Incidence and risk factors for patellofemoral dislocation in adults with Charcot-Marie-Tooth disease: An observational study

Background and Purpose: Patellofemoral (PF) dislocation is frequently encountered in clinical practice among people with Charcot-Marie-Tooth disease (CMT), but the frequency and risk factors for PF dislocation in adults with CMT are unknown. This study aimed to establish the incidence of PF dislocation in adults with CMT and to explore the risk factors associated with PF dislocation. Methods: This is a cross-sectional study involving adults with a diagnosis of CMT, attending their outpatient clinics at a specialist neuromuscular centre in the United Kingdom. Eighty-one individuals were interviewed about any PF dislocation and underwent a lower-limb assessment, with a focussed knee examination, to identify possible risk factors for PF dislocation. The incidence of PF dislocation was expressed as a percentage (number of individuals with a positive history of patellar dislocation/overall sample) and the association between different risk factors and PF dislocation was explored using logistic regression analysis. Results: The incidence of PF dislocation was 22.2% (18/81). PF dislocation was associated with a younger age at the time of the assessment (p = 0.038) and earlier disease onset (p = 0.025). All people bar two who dislocated had CMT1A (88.9%), but there was no difference in terms of CMT distribution with the non-dislocation group (p = 0.101). No association was found between PF dislocation and CMT severity measured by CMTSS (p = 0.379) and CMTES (p = 0.534). Patella alta (p = 0.0001), J-sign (p = 0.004), lateral patellar glide (p = 0.0001), generalised joint hypermobility (p = 0.001) and knee flexors weakness (p = 0.008) were associated with an increased risk of dislocation. Patella alta (p = 0.010) and lateral patellar glide (p = 0.028) were independent PF dislocation predictors. Conclusions: PF dislocation was common in this cohort with CMT and was associated with multiple risk factors. Future studies should be conducted to confirm the present findings so that the identified risk factors may be addressed by clinicians through preventive, supportive and corrective measures

Do UK Allied Health professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations?

Objectives The COVID-19 pandemic caused a rapid shift to remote consultations. United Kingdom (UK) NHS Allied Health Professional (AHP) services may have been unprepared for telehealth implementation. This study explored these services’ organisational readiness regarding telehealth guidelines implementation and staff training. Methods A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK AHPs and AHP service managers between May and June 2021. Results 658 participants answered the survey (119 managers and 539 clinicians). Most services, in which telehealth was in place, had implemented telehealth guidelines (clinicians, 64%; managers, 82%), with most guidelines produced by the NHS staff who use them for their consultations. Most clinicians reported that guidelines had ambiguous areas (e.g., regarding protection from litigation and dealing with emergencies), whereas most managers reported the opposite opinion. Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients, while recommended consultation length and how to conduct telehealth with certain population groups were least reported. Clinicians lacked training in most telehealth aspects, while managers reported that staff training focused on telehealth software and hardware. For both clinicians and managers, training is needed on how to deal with emergencies during telehealth. Conclusion UK NHS AHP services are not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities and hinder the success of the NHS digital transformation. The absence of national guidelines highlights the need for uniform AHP telehealth guidelines

Telehealth provision across allied health professions (AHP): An investigation of reimbursement considerations for its successful implementation in England

The use of telehealth is not new, however, its recent ubiquity in the National Health Service (NHS) led to the realization that telehealth can offer people a more tailored elective pathway. Resulting in the UK government declaring that digital technology is fundamental to future patient care with a commitment to deliver “at-scale virtual consultations.”1 This ambitious plan requires strategic financial plannin

Framework to guide Allied Health Professional telehealth patient consultation guidelines and training

Purpose AHPs make up the third largest healthcare workforce in the UK NHS and with their wide range of skills make a significant contribution to the health and care of people using their services. Current telehealth guidelines and training programmes for AHPs are not sufficiently comprehensive and lack information on key telehealth aspects, meaning AHPs may not be adequately supported in the delivery of remote patient consultations. Therefore, a policy brief to guide the development of AHP telehealth patient consultation guidelines and training was developed to meet the needs of policymakers, AHP professional bodies, and clinical services. The intended purposes of this policy brief are to: (1) present key telehealth domains that should be considered when designing telehealth guidelines for patient consultations, and (2) present areas in which AHPs should be trained prior to providing telehealth consultations. This policy brief aims to provide guidance and facilitate further discussion on the essential components of telehealth guidelines and staff training, it is not an exhaustive list of recommendations. Recognising the diversity of telehealth applications and the differences between and within individual allied health professions, this policy brief is not profession specific and may require adaptation to the context of use and individual circumstances. Policy brief development This policy brief was developed in four phases, which include: (1) a scoping review to synthesise available evidence; (2) a survey to explore the opinions of UK AHP clinicians and service managers on their telehealth service guidelines and training; (3) formulation of the draft policy brief; (4) consultation with stakeholders and formulation of the final policy brief. Patient users of telehealth were not involved in the development of this policy brief. However, the policy brief considers patient users’ suitability, needs and requirements. Audience This policy brief is intended to inform the development of telehealth consultation guidelines and training for AHP patient consultations. Therefore, the target audience includes policymakers, AHP professional bodies, AHP service managers, and professional societies involved in the planning and management of AHP training, clinical and academic staff involved in training AHPs, and independent AHPs requiring support in their telehealth patient consultations. Telehealth definition Telehealth is defined by the World Health Organization (WHO) as “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (1). For this policy brief, telehealth was defined as a telephone or video consultation with a patient

Effectiveness of conservative non-pharmacological interventions in people with muscular dystrophies: a systematic review and meta-analysis.

INTRODUCTION: Management of muscular dystrophies (MD) relies on conservative non-pharmacological treatments, but evidence of their effectiveness is limited and inconclusive. OBJECTIVE: To investigate the effectiveness of conservative non-pharmacological interventions for MD physical management. METHODS: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, CINHAL, Embase, AMED and Cochrane Central Register of Controlled Trial (inception to August 2022). Effect size (ES) and 95% Confidence Interval (CI) quantified treatment effect. RESULTS: Of 31,285 identified articles, 39 studies (957 participants), mostly at high risk of bias, were included. For children with Duchenne muscular dystrophy (DMD), trunk-oriented strength exercises and usual care were more effective than usual care alone in improving distal upper-limb function, sitting and dynamic reaching balance (ES range: 0.87 to 2.29). For adults with Facioscapulohumeral dystrophy (FSHD), vibratory proprioceptive assistance and neuromuscular electrical stimulation respectively improved maximum voluntary isometric contraction and reduced pain intensity (ES range: 1.58 to 2.33). For adults with FSHD, Limb-girdle muscular dystrophy (LGMD) and Becker muscular dystrophy (BMD), strength-training improved dynamic balance (sit-to-stand ability) and self-perceived physical condition (ES range: 0.83 to 1.00). A multicomponent programme improved perceived exertion rate and gait in adults with Myotonic dystrophy type 1 (DM1) (ES range: 0.92 to 3.83). CONCLUSIONS: Low-quality evidence suggests that strength training, with or without other exercise interventions, may improve perceived exertion, distal upper limb function, static and dynamic balance, gait and well-being in MD. Although more robust and larger studies are needed, current evidence supports the inclusion of strength training in MD treatment, as it was found to be safe

The UK prosthetic and orthotic workforce: current status and implications for the future

Background Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. Methods To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. Results The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they “definitely” planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation’s (WHO) recommendation. Conclusions The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape

Progetto resiliente e adattamento climatico. Metodologie, soluzioni progettuali e tecnologie digitali

La rigenerazione delle città in una prospettiva climate-resilient rappresenta una sfida globale, da affrontare tuttavia in base a priorità e opportunità definite localmente, data l’influenza delle specifiche condizioni di contesto in termini di vulnerabilità sistemica e l’incidenza del microclima urbano sulle variabili climatiche. Emerge in tal senso una crescente necessità di approcci metodologici e strumenti operativi in grado di gestire la complessità e la dimensione multiscalare dei processi di trasformazione dell’ambiente naturale e costruito in un’ottica di sostenibilità e resilienza. Il volume presenta gli esiti del Programma di Ricerca di Ateneo dell’Università di Napoli Federico II SIMMCITIES_NA (2017-2018), relativi all’inquadramento di tali temi dal punto di vista teorico e alla sistematizzazione tecnico-scientifica dei risultati della prima fase di sperimentazione progettuale, sviluppata attraverso l’applicazione di modelli operativi e strumenti di design computazionale in grado di incorporare nel processo progettuale i necessari livelli di informazione e controllo prestazionale degli interventi

Approcci di computational design per la rigenerazione resiliente dello spazio pubblico/Computational design based approaches for public space resilient regeneration

In ambito urbano il tema del resilient-based design per l’adattamento agli impatti climatici è fra quelli in cui è rilevante l’interdipendenza fra innovazione tecnologica, governance delle risorse e strategie di sviluppo sostenibile. Gli spazi pubblici costituiscono un sistema chiave per la sperimentazione delle più efficaci strategie per la riduzione degli impatti climatici attraverso approcci che utilizzano strumenti di computational design negli interventi di adattamento climatico. Il contributo presenta i risultati del Progetto di Ricerca di Ateneo finanziato per il periodo 2017-2019 dall’Ateneo Federico II dal titolo SIMMCITIES_NA, Scenario Impact Modelling Methodology for a Climate change-Induced hazards Tool for Integrated End-users Strategic planning and design - Napoli

Retrofit edilizio

Il tema della riconversione sostenibile del patrimonio edilizio esistente risulta, attualmente in Europa, uno dei punti qualificanti alla base di strategie comunitarie e governative rivolte alla riduzione degli impatti sull’ambiente del settore edilizio. All’interno di tale tematica gli interventi di retrofit tecnologico, orientati all’innalzamento dell’offerta prestazionale e delle caratteristiche degli edifici attraverso l’utilizzo di tecnologie innovative, acquistano particolare rilievo in quanto il patrimonio edilizio esistente presenta numerosi deficit sia fisici che funzionali, mentre dal punto di vista prestazionale si presenta carente sul piano delle condizioni di comfort e del rendimento energetico. Il contributo raccoglie gli esiti del Convegno Internazionale The Retrofit Challenge: learning from Europe. Planning, design and management of retrofitting organizzato dall’Unità di Ricerca “Tecnologia e Ambiente” del Dipartimento di Progettazione Urbana e di Urbanistica dell’Uni¬versità di Napoli Federico II. L’evento ha previsto i contributi di importanti studiosi e professionisti internazionali da cui sono emerse alcune tra le principali azioni procedurali, progettuali e gestionali relative agli interventi di retrofit degli edifici attuate nel Regno Unito e in Francia. In questi paesi sono infatti previsti indirizzi di politica tecnica con misure di incentivazione e supporto allo sviluppo degli interventi di retrofit degli edifici esistenti, attraverso azioni per il loro adeguamento e aggiornamento tramite l’utilizzo di prodotti e tecnologie innovative. In particolare dalle relazioni di qualificati progettisti ed esperti del settore sono emerse alcune riflessioni e significativi dati sul tema del retrofit