International scientific consensus on medical plantar pressure measurement devices: technical requirements and performance

Background. Since 2006, the Italian National Institute of Health (ISS) has been conducting independent scientific activities to standardize the technical assessment of plantar pressure measurement devices (PMDs). Material and methods. On the basis of the ISS results, in 2010 the Pedobarographic Group of the International Foot and Ankle Biomechanics community (i-FAB-PG) promoted a consensus activity about the main technical requirements for the appropriate use of PMDs. The activity relied on a moodle- based on-line forum, documents exchange, discussions, reviews, meetings and a final sur - vey. Results. The participation of clinical and technical researchers, users, and manufactur - ers, contributed to the delivery of the hereby reported recommendations which specifically regard Medical PMDs in the form of platforms. Conclusions. The i-FAB-PG community reached overall agreement on the recommendations, with a few minor objections which are reported and commented in the document. Relevance. The present document, the highest result achievable within a small scientific community, will hopefully represent the starting point of the wider process of establishing official international guidelines or standards, within scientific communities and standardization organizations

Health Software: a new CEI Guide for software management in medical environment

The increasing spread of software components in the healthcare context renders explanatory guides relevant and mandatory to interpret laws and standards, and to support safe management of software products in healthcare.In 2012 a working group has been settled for the above purposes at CEI (Italian Electrotechnical Committee), made of experts from ISS (Italian National Institute of Health), representatives of industry, and representatives of the healthcare organizations.As a first outcome of the group activity, Guide CEI 62-237 was published in February 2015. The Guide incorporates an innovative approach based on the proper contextualization of software products, either medical devices or not, to the specific healthcare scenario, and addresses the risk management of IT systems.The Guide provides operators and manufacturers with an interpretative support with many detailed examples to facilitate the proper contextualization and management of health software, in compliance with related European and International regulations and standards

Textured insoles affect the plantar pressure distribution while elite rowers perform on an indoor rowing machine

Introduction: During rowing, foot positioning on the foot stretcher is critical to optimise muscle force transmission and boat propulsion. Following the beneficial effects of textured insoles on gait and balance, this study aims at investigating whether passive stimulation of foot mechanoreceptors induced by these insoles may contribute to improving foot loading pattern and symmetry during indoor rowing. Methods: Eleven elite rowers were assessed during controlled training on a standard rowing machine while wearing control, low-density or high-density textured insoles. Plantar pressure and knee and trunk kinematics were measured; performance data were recorded from the machine. Insole effect on kinematic parameters, peak and average values of foot force, contact area and position of centre of pressure was assessed with ANOVA and Bonferroni correction for pair-wise comparisons. Results: A main effect was observed for force and contact area, with the high-density insoles providing greatest values (P0.190), even though symmetry was higher with high-density insoles. Kinematics (P = 0.800) and rowing performance were not affected by insole type; a consistent though not statistically significant increase in mean travelled distance was observed for denser insoles (P>0.21). Conclusion: The high-density textured insoles affected foot loading distribution during indoor rowing. Rowers applied greater foot force and over a greater foot stretcher area with the high-density than the low-density and control insoles. These findings and the methodology applied may be relevant for the understanding and monitoring of rowing performance. © 2017 Vieira et al

Segmental lower limb mobility, muscle activity and plantar pressure analysis in individuals living with diabetic peripheral neuropathy : a systematic review and meta-analysis

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, affecting up to 50% of individuals and their quality of life. DPN is characterised by the progressive loss of proprioception, somatosensory sensitivity and intrinsic distal muscle function. Musculoskeletal complications may cause bony deformities, such as clawing of digits and prominence of metatarsophalangeal joints and increase plantar pressures resulting in skin breakdown and ulceration. Since the repetitive action of mechanical stress during gait in the presence of DPN may lead to ulcer development, better understanding of the mechanism and biomechanical components of ulcer development is of vital importance. Literature shows that DFU are found on high plantar pressure areas, however, in the absence of neuropathy, high pressure areas alone do not lead to ulceration. This systematic review and meta-analysis aims to provide a comprehensive understanding of lower limb joint and muscle function and plantar pressures during gait in the presence of DPN. This, may provide evidence for the design of more efficient and specific treatment options of healing in order to prevent risk of amputation and reulceration. Reducing the mechanical loading on the ulcerated foot during gait may influence the healing of DFU and provide preventative mechanisms of ulceration.peer-reviewe

A quality assessment of systematic reviews on telerehabilitation: what does the evidence tell us?

Aims. To evaluate the quality of systematic reviews on telerehabilitation. Methods. The AMSTAR – Assessment of Multiple Systematic Reviews – checklist was used to appraise the evidence related to the systematic reviews. Results. Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i) analysis of the grey literature; ii) a list of the excluded studies and their haracteristics; iii) the identification of possible source of bias and the assessment of its likehood; iv) an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the highscored systematic reviews telerehabilitation resulted at least as effective as usual care: 1) in the short term treatment of mental health related to people affected by spinal cord injury; 2) in rural communities for treating patients affected by chronic conditions; 3) in treating common pathologies (mainly asthma) affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. Conclusions. In the authors’ knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies

Telemedicine in palliative care: a review of systematic reviews

Aims. To evaluate the quality of systematic reviews on telemedicine applications in palliative care. Methods. A structured literature review was conducted to identify systematic reviews dealing with telemedicine in palliative care; the AMSTAR – Assessment of Multiple Systematic Reviews – checklist was used to appraise the evidence related to the systematic reviews. Results: 405 records were initially identified; of these 14 were eligible for full-text analysis. In summary, the research strategy allowed the identification of 6 reviews to be included which showed a medium quality (AMSTAR score in between 4 and 7). All the included systematic reviews considered telemedicine applications as a feasible means to be used in palliative care; however, the positive findings are counterbalanced by several critical issues mainly related to the evidence from the primary studies included in each single review. Conclusions. Results of this first attempt to appraise the evidence in the field of telemedicine applications in palliative care highlighted that there is still limited evidence related to this approach. Strengths and weaknesses that impact on the general quality of the reviews were identified and relevant points to be taken into account for future research were suggested