performing static, linear dynamic, and angular dynamic calibrations using marker distances associated with upper and lower extremity gait and wheelchair models. Data were analyzed to determine accuracy and resolution within a defined capture volume using a standard Cartesian reference system. Two additional cameras along with AMASS and Visual3D (C-Motion, Inc., Germantown, MD) biomechanical modeling software were used to determine joint kinematics at the pelvis, hip, knee, and ankle of ten control subjects (mean age 21.5 ± 1.65 years). The same data were processed through Nexus (Vicon Motion Systems, Oxford, England) modeling software. The joint angle data was statistically compared between the two systems using a variance components model which determined the variability between maximum, minimum, and range values. Static accuracy ranged from 99.31% to 99.90%. Static resolution ranged from 0.04 ± 0.15 mm to 0.63 ± 0.15 mm at the 0.05 level of significance. The dynamic accuracy ranged from 94.82% to 99.77 %, and dynamic resolution ranged from 0.09 ± 0.26 mm to 0.61 ± 0.31 mm at the 0.05 level of significance. These values are comparable to those reported for a standard Vicon 524 (Vicon Motion Systems, Oxford, England) motion analysis system. Gait cycle maximum, minimum, and range values showed no significant difference when comparing Visual3D and Nexus at the pelvis, hip, and knee. Significant differences were seen at the tibia (rotation) and foot due to foot model variations between the two systems. The results support application of the lower cost Optitrack cameras and Visual3D software for 3D kinematic assessment of lower extremity motion during gait. Additional potential applications supported by these findings include other lower extremity models, assisted ambulation, and wheelchair mobility

Community-based rehabilitation for people with disabilities in low- and middle-income countries: a systematic review

Review question: We reviewed the evidence about the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. Background: People with disabilities include those who have long-term physical, mental, intellectual or sensory impairments, which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others. There are estimated to be over one billion people with disabilities globally and 80% of them live in low- and middle-income countries. They are often excluded from education, health, and employment and other aspects of society leading to an increased risk of poverty. Community-based rehabilitation interventions are the strategy endorsed by the World Health Organization and other international organisations (e.g. ILO, IDDC) for addressing the needs of this group of people in low- and middle-income countries. These interventions aim to enhance the quality of life of people with disabilities and their carers, by trying to meet their basic needs and ensuring inclusion and participation using predominantly local resources. These interventions are composed of up to five components: health, education, livelihood, social and empowerment. Currently only few people who need them benefit from these interventions, and so it is important to assess the available evidence to identify how to best implement these programmes. Study characteristics: The evidence in this review is current to July 2012. This review identified 15 studies that assessed the impact of community-based rehabilitation on the lives of people with disabilities and their carers in low- and middle-income countries. The studies included in the review used different types of community-based rehabilitation interventions and targeted different types of physical (stroke, arthritis, chronic 7 The Campbell Collaboration | www.campbellcollaboration.org obstructive pulmonary disease) and mental disabilities (schizophrenia, dementia, intellectual impairment). Key results: Overall, randomised controlled trials suggested a beneficial effect of community-based rehabilitation interventions in the lives of people with physical disabilities (stroke and chronic obstructive pulmonary disease). Similar results were found for non-randomised studies for physical disabilities (stroke and arthritis) with the exception of one non-randomised study on stroke showing community-based rehabilitation was less favourable than hospital-based rehabilitation. Overall, randomised controlled trials suggested a modest beneficial effect of community-based rehabilitation interventions for people with mental disabilities (schizophrenia, dementia, intellectual impairment), and for their carers (dementia). Similar results were found for non-randomised studies for mental disabilities (schizophrenia). However, the methodological constraints of many of these studies limit the strength of our results. In order to build stronger evidence, future studies will need to adopt better study designs, will need to focus on broader clients group, and to include economic evaluations

Objective methods of monitoring usage of orthotic devices for the extremities: a systematic 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

Outcome of accelerated ponseti technique in the treatment of idiopathic clubfoot

INTRODUCTION: The standard Ponseti method described for the treatment of idiopathic CTEV requires a serial manipulations and castings at weekly intervals. Few published results stated that correction can be achieved in a shorter period of time with multiple manipulations and castings per week. OBJECTIVE: This study was to evaluate the outcome of accelerated ponseti technique for idiopathic clubfoot by manipulations and casting done twice a week. MATERIALS & METHODS: The study included the modified group 21 patients with 25 idiopathic clubfeet treated with the accelerated Ponseti method twice a week. RESULTS: The average age of the patients at the time of treatment was 21days.All aspects of the deformity with the exception of the equinus were corrected in average of 14 days and average of 4.71 casts with one case of relapse, 7 cases only required tenotomy for correcting equinus. CONCLUSION: The accelerated Ponseti method of treatment program with twice a week manipulation and casting is safe and effective. It significantly shortens the timeframe for the treatment and compliance of parents towards the treatment. The results obtained in our study showed good correction of deformity in very shorter period of treatment when compared to standard method, which helps reducing economic concerns, cast complications and improving patients compliance