CONSIDERATIONS FOR IMPLEMENTING AN ANKLE FOOT ORTHOSIS TO IMPROVE MOBILITY IN PERIPHERAL ARTERY DISEASE

An ankle- foot orthosis (AFO) can contribute to push-off during walking by storing energy from heel strike in the rigid strut and subsequently returning force during push-off. Peripheral artery disease (PAD), a manifestation of systemic atherosclerosis, blocks the arteries supplying blood to the legs and causes muscle pain and weakness, which leads to difficulty walking. Wearing an AFO can help patients with PAD walk better. In our study, subjects decided whether to adopt or not adopt the AFO. Our goal is to assess early AFO intervention withdrawal (wAFO) and AFO intervention completion (cAFO). Participants (n=21) were recruited and consented to wear an AFO for three months. The subjects were assessed for early AFO intervention withdrawal (n=6) and completion (n=15). Semi-structured interviews were conducted, and data were analyzed using a summative content analysis approach. Only six of fourteen of cAFO subjects described their initial reactions to the AFO as negative versus three of six wAFO subjects. The wAFO group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and pre-existing health issues as a barrier to the use of the AFO (3/6 vs 5/15). Patients withdrawing prior to completion of the AFO intervention tended to have increased negative perceptions, comorbidities, and physical discomfort. Both groups reported positive aspects of the AFO such as ease in standing and walking. Subjects that consented to follow up after six months of AFO intervention answered semi-structured questionnaires and a survey based on the i-PARIHS framework

Considerations for Implementation of an Ankle-Foot Orthosis to Improve Mobility in Peripheral Artery Disease

Objective To explore the perceptions of wearing an ankle-foot orthosis (AFO) in patients with peripheral artery disease (PAD) who did and did not adopt the AFO intervention. This follows a clinical trial of the effectiveness of an AFO in improving walking distances for patients with PAD-related claudication. Design A randomized crossover trial of standard of care and an AFO for 3 months. Semistructured interviews were conducted 1.5 months into the AFO intervention to understand acceptability, demand, implementation, and practicality. Data were analyzed using a summative content analysis approach. Setting Vascular surgery clinic and biomechanics research laboratory. Participants Patients (N=15; male, 100%; age, 71.9±.6.7y; body mass index [calculated as weight in kilograms divided by height in meters squared], 29.0±.5.5; ankle brachial index: AFO intervention withdrawal, 0.543; AFO intervention completion, 0.740) with claudication completed the study, and 6 withdrew prior to intervention completion. Interventions A certified orthotist fit participants with an AFO that was worn for 3 months. Main Outcome Measures Qualitative analysis of the semistructured interviews. Results Key differences were reported between AFO intervention completion and AFO intervention withdrawal. Six of 14 of AFO intervention completion participants described their initial reactions to the AFO as negative vs 3 of 6 AFO intervention withdrawal participants. Only 5 of 15 AFO intervention completion participants reported minimal use of the AFO compared with 5 of 6 AFO intervention withdrawal participants. The AFO intervention withdrawal group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and preexisting health issues becoming a barrier to the use of the AFO (3/6 vs 5/15). Positive aspects reported included ease in standing and walking for AFO intervention withdrawal (4/6) and AFO intervention completion groups (13/15) as well as walking straighter and longer with less pain for AFO intervention withdrawal (3/6) and AFO intervention completion groups (9/15). Conclusions Patients withdrawing prior to completion of AFO intervention tended to have more negative perceptions, more comorbidities, and more physical discomfort than those completing the intervention. Both groups reported positive aspects of the AFO. Implementation studies are needed to address barriers to AFO adoption

Awareness and perceptions of electroconvulsive therapy among psychiatric patients: a cross-sectional survey from teaching hospitals in Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients.</p> <p>Methods</p> <p>This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan.</p> <p>Results</p> <p>We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001).</p> <p>Conclusion</p> <p>We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.</p

Commentary and Reflection Related to the Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care

Telehealth nursing enabling communication with chronic disease patients has shown to improve medical outcomes for patients suffering from diabetes mellitus, chronic obstructive pulmonary disease (COPD), and chronic heart disease. Studies have been conducted to examine whether telehealth technology impacts the perceived level of internal service quality (SQ) delivered by nurses within a telehealth organization. Overall, the perspectives toward telehealth SQ researched through case studies showed positive results. The innovative role of telehealth nursing and related technology toward patient care was highlighted. Literature establishes how telehealth provides daily monitoring of patient health, which has the benefits of peace of mind, immediate feedback for patients, family, and caregivers, as well as the convenience of scheduling. This commentary not only reflects but also aims to analyze the effectiveness of the telehealth nursing interventions and reasons for the delayed implementation across United States. Improving and implementing telehealth methods in the case of chronic patients suffering from diabetes, COPD, and heart disease can lead to reductions in health-care errors and readmissions. Telehealth nursing has the potential of decreasing the length of hospital stay, at the same time improving satisfaction of care teams, while the patient management continues at home

Investigation of Roll-over Shape Characteristics in Healthy Older Individuals

Human lower limbs demonstrate rocker like qualities during the stance phase of walking, which are quantified using roll-over shape (ROS). The ROS quantifies the effective geometry traced by the ankle-foot complex during the single support phase of walking. Literature shows that the ROS in healthy young individuals is invariant to walking at different speeds, while wearing different types of footwear, and when carrying additional weight. ROS has been used in prosthetic foot design and alignment, orthoses design as well as alignment and shoe design. However, ROS characteristics have been studied in healthy young adults and children but not in older people, who could benefit more from these assistive devices. This pilot project was conducted to study the roll-over characteristics in healthy older individuals. Five healthy older subjects (Male, mean age 64.6 years) participated in a previous IRB approved study and their gait data was retrospectively analyzed. Gait data was collected using a 3D motion capture system with eight infrared camera and center of pressure (CoP) data was collected using a force plate embedded in the walkway. Three gait trials for each leg of the subject at self-selected walking speed were used for the analysis. The average ROS radii found in healthy older individuals are comparable to children and young adults, however arc length was longer in these adults. Our intention is to conduct a future study with a larger sample size of older individuals

IMPLEMENTIATION OF AN ANKLE FOOT ORTHOSIS TO IMPROVE MOBILITY IN PERIPHERAL ARTERY DISEASE PATIENTS

An ankle- foot orthosis (AFO) can contribute to push-off during walking by storing energy from heel strike in the rigid strut and subsequently returning force during push-off. Through the substitution paradigm, the AFO decreases muscle and blood flow demand by substituting for the ankle plantar flexor torque and power. Peripheral artery disease (PAD), a manifestation of systemic atherosclerosis, blocks the arteries supplying blood to the legs and causes muscle pain and weakness, which leads to difficulty in walking. Wearing an AFO immediately increases the distance patients with PAD can walk. However, subjects almost immediately decide whether to adopt or not adopt the AFO. Our goal is to assess early AFO intervention withdrawal (wAFO) and AFO intervention completion (cAFO). Participants (n=21) were recruited and consented to wear an AFO for three months. The subjects were assessed for early AFO intervention withdrawal (n=6) and completion (n=15). Semi-structured interviews were conducted, and data were analyzed using a summative content analysis approach. Only six of fourteen of cAFO subjects described their initial reactions to the AFO as negative versus three of six wAFO subjects. The wAFO group reported higher levels of physical discomfort with the use of the AFO (4/6 vs 7/15) and pre-existing health issues as a barrier to the use of the AFO (3/6 vs 5/15). Patients withdrawing prior to completion of the AFO intervention tended to have increased negative perceptions, comorbidities, and physical discomfort. Both groups reported positive aspects of the AFO such as ease in standing and walking

An open source service oriented Mobile Business Intelligence Tool (MBIT)

Corporate executives require relevant and intelligent business information in real-time to take strategic decisions. They require the freedom to access this information anywhere and anytime. There is a need to extend this functionality beyond the office and on the fingertips of the decision makers. Mobile Business Intelligence Tool (MBIT) aims to provide these features in a flexible and cost-efficient manner. This paper describes the detailed architecture of MBIT to overcome the limitations of existing mobile business intelligence tools. Further, a detailed implementation framework is presented to realize the design. This research highlights the benefits of using service oriented architecture to design flexible and platform independent mobile business applications. © 2009 IEEE

Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review

Objective The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings. Methods Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients’ compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance. Results Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics. Conclusions Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices

Long-term use of an ankle-foot orthosis intervention in patients with peripheral artery disease using the integrated promoting action on research implementation in health services (i-PARIHS) framework

Background Peripheral artery disease (PAD) is a cardiovascular disease that limits patients\u27 walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. Purpose The purpose of the study was to determine the implementation and patients\u27 perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. Design A convergent mixed methods design was used to evaluate participants\u27 perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. Setting Vascular surgery clinic and biomechanics research laboratory. Participants Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. Interventions A certified orthotist fit participants with an AFO that was worn for 3 months. Main outcome measures Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. Results The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. Conclusions Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients\u27 perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject\u27s lifestyle. Clinical Trial Registration No.: NCT02902211