Interventions for increasing ankle joint dorsiflexion : a systematic review and meta-analysis

BACKGROUND: Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and meta-analysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations. METHODS: Keyword searches of Embase Medline Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclusion if they assessed the effect of a non-surgical intervention on ankle joint dorsiflexion in healthy populations. Studies were quality rated using a standard quality assessment scale. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and results were pooled where study methods were homogenous. RESULTS: Twenty-three studies met eligibility criteria, with a total of 734 study participants. Results suggest that there is some evidence to support the efficacy of static stretching alone (SMDs: range 0.70 to 1.69) and static stretching in combination with ultrasound (SMDs: range 0.91 to 0.95), diathermy (SMD 1.12), diathermy and ice (SMD 1.16), heel raise exercises (SMDs: range 0.70 to 0.77), superficial moist heat (SMDs: range 0.65 to 0.84) and warm up (SMD 0.87) in improving ankle joint dorsiflexion ROM. CONCLUSIONS: Some evidence exists to support the efficacy of stretching alone and stretching in combination with other therapies in increasing ankle joint ROM in healthy individuals. There is a paucity of quality evidence to support the efficacy of other non-surgical interventions, thus further research in this area is warranted.

Agreement between temporal and spatial gait parameters from an instrumented walkway and treadmill system at matched walking speed

Background Commercially available instrumented treadmill systems that provide continuous measures of temporospatial gait parameters have recently become available for clinical gait analysis. This study evaluated the level of agreement between temporospatial gait parameters derived from a new instrumented treadmill, which incorporated a capacitance-based pressure array, with those measured by a conventional instrumented walkway (criterion standard). Methods Temporospatial gait parameters were estimated from 39 healthy adults while walking over an instrumented walkway (GAITRite®) and instrumented treadmill system (Zebris) at matched speed. Differences in temporospatial parameters derived from the two systems were evaluated using repeated measures ANOVA models. Pearson-product-moment correlations were used to investigate relationships between variables measured by each system. Agreement was assessed by calculating the bias and 95% limits of agreement. Results All temporospatial parameters measured via the instrumented walkway were significantly different from those obtained from the instrumented treadmill (P < .01). Temporospatial parameters derived from the two systems were highly correlated (r, 0.79–0.95). The 95% limits of agreement for temporal parameters were typically less than ±2% of gait cycle duration. However, 95% limits of agreement for spatial measures were as much as ±5 cm. Conclusions Differences in temporospatial parameters between systems were small but statistically significant and of similar magnitude to changes reported between shod and unshod gait in healthy young adults. Temporospatial parameters derived from an instrumented treadmill, therefore, are not representative of those obtained from an instrumented walkway and should not be interpreted with reference to literature on overground walking.

Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system

Background Despite the emerging use of treadmills integrated with pressure platforms as outcome tools in both clinical and research settings, published evidence regarding the measurement properties of these new systems is limited. This study evaluated the within– and between–day repeatability of spatial, temporal and vertical ground reaction forces measured by a treadmill system instrumented with a capacitance–based pressure platform. Methods Thirty three healthy adults (mean age, 21.5 ± 2.8 years; height, 168.4 ± 9.9 cm; and mass, 67.8 ± 18.6 kg), walked barefoot on a treadmill system (FDM–THM–S, Zebris Medical GmbH) on three separate occasions. For each testing session, participants set their preferred pace but were blinded to treadmill speed. Spatial (foot rotation, step width, stride and step length), temporal (stride and step times, duration of stance, swing and single and double support) and peak vertical ground reaction force variables were collected over a 30–second capture period, equating to an average of 52 ± 5 steps of steady–state walking. Testing was repeated one week following the initial trial and again, for a third time, 20 minutes later. Repeated measures ANOVAs within a generalized linear modelling framework were used to assess between–session differences in gait parameters. Agreement between gait parameters measured within the same day (session 2 and 3) and between days (session 1 and 2; 1 and 3) were evaluated using the 95% repeatability coefficient. Results There were statistically significant differences in the majority (14/16) of temporal, spatial and kinetic gait parameters over the three test sessions (P < .01). The minimum change that could be detected with 95% confidence ranged between 3% and 17% for temporal parameters, 14% and 33% for spatial parameters, and 4% and 20% for kinetic parameters between days. Within–day repeatability was similar to that observed between days. Temporal and kinetic gait parameters were typically more consistent than spatial parameters. The 95% repeatability coefficient for vertical force peaks ranged between ± 53 and ± 63 N. Conclusions The limits of agreement in spatial parameters and ground reaction forces for the treadmill system encompass previously reported changes with neuromuscular pathology and footwear interventions. These findings provide clinicians and researchers with an indication of the repeatability and sensitivity of the Zebris treadmill system to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces.

Is the clinical Queensland High Risk Foot Form valid or reliable for research?

Background High-risk foot complications such as neuropathy, ischaemia, deformity, infections, ulcers and amputations consume considerable health care resources and typically result from chronic diseases. This study aimed to develop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool. Methods Phase one involved developing a QHRFF using an existing diabetes high-risk foot tool, literature search, expert panel and several state-wide stakeholder groups. Phase two tested the criterion-related validity along with inter- and intra-rater reliability of the final QHRFF. Three cohorts of patients (n = 94) and four clinicians, representing different levels of expertise, were recruited. Validity was determined by calculating sensitivity, specificity and positive predictive values (PPV). Kappa and intra-class correlation (ICC) statistics were used to establish reliability. Results A QHRFF tool containing 46-items across seven domains was developed and endorsed. The majority of QHRFF items achieved moderate-to-perfect validity (PPV = 0.71 – 1) and reliability (Kappa/ICC = 0.41 – 1). Items with weak validity and/or reliability included those identifying health professionals previously attending the patient, other (non-listed) co-morbidity, previous foot ulcer, foot deformity, optimum offloading and optimum footwear. Conclusions The QHRFF had moderate-to-perfect validity and reliability across the majority of items, particularly identifying individual co-morbidities and foot complications. Items with weak validity or reliability need to be re-defined or removed. Overall, the QHRFF appears to be a valid and reliable tool to assess, collect and measure clinical data pertaining to high-risk foot complications for clinical or research purposes.

Evaluating the impact of high risk foot training on undergraduate podiatry students

Background Diabetes is the leading cause of high risk foot (HRF) complications, admissions and lower limb amputation. Best practice training of podiatrists is known to have a beneficial impact on such outcomes; however, there has been a paucity of studies into undergraduate diabetes podiatry training. The primary aim of this paper was to investigate the changes in final year podiatry students’ confidence, knowledge and clinical practice in the management of HRF complications. Methods This was a prospective longitudinal study of final year podiatry students (n=25) at the Queensland University of Technology. All participants throughout 2011 undertook an intervention of a series of “hands on” HRF workshops, on-campus clinics and external clinical rotations. Outcome measures included customised confidence and knowledge surveys in HRF management across four time points. A timed simulated case scenario was used to evaluate changes in clinical practice at two time points. Friedman and Wilcoxon Signed Rank Tests were used to calculate differences between time points Results Overall improvements between the first and last time points were demonstrated in 20/21 confidence items (p<0.001), 12/27 clinical practice items (p<0.05) and 3/12 knowledge items (p<0.001). Although 8/12 knowledge items recorded high baseline scores of over 80%. Conclusions Overall, it appears student confidence and clinical practice improved with the introduction of designated HRF activities, whilst knowledge remained high. This suggests “hands on” practice and not didactic lectures improve students’ clinical confidence and practice. Results from the 2012 student cohort will also be presented at this conference.

More than just HD

Television’s 50th anniversary marks half a century of extraordinary technological development. This begs the question: is the best we can expect for the next 50 years just Higher Definition pictures of the same old crap?

WATER - a series of photographs by Louise Grayson

This body of photographic work has been created to firstly, explore a new approach to practice-led research that uses an “action genre” approach to reflective practice (Lemke) and secondly, to visually explore human interaction with the fundamental item in life - water. The first of these is based on the contention that to understand the meanings inherent in photographs we cannot look merely at the end result. It is essential to keep looking at the actions of practitioners, and the influences upon them, to determine how external influences affect the meaning potential of editorial photographs (Grayson, 2012). WATER therefore, provides an ideal platform to reflect upon the actions and influences involved in creating work within the photographic genre of photojournalism. It enables this practitioner to reflect on each stage of production to gain a better understanding of how external influences impact the narrative potential within images created. There are multi-faceted influences experienced by photographers who are creating images that, in turn, are part of constructing and presenting the narrative potential of editorial photographs. There is an important relationship between professional photographers and the technical, cultural, economic and institutional forces that impinge upon all stages of production and publication. What results is a greater understanding of technical, cultural, economic and institutional forces that impinge upon all stages of production and publication. Therefore, to understand the meanings inherent in photographs within WATER, I do not look merely at the end result. It provides a case study looking at my actions in the filed, and the influences upon me, to determine how external influences affect the meaning potential of these photographs (Grayson, 2012). As a result, this project adds to the body of scholarship around the definition of Photojournalism, how it has adapted to the current media environment and provides scope for further research into emerging new genres within editorial photography, such as citizen photojournalism. Concurrently, the photographs themselves were created to visually explore how there remains a humanistic desire to interact with the natural form of water even while living a modern cosmopolitan life around it. Taking a photojournalistic approach to exploring this phenomenon, the images were created by “capturing moments as they happened” with no posing or setting up of images. This serendipitous approach to the photographic medium provides the practitioner with at least an attempt to direct the subjectivity contained explicitly in photographs. What results is a series of images that extend the visual dialogue around the role of water within modern humanistic lifestyles and how it remains an integral part of our society’s behaviors. It captures important moments that document this relationship at this time of modern development. The resulting works were exhibited and published as part of the Head On Photo Festival, Australia's largest photo festival and the world's second largest festival in Sydney 20-24 May 2013. The WATER series of images were curated by three Magnum members; Ian Berry, Eli Reed and Chris Steele-Perkins. Magnum is a highly regarded international photographic co-operative with editorial offices in New York, London, Paris and Tokyo. There was a projection of the works as part of the official festival programme, presented to both members of the public and Sydney’s photography professionals. In addition, a sample of images from the WATER series was chosen for inclusion in the Magnum-published hardcover book. References Grayson, Louise. 2012. “Editorial photographs and patterns of practice.” Journalism Practice. Accessed: http://www.tandfonline.com/doi/abs/10.1080/17512786.2012.726836#.UbZN-L--1RQ Lemke, Jay. 1995. Textual Politics: Discourse and Social Dynamics. London: Taylor & Francis.

Why fit contact lenses? Part 1 - clinical reasons

There are probably two main reasons why some practitioners do not bother fitting contact lenses – that it is not profitable and it is clinically too difficult. Although this article will concentrate on clinical issues rather than questions of profitability, I feel that the belief that contact lens fitting is not as profitable as prescribing spectacles is unfounded.

Ten reasons why rigid contact lenses are obsolete

There have only been minor improvements in rigid lens material developments since silicone acrylates and fluoro-silicone acrylates were introduced over a quarter of a century ago. Although there have been enhancements in mechanical lathing technology in the rigid lens field - primarily as a result of developments in computer-controlled systems - rigid lenses are still manufactured using labour-intensive lathing processes, which is why the lens unit cost remains much higher than for disposable soft lenses.

Globalisation of CL prescribing : the UK perspective

Globalisation is a concept that templates onto many aspects of the commercial world, and the contact lens field is no exception. The major international companies have worldwide distribution networks and supply lenses of the same product names and replacement frequencies to all nations, with a few minor adjustments for marketing and regulatory reasons. Small and mediumsized companies, often producing more specialist lenses, are also active in markets across the world.

Evolution or revolution?

Cosmetic tinted soft lenses, which were prescribed in 4-8 per cent of soft lens fits between 1997-2001, have declined in use and since 2003 have accounted for less than 2 per cent of soft lens fits. In general, there has been a slow but steady increase in the rate of prescribing for presbyopia.

Biocompatibility, SiH lenses and the impact of hydration on comfort

Silicone hydrogel (SiH) contact lenses have been available for over a decade. During that time, these highly innovative materials and designs have continually improved and now represent a major percentage of fits within the global contact lens market.1 Their high oxygen transmissibility has drastically reduced the incidence of hypoxia-related conditions such as corneal edema, limbal hyperaemia, and corneal vascularisation.2,3 However, there remain significant challenges in the quest for the ideal contact lens. The silicone material used in SiH contact lenses is inherently more hydrophobic than the non-silicone hydrogel materials. SiH lens manufacturers must find ways to overcome lens surface hydrophobicity since it can create issues in terms of lens wettability and surface deposition. Achieving ideal lens water content presents yet another challenge since increasing water content in a silicone hydrogel lens can reduce oxygen transmissibility. This is because increasing water content results in decreased silicone content in the lens and silicone is a better transmitter of oxygen than water.

A comparison between bagasse and water efficient alternatives using KOH/AQ pulping

Numerous crops grow in sugar regions that have the potential to increase the amount of biomass available to a small bagasse-based pulp factory. Arundo donax and Sorghum offer unique advantages to farmers compared to other agricultural crops. Sorghum bicolour requires only 1/3 of the water of sugarcane. Arundo donax is a very high yield crop, it can also grow with little water but it has the further advantage in that it is also highly stress tolerant, making it suitable for land which is unsuited to other crops. Pulps produced from these crops were benchmarked against sugarcane bagasse pulp. Arundo, sorghum and bagasse were pulped using KOH and anthraquinone to 20 Kappa number so as to produce a bleachable pulp which is suitable for making photocopier paper and tissue products. The unbleached sorghum pulp has better tensile strength properties than the unbleached Arundo pulp (43.8 Nm/g compared to 21.4 Nm/g) and the bleached sorghum pulp tensile strength was similar to bagasse (28.4 Nm/g). At 20 Kappa number, sorghum pulp had acceptable yield for a non-wood fibre (45% c.f. 55% for bagasse), Arundo donax pulp had low tensile strength, and relatively low yield (38.7%), even for an agricultural fibre and required severe cooking conditions to achieve similar delignification to sugarcane bagasse or sorghum. Sorghum and Arundo donax produced thicker handsheets than bagasse (>160 µm c.f. 122 µm for bagasse). In preliminary experiments sorghum and bagasse responded slightly better to Totally Chlorine Free peroxide bleaching (QPP), although none achieved a satisfactory brightness level and further improvement would be required to produce a bleached pulp.