On Holiday! Policy and provision for disabled children and their families

This summary describes some findings from the On Holiday! study, carried out by the Thomas Coram Research Unit between 2004 and 2006 and funded by DfES. The study investigated the experiences of disabled children and their families outside school time and especially during the school holidays. The study took an approach informed by a social model of disability, one which emphasises the social construction of disability, rather than impairment

Effect of ACL Reconstruction on Range of Tibial Rotation:A Systematic Review of Current Literature and a Recommendation for a Standard Measuring Protocol

Background: Tibial rotation is an important topic in anterior cruciate ligament (ACL) surgery, and many efforts are being made to address rotational stability. The exact role of the ACL in controlling tibial rotation in clinical studies is unknown. Purpose: To quantify the effect of ACL reconstruction on the amount of tibial rotation based on the current available literature. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search of the PubMed and EMBASE databases was performed in August 2019. Two independent reviewers reviewed titles and abstracts as well as full-text articles. A total of 2383 studies were screened for eligibility. After screening of titles and abstracts, 178 articles remained for full-text assessment. Ultimately, 13 studies were included for analysis. A quality assessment was performed by means of the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and the ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions) tools. Results: According to the studies using computer-assisted surgery that were included in this review, ACL reconstruction resulted in an average reduction in tibial rotation of 17% to 32% compared with preoperatively; whether the range of tibial rotation returned to preinjury levels remained unclear. In the current literature, a gold standard for measuring tibial rotation is lacking. Major differences between the study protocols were found. Several techniques for measuring tibial rotation were used, each with its own limitations. Most studies lacked proper description of accompanying injuries. Conclusion: ACL reconstruction reduced the range of tibial rotation by 17% to 32%. Normal values for the range of tibial rotation in patients with ACL deficiency and those who undergo ACL reconstruction could not be provided based on the current available literature owing to a lack of uniform measuring techniques and protocols. Therefore, we advocate uniformity in measuring tibial rotation

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint:A Multicenter Retrospective Cohort Study

BACKGROUND: Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.METHODS: A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion.RESULTS: Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index.CONCLUSION: Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery.LEVEL OF EVIDENCE: Level III, retrospective case control study.</p

‘I might be lucky and go back to school’: Factors affecting inclusion in education for children with disabilities in rural Malawi

Background: Globally, children with disabilities are often excluded from and within schools. Objectives: This study explored experiences of inclusion in education amongst children with disabilities in Malawi. The enquiry focused on the perspectives of children and their caregivers on barriers and enablers of inclusion. Method: Data were gathered through in-depth interviews with 37 children with disabilities, 61 caregivers and 13 teachers from Ntcheu and Mangochi districts and analysed thematically using the International Classification of Functioning, Disability and Health as a framework. Results: Overall, this research study found that children with disabilities face persistent and systemic barriers to attending, progressing and learning in school. Conclusion: School outcomes were influenced by a range of impairment-related, personal and environmental factors, including poor health, household poverty, attitudes of caregivers, teachers, peers and children themselves and school resources for inclusive education. Contribution: These findings carry implications for policy and planning in inclusive education and other services to support the health and well-being of children with disabilities in Malawi