Functional electrical stimulation for foot drop in multiple sclerosis: a systematic review and meta-analysis of the effect on gait speed

Objective: To review the efficacy of functional electrical stimulation (FES) used for foot drop in people with multiple sclerosis (pwMS) on gait speed in short and long walking performance tests. Data sources: Five databases (Cochrane Library, CINAHL, Embase, MEDLINE, Pubmed) and reference lists were searched. Study selection: Studies of both observational and experimental design where gait speed data in pwMS could be extracted were included. Data extraction: Data were independently extracted and recorded. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Data synthesis: Nineteen studies (described in 20 articles) recruiting 490 pwMS were identified and rated moderate or weak, with none gaining a strong rating. All studies rated weak for blinding. Initial and ongoing orthotic and therapeutic effects were assessed with regards to the impact of FES on gait speed in short and long walking tests. Meta-analyses of the short walk tests revealed a significant initial orthotic effect (t = 2.14, p = 0.016) with a mean increase in gait speed of 0.05 meters per second (m/s) and ongoing orthotic effect (t = 2.81, p = 0.003) with a mean increase of 0.08m/s. There were no initial or ongoing effect on gait speed in long walk tests and no therapeutic effect on gait speed in either short or long walk tests. Conclusions: FES used for foot drop has a positive initial and ongoing effect on gait speed in short walking tests. Further fully-powered randomized controlled trials comparing FES with alternative treatments are required

Inzicht in de houding van Voedselbankklanten ten opzichte van medische zorg

SamenvattingSinds 2020 voert Provincie Groningen een nieuw armoedebeleid waarbij de nadruk vooral op preventie van armoede ligt. Voedselbank Groningen Stad levert een bijdrage door een Tienpuntenplan op te stellen om mogelijkheden uit te lichten ter voorkoming van armoedeproblemen in Groningen. Eén van de beschreven mogelijkheden gaat over nalatig gebruik van gezondheidszorg onder klanten van Voedselbank Groningen Stad.Om deze hypothese te onderzoeken is de onderzoeksvraag ‘Wat is de houding van klanten van Voedselbank Groningen Stad ten aanzien van medische zorg?’ opgesteld. Aan de hand van literatuurstudie en descriptieve analyse van 49 interviews met klanten van Voedselbank Groningen Stad is de invloed van financiële krapte op de (lichamelijke en mentale) gezondheid, zorggebruik en de houding van de bezoekers van Voedselbank Groningen Stad ten opzichte van medische zorg in kaart gebracht.De onderzoeksresultaten wijzen uit dat klanten van Voedselbank Groningen Stad gebruikmaken van gezondheidszorg en over het algemeen de medische zorg bereikbaar vinden, maar ook regelmatig zorgmijdend gedrag vertonen. De drempels voor het zoeken en gebruik maken van medische hulp zijn met name te vinden in de kosten van medische zorg enerzijds en anderzijds, in bestaande twijfels over de betrouwbaarheid van medische zorg. Zorgmijding door kosten kan vooral worden verklaard door betaalbaarheid; respondenten verwachten dat zorggebruik samengaat met kosten voor specialistenbezoek, behandeling of medicatie. Zorgmijding door wantrouwen kan daarentegen mogelijk worden verklaard door de mate van health literacy (gezondheidsvaardigheden), waardoor de respondenten de (huis)arts moeilijker kunnen begrijpen en het lastig vinden om het zorgsysteem te doorgronden.Zowel respondenten als literatuur gaven suggesties voor implicaties om de ervaren drempels op te heffen. Om de betaalbaarheid van gezondheidszorg te vergroten zou een inkomensafhankelijk eigen risico een optie zijn. Ook kan er gedacht worden aan het vergoeden vanuit tandartskosten vanuit het basispakket. Om het vertrouwen in de gezondheidszorg toe te laten nemen bij individuen met minder health literacy zouden (huis)artsen meer aandacht kunnen vestigen op differentiatie tussen verschillende groepen in de samenleving; bijvoorbeeld door minder vaktaal te gebruiken

Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated withrheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studieshave recommended service and footwear design improvements, it is not known if services have improved or if thisfootwear meets the personal needs of people with RA. As an earlier study found that this footwear has moreimpact on women than males, this study explores women’s experiences of the process of being provided with itand wearing it. No previous work has compared women’s experiences of this footwear in different countries,therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain.Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten womenwith RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) wasadopted during data collection and analysis. Conversational style interviews were used to collect the data.Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approachto the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different toothers; footwear influencing social participation; and the women’s wishes for improved footwear services. Despitetheir nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and angerand that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives.This results in severe restriction of important activities, particularly those involving social participation. However,where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, theacceptance of this footwear was much more evident and there was less wastage as a result of the footwear beingprescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with theonly choice being to reject it once it had been provided. All the women were vocal about what would improvetheir experiences and this centred on the consultation with both the referring practitioner and the practitioner thatprovides the footwear.Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of whatit is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of theirconsultations with practitioners has revealed the tension between the practitioners’ requirements and the women’s‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of usingtherapeutic footwear as an intervention

Women’s experiences of wearing therapeutic footwear in three European countries

Background: Therapeutic footwear is recommended for those people with severe foot problems associated with rheumatoid arthritis (RA). However, it is known that many do not wear them. Although previous European studies have recommended service and footwear design improvements, it is not known if services have improved or if this footwear meets the personal needs of people with RA. As an earlier study found that this footwear has more impact on women than males, this study explores women’s experiences of the process of being provided with it and wearing it. No previous work has compared women’s experiences of this footwear in different countries, therefore this study aimed to explore the potential differences between the UK, the Netherlands and Spain. Method: Women with RA and experience of wearing therapeutic footwear were purposively recruited. Ten women with RA were interviewed in each of the three countries. An interpretive phenomenological approach (IPA) was adopted during data collection and analysis. Conversational style interviews were used to collect the data. Results: Six themes were identified: feet being visibly different because of RA; the referring practitioners’ approach to the patient; the dispensing practitioners’ approach to the patient; the footwear being visible as different to others; footwear influencing social participation; and the women’s wishes for improved footwear services. Despite their nationality, these women revealed that therapeutic footwear invokes emotions of sadness, shame and anger and that it is often the final and symbolic marker of the effects of RA on self perception and their changed lives. This results in severe restriction of important activities, particularly those involving social participation. However, where a patient focussed approach was used, particularly by the practitioners in Spain and the Netherlands, the acceptance of this footwear was much more evident and there was less wastage as a result of the footwear being prescribed and then not worn. In the UK, the women were more likely to passively accept the footwear with the only choice being to reject it once it had been provided. All the women were vocal about what would improve their experiences and this centred on the consultation with both the referring practitioner and the practitioner that provides the footwear. Conclusion: This unique study, carried out in three countries has revealed emotive and personal accounts of what it is like to have an item of clothing replaced with an ‘intervention’. The participant’s experience of their consultations with practitioners has revealed the tension between the practitioners’ requirements and the women’s ‘social’ needs. Practitioners need greater understanding of the social and emotional consequences of using therapeutic footwear as an intervention

Six weeks Use of a Wearable Soft-robotic Glove During ADL:Preliminary Results of Ongoing Clinical Study

In this ongoing study, an assistive wearable soft-robotic glove, named Carbonhand, is tested at home for 6 weeks by subjects with decreased handgrip strength to receive a first insight in the therapeutic effect of using this assistive grip-supporting glove during ADLs. Preliminary results of the first 13 participants showed that participants appreciated use of the glove to assist them with daily life activities. Even more, grip strength without glove improved and functional performance showed increases as well. These preliminary findings hold promise for observing a clinical effect of using the soft-robotic glove as assistance in ADLs upon completion of data collection