Use and usability of custom-made orthopedic shoes

The goal of this study was to investigate the use of custom-made orthopedic shoes (OS) and the association between the use of OS and the most relevant aspects of their usability. Over a 6-month period, patients meeting the inclusion criteria were recruited by 12 orthopedic shoe companies scattered throughout the Netherlands and asked to complete a questionnaire composed of a pre- and post-OS section. Patients with different pathologies were included in the study (n = 339; response 67%). Mean age of the patients was 63 +/- 15 years, and 38% were male. Three months after delivery, 81% of the patients used their OS frequently (4-7 days/week), 13% occasionally (1-3 days/week), and 6% did not use their OS. Associations were found between use and all measured aspects of usability (p-values varied from <0.001 to 0.028). Patients who used their OS more often had a more positive opinion regarding all the aspects of usability. We conclude that all aspects of the usability of OS are relevant in relation to their use and should be taken into account when prescribing and evaluating OS

Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes

Major lower-limb amputation (LLA) is a life-changing event associated with poor post-operative physical and psychological functioning and decreased quality of life. The general physical condition of most LLA patients prior to surgery is already significantly deteriorated due to chronic peripheral vascular disease often in combination with diabetes. Pre-operative rehabilitation (also called `pre-rehabilitation') is an increasingly common strategy used in multiple patient populations to improve patients' physical and mental condition prior to surgery, thus aiming at improving the post-operative patient outcomes. Given the positive effects of post-surgical outcomes in many patient populations, we hypothesize that pre-operative rehabilitation will improve post-operative outcomes after LLA. To test this hypothesis, a literature search of PubMed, EMBASE, EBSCOhost, Web of Science and ScienceDirect was performed to identify studies that investigated the impact of a pre-operative rehabilitation therapy on post-operative outcomes such as length of hospital stay, mobility, physical functioning, and health related quality of life. No time restrictions were applied to the search. Only articles published in English were included in the selection. Two studies satisfied the eligibility criteria for inclusion in the review, one qualitative and one quantitative study. The quantitative study reported a beneficial effect of pre-rehabilitation, resulting in post-operative mobility (at least indoor ambulation) in 63% of the included LLA patients. There is a need for prospective clinical studies examining the effect of pre-rehabilitation on post-operative outcomes to be able to confirm or reject our hypothesis. Although the hypothesis seems plausible, evidence is lacking to support our hypothesis that pre-operative rehabilitation will improve post-operative outcomes in patients with LLA. The qualitative study indicated that integrating pre-rehabilitation in the care for LLA patients seems to be limited to a selected group of dysvascular patients, but at this stage cannot be advised based on current evidence even in this subgroup. Further research is needed to clarify whether such an intervention prior to amputation would be a useful and effective tool for optimizing post-operative outcomes in LLA patients

Factors influencing the use of therapeutic footwear in persons with diabetes mellitus and loss of protective sensation:A focus group study

Background Persons with diabetes mellitus (DM) and loss of protective sensation (LOPS) due to peripheral neuropathy do not use their therapeutic footwear (TF) consistently. TF is essential to prevent foot ulceration. In order to improve compliance in using TF, influencing factors need to be identified and analyzed. Persons with a history of foot ulceration may find different factors important compared with persons without ulceration or persons who have never used TF. Therefore, the objective of this study was to determine factors perceived as important for the use of TF by different groups of persons with DM and LOPS. Method A qualitative study was performed using focus group discussions. Subjects (n = 24) were divided into 3 focus groups based on disease severity: ulcer history (HoU) versus no ulcer history (no-HoU) and experience with TF (TF) versus no experience (no-TF). For each group of 8 subjects (TF&amp;HoU; TF&amp;no-HoU; no-TF&amp;no-HoU), an online focus group discussion was organized to identify the most important influencing factors. Transcribed data were coded with Atlas.ti. The analysis was performed following the framework approach. Results The factors comfort and fit and stability/balance were ranked in the top 3 of all groups. Usability was ranked in the top 3 of group-TF&amp;noHoU and group-noTF&amp;noHoU. Two other factors, reducing pain and preventing ulceration were ranked in the top 3 of group-TF&amp;no- HoU and group-TF&amp;HoU, respectively. Conclusion Experience with TF and a HoU influence which factors are perceived as important for TF use. Knowledge of these factors during the development and prescription process of TF may lead to increased compliance. Although the main medical reason for TF prescription is ulcer prevention, only 1 group gave this factor a high ranking. Therefore, next to focusing on influencing factors, person-centered education on the importance of using TF to prevent ulcers is also required.</p

HoMEcare aRm rehabiLItatioN (MERLIN):preliminary evidence of long term effects of telerehabilitation using an unactuated training device on upper limb function after stroke

BACKGROUND: While short term effects on upper limb function of stroke patients after training with robotic devices have been studied extensively, long term effects are often not addressed. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated training device using serious games and a telerehabilitation platform in the patient’s home situation. Short term effects showed that upper limb function improved after training with MERLIN. The aim was to determine long term effects on upper limb function and quality of life. METHODS: Six months after cessation of the 6 week MERLIN training program, the upper limb function and quality of life of 11 chronic stroke patients were assessed. Upper limb function was measured using the Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE). EuroQoL-5D (EQ-5D) was used to measure quality of life. RESULTS: The WMFT, ARAT and EQ-5D did not show significant differences 6 months after the training period compared to directly after training. At 6 months follow-up, FMA-UE results were significantly better than at baseline. Time plots showed a decreasing trend in all tests. CONCLUSION: Training effects were still present at 6 months follow-up, since arm function seemed similar to directly after training and FMA-UE results were better than at baseline. However, because of the decreasing trend shown in all tests, it is questionable if improvements will be maintained longer than 6 months. Due to the sample size and study design, results should be interpreted with caution. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/753

Conservative interventions to improve foot progression angle and clinical measures in orthopedic and neurological patients:A systematic review and meta-analysis

To establish the comparative effects of conservative interventions on modifying foot progression angle (FPA) in children and adults with orthopaedic and neurological disease was the main aim of the literature review. Pubmed, Embase, Cinahl, and Web of Science were systematically searched for studies evaluating the effects of conservative interventions on correcting the FPA. The study protocol was registered with PROSPERO (CRD42020143512). Two reviewers independently assessed studies for inclusion and quality. Studies that assessed conservative interventions that could have affected the FPA and objectively measured the FPA were included. Within group Mean Differences (MD) and Standardized Mean Differences (SMDs) of the interventions were calculated for the change in FPA and gait performance (walking speed, stride/step length) and clinical condition (pain). Intervention effects on FPA were synthesized via meta-analysis or qualitatively. 41 studies were identified. For patients with knee osteoarthritis gait training interventions (MD = 6.69° and MD = 16.06°) were significantly more effective than mechanical interventions (MD = 0.44°) in modifying the FPA towards in-toeing (p < 0.00001). Increasing or decreasing the FPA significantly improved pain in patients with medial knee OA. Results were inconclusive for the effectiveness of gait training and mechanical devices in patients with neurological diseases. Gait feedback training is more effective than external devices to produce lasting improvements in FPA, reduce pain, and maintain gait performance in patients with medial knee OA. However, in neurological patients, the effects of external devices on improvements in FPA depends on the interaction between patient-specific impairments and the technical properties of the external device

Effect of awareness of being monitored on wearing of orthopaedic footwear

OBJECTIVE: To investigate the effect of awareness of being monitored on wearing time and adherence to wearing orthopaedic footwear. Quantitative assessment of wearing time was made using direct measurement with temperature sensors during the first 3 months after provision of footwear. DESIGN: Randomized controlled trial. INTERVENTION: Awareness that the temperature sensor is used for measuring wearing time. METHODS: All 55 participants had a temperature sensor built into the medial arch of the left insole of their orthopaedic footwear. Participants were assigned randomly to either an "awareness group" (n = 25, mean age 67 years) and knew they were being monitored for wearing time, or a "no awareness group" (n = 30, mean age 65 years) and only knew their shoe temperature was being measured. Differences were assessed with a linear mixed model. RESULTS: Mean (standard deviation; SD) wearing time in the intervention group was 7.32 h/day (SD 4.2), and 6.11 h/day (SD 4.1) in the control group (p = 0.017). A significant interaction effect was found between awareness and pathology group on wearing time (p = 0.036). The difference was especially large (7.0 (SD 4.7) vs 2.4 (SD 2.2) h/day) in the subgroup of people with diabetes. CONCLUSION: Awareness of being monitored increases wearing time and wearing of orthopaedic footwear

Quantifying lower limb inter-joint coordination and coordination variability after four-month wearing arch support foot orthoses in children with flexible flat feet

Introduction: Flat feet in children negatively affect lower limb alignment and cause adverse health-related problems. The long-term application of foot orthoses (FOs) may have the potential to improve lower limb coordination and its variability. Aim: To evaluate the effects of long-term use of arch support FOs on inter-joint coordination and coordination variability in children with flexible flat feet. Methods: Thirty boys with flexible flat feet were randomly assigned to the experimental (EG) and control groups. The EG used medial arch support FOs during daily activities over a four-month period while the control group received a flat 2-mm-thick insole for the same time period. Lower-limb coordination and variability during the 3 sub-stance phases were quantified using a vector coding technique. Results: Frontal plane ankle-hip coordination in EG during mid-stance changed to an anti-phase pattern (156.9) in the post-test compared to an in-phase (221.1) in the pre-test of EG and posttest of CG (222.7). Frontal plane knee-hip coordination in EG during loading response (LR) changed to an anti-phase pattern (116) in the post-test compared to an in-phase (35.5) in the pre-test of EG and post-test of CG (35.3). Ankle inversion/eversion-knee internal/external rotation joint coupling angle in EG changed to an in-phase pattern (59) in the post-test compared to a proximal phase (89) in the pre-test. Coupling angle variability increased in the post-test of EG for sagittal plane ankle-hip during push-off, transverse plane ankle-hip during LR and mid-stance, and transverse plane knee-hip during LR and mid-stance compared to pre-test of EG and post-test of CG. Conclusion: The long-term use of arch support FOs proved to be effective to alter lower limb coordination and coordination variability during walking in children with flexible flat feet. This new insight into coordinative function may be useful for improving corrective exercise strategies planned for children with flat feet

Factors Associated With Lower Limb Injuries in Recreational Runners:A Cross-Sectional Survey Including Mental Aspects and Sleep Quality

Knowledge about prevalence and etiology of running-related injuries (RRIs) is important to design effective RRI prevention programs. Mental aspects and sleep quality seem to be important potential risk factors, yet their association with RRIs needs to be elucidated. The aims of this study are to investigate the epidemiology of RRIs in recreational runners and the association of mental aspects, sleep, and other potential factors with RRIs. An internet-based questionnaire was sent to recreational runners recruited through social media, asking for personal and training characteristics, mental aspects (obsessive passion, motivation to exercise), sleep quality, perceived health, quality of life, foot arch type, and RRIs over the past six months. Data were analyzed descriptively and using logistic regression. Self-reported data from 804 questionnaires were analyzed. Twenty-five potential risk factors for RRIs were investigated. 54% of runners reported at least one RRI. The knee was the most-affected location (45%), followed by the lower leg (19%). Patellofemoral pain syndrome was the most-reported injury (20%), followed by medial tibial stress syndrome (17%). Obsessive passionate attitude (odds ratio (OR):1.35; 95% confidence interval (CI):1.18-1.54), motivation to exercise (OR:1.09; CI:1.03-1.15), and sleep quality (OR:1.23; CI:1.15-1.31) were associated with RRIs, as were perceived health (OR:0.96; CI:0.94-0.97), running over 20 km/week (OR:1.58; CI:1.04-2.42), overweight (OR:2.17; CI:1.41-3.34), pes planus (OR:1.80; CI:1.12-2.88), hard-surface running (OR:1.37; CI:1.17-1.59), running company (OR:1.65; CI:1.16-2.35), and following a training program (OR:1.51; CI:1.09-2.10). These factors together explained 30% of the variance in RRIs. A separate regression analysis showed that mental aspects and sleep quality explain 15% of the variance in RRIs. The association of mental aspects and sleep quality with RRIs adds new insights into the multifactorial etiology of RRIs. We therefore recommend that besides common risk factors for RRI, mental aspects and sleep be incorporated into the advice on prevention and management of RRIs

Corrigendum to "Quantifying lower limb inter-joint coordination and coordination variability after four-month wearing arch support foot orthoses in children with flexible flat feet" [Human Movement Science 70 (2020) 102593]

The authors regret: The first line under section 2.4 Calculation of coordination and coordination variability should read: • ‘The following equations are based on the step by step approach devised and reported by Needham et al. (2014)’. • Cite Chang et al. (2008) in addition to Sparrow et al. (1987) for equation, 4. Chang et al. (2008) already cited in paper. • Cite Batschelet (1981) in addition to Hamill et al., (2000). Batschelet, E., 1981. Circular Statistics in Biology. Academic Press, New York. The authors would like to apologise for any inconvenience caused.</p

The effect of changing mediolateral center of pressure on rearfoot eversion during treadmill running

INTRODUCTION: Atypical rearfoot eversion is an important kinematic risk factor in running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping, yet a running gait retraining is lacking. Therefore, the aim was to investigate the effects of changing mediolateral center of pressure (COP) on rearfoot eversion, subtalar pronation, medial longitudinal arch angle (MLAA), hip kinematics and vertical ground reaction force (vGRF). METHODS: Fifteen healthy female runners underwent gait retraining under three conditions. Participants were instructed to run normally, on the lateral (COP lateral) and medial (COP medial) side of the foot. Foot progression angle (FPA) was controlled using real-time visual feedback. 3D measurements of rearfoot eversion, subtalar pronation, MLAA, FPA, hip kinematics, vGRF and COP were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes in outcome between three conditions. Data were also analyzed using statistic parameter mapping. RESULTS: Running on the lateral side of the foot compared to normal running and running on the medial side of the foot reduced peak rearfoot eversion (mean difference (MD) with normal 3.3°, p < 0.001, MD with COP medial 6°, p < 0.001), peak pronation (MD with normal 5°, p < 0.001, MD with COP medial 9.6°, p=<0.001), peak MLAA (MD with normal 2.3°, p < 0.001, MD with COP medial 4.1°, p < 0.001), peak hip internal rotation (MD with normal 1.8°, p < 0.001), and peak hip adduction (MD with normal running 1°, p = 0.011). Running on the medial side of the foot significantly increased peak rearfoot eversion, pronation and MLAA compared to normal running. SIGNIFICANCE: This study demonstrated that COP translation along the mediolateral foot axis significantly influences rearfoot eversion, MLAA, and subtalar pronation during running. Running with either more lateral or medial COP reduced or increased peak rearfoot eversion, peak subtalar pronation, and peak MLAA, respectively, compared to normal running. These results might use as a basis to help clinicians and researchers prescribe running gait retraining by changing mediolateral COP for runners with atypical rearfoot eversion or MLAA