Mobility Aids Research Articles

MECHANICAL INTERVENTIONS IN THE MANAGEMENT OF KNEE OSTEOARTHRITIS: AN OA TRIAL BANK INDIVIDUAL PARTICIPANT DATA META-ANALYSIS INITIATIVE STATUS UPDATE

Purpose: Treatment for knee osteoarthritis (OA) may aim to alter biomechanics and reduce joint loads through the application or wear of mechanical interventions like bracing, taping, insoles, footwear, or mobility aids. The OARSI guidelines conditionally recommend use of mobility aids and wedged insoles for knee OA management, but conditionally to strongly recommend against taping and bracing, based on a lack of clear efficacy from low quality evidence. However, knee OA is a heterogeneous condition, and it may be that clearly defined subgroups of patients may be more likely to respond to mechanical interventions.We are conducting a systematic review with individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs) investigating mechanical interventions to treat painful knee OA.

Training Program to Modify Manual Wheelchairs to Simplified Power Wheelchairs for Community Dwelling Elderly People and Caregivers.

Mobility aids, particularly power wheelchairs, are necessary for elderly individuals who have health problems and disabilities. However, there is a limitation in providing power wheelchairs for such people in the community. The objectives of this study were to develop a prototype for a simplified power wheelchair and develop and evaluate a training program that has the potential to encourage evaluation and modification of the wheelchair for the elderly and their caregivers in the community. Twenty-four participants consist of elderly people and caregivers who were interested in the training program that comprised two sessions: theory and fieldwork experience. Results showed that the elderly people and caregivers, who had no knowledge or experience of wheelchair modification, were able to learn and provide suggestions for wheelchair users in their community. Two themes emerged from evaluating the training program, which included “benefits from the training program” and “improvement of the training program in the future.” Key concepts were elicited and considered in six categories: sufficient knowledge and practical learning to build confidence, values of fieldwork experiences, team support, organizational support, expansion of various contexts, and system of continued connection and services after training.

Anticholinergic Drug Use on Admission and the Risk of In-Hospital Falls in Older Hospitalized Patients.

PurposeIn-hospital falls, especially among older patients, are a major and underestimated problem. Several studies have suggested a possible association between anticholinergic drug use and falls, but the results are inconclusive and studies focusing on in-hospital falls are scarce. The aim of the present study was to investigate whether anticholinergic drug exposure on admission is associated with in-hospital falls.Patients and MethodsThis retrospective chart review study was conducted in the Erasmus MC University Medical Center, Rotterdam, the Netherlands. Patients aged 65 years and older, who were acutely admitted to the geriatric ward between 2012 and 2015, were included. Anticholinergic drug exposure was determined with the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden scale (ACB) and the list of Chew. Logistic regression was used to investigate the possible association between anticholinergic drug exposure and in-hospital falls. Analyses were adjusted for age, sex, fall history, fall as reason for admission, number of drugs on admission, use of a mobility aid and delirium.ResultsA total of 905 patients were included, of which 94 patients experienced one or more in-hospital falls. Each additional anticholinergic drug in use, according to the ARS, was associated with an increased odd of experiencing a fall (OR = 1.49, 95% CI: 1.06–2.10). Other measures, ie anticholinergic drug use (yes/no) and different categories of anticholinergic drug burden, measured with the ARS, ACB and list of Chew, were all not associated with in-hospital falls.ConclusionAnticholinergic drug exposure on admission is possibly not a main risk factor for in-hospital falls among older patients.

A survey of nurses, physiotherapists and occupational therapists in mobility care and gait aid use for hospital patients with dementia

This study described mobility care practice of nurses, physiotherapists and occupational therapists and gait aid use for hospital patients with dementia. Two surveys, tailored to staff mobility care roles were distributed in Australian hospitals. Physiotherapists and occupational therapists were asked additional questions regarding assessments and factors for prescribing gait aids to patients with dementia. Descriptive statistics for closed-ended and summative content analyses for open-ended questions were undertaken. Nurses (n=56), physiotherapists (n=11) and occupational therapists (n=23) used various practices to ensure ambulation safety for patients with dementia. Nurses and occupational therapists commonly referred patients with dementia to physiotherapists for mobility and gait aid assessments. Therapists predominantly considered the severity of dementia, the person's learning ability and mobility history in deciding about gait aid use. Exploring ways to strengthen nursing and health professional education, and inter-professional practice for safe mobility in patients with dementia, with and without gait aids, could be helpful.

Hereditary Spastic Paraplegia in Koreans: Clinical Characteristics and Factors Influencing the Disease Severity.

Hereditary spastic paraplegia (HSP) progresses over time and is associated with locomotive dysfunction. Understanding the factors affecting disease severity and locomotive function is important in HSP. This study investigated the factors influencing disease severity and ambulation status of HSP.We consecutively enrolled 109 Korean patients (64 males, and 45 females)from 84 families with a clinical diagnosis of HSP. HSP was primarily diagnosed based on clinical criteria including clinical findings, family history, and supported by genetic studies. Epidemiological and clinical features of the patients were analyzed, and the Spastic Paraplegia Rating Scale (SPRS) score and ambulatory status were used to evaluate disease severity.Ninety-two (84.4%) patients had pure HSP, and 55 (50.4%) had a dominant family history. Thirty-one (28.4%) patients required a mobility aid for locomotion. A Kaplan-Meier analysis showed that HSP patients lost their independent gait ability after a median disease duration of 34 years. Those with an age at onset of ≤18 years had a longer median independent walking time. Pure HSP is characterized by predominant bilateral lower extremity weakness and spasticity, whereas complicated HSP presents more complex neurological findings such as ocular and bulbar symptoms, ataxia, and cognitive impairment. Complicated HSP was significantly correlated with the SPRS mobility score (β=3.70, 95% confidence interval=0.45-6.94). The age at onset and disease duration were significantly correlated with disease severity, and they were significant predictors of the use of a mobility aid (p<0.05).These findings suggest that a later age at onset and longer disease duration are significant factors affecting the disease severity and ambulatory function in patients with HSP. These findings can help clinicians to identify subjects at risk of locomotive impairment.

How older people experience the age-friendliness of The Hague: A quantitative study

The municipality of The Hague has been a member of the WHO's Global Network for Age-Friendly Cities and Communities since 2015. The municipality commissioned a survey to investigate how older citizens view the age-friendliness of their city. A cross-sectional survey was conducted among a diverse sample of 393 community-dwelling older citizens. The survey made use of the Age Friendly Cities and Communities Questionnaire (AFCCQ), and multilevel regression techniques to investigate how social groups differ on the domains of the AFCCQ. The Hague scored a satisfied as an overall score (16.9 ± 8.87), and a satisfied on social participation (2.6 ± 2.46), civic participation and employment (1.4 ± 1.34), communication and information (1.4 ± 1.32), respect and social inclusion (1.6 ± 1.59), community support and health services (2.7 ± 2.79), transportation (1.7 ± 1.26) and financial situation (1.9 ± 1.26). The Hague has an above-average score in the field of housing (2.4 ± 1.06). For Outdoor spaces and buildings, the municipality scores a moderate positive score (0.9 ± 1.41). Significant differences were found for sex, age, socio-economic position, receiving care support, and use of mobility aids. The findings show that older people have different perceptions regarding their city's age-friendliness. Policy makers must acknowledge this heterogeneity among their older citizens and adapt city policies accordingly.

Developing and delivering a virtual assistive technology training programme for mobility aids in Papua New Guinea

Developing and delivering a virtual assistive technology training programme for mobility aids in Papua New Guinea

Satisfaction on the Use of Mobility Aids Among Lower Limb Amputees and Impact on Activities of Daily Living in Selangor, Malaysia

Introduction: This study aims to determine the level of satisfaction on the mobility aids the dependence in activities of daily living among amputees in Bangi, Selangor. Methods: The data was collected at Pusat Latihan Perindustrian dan Pemulihan (PLPP), Bangi in Selangor, Malaysia, on 55 lower-limb amputees using a cross-sectional design. An instrument used was adapted from Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) and Barthel Index (BI). These two instruments were combined to evaluate the satisfaction of assistive aids used and dependence of activities daily living. Results: Total mean score of level of satisfaction was 3.99 (95%CI=3.85–4.13) and level of dependence was 85.00 (95%CI=81.28–88.72). The Kruskal-Wallis test was conducted to evaluate the association of mobility aids used with level of satisfaction and level of dependence. The results showed there was no significant association between mobility aids used and level of satisfaction. Meanwhile there was a significant association between mobility aids used and dependence (p=0.001). Multiple linear regression test showed the combination of mobility aids used and level of satisfaction was found significantly associated with the level of dependency (p=0.024). The final analysis, when only mobility aids used was included as a single variable (without the combination with the level of satisfaction), it was found statistically associated with the level of independence while the level of satisfaction score is excluded. Conclusion: Mobility aids used was found no significant association with the level of satisfaction however, user who used cast prosthesis as mobility aids found prothesis provided them more dependency in performing activities daily living. Despite prothesis was found as the most convenience mobility aid, users did not see it as something that can give them satisfaction. This could be because of the mobility aids that provide dependency are not cost-effective. It is recommended that users can get more options to use mobility aids that can provide them dependency, nevertheless the mobility aids must be affordable for them.

The unmet need for treatment of children with musculoskeletal impairment in Malawi

BackgroundMore than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi. Previous studies in Malawi on childhood disability and the impact of musculoskeletal impairment (MSI) on the lives of children have been done but on a small scale and have not used disability measurement tools designed for children. Therefore in this study, we aimed to estimate the MSI prevalence, causes, and the treatment need among children aged 16 years or less in Malawi.MethodsThis study was carried out as a national cross sectional survey. Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation.ResultsOf 3792 children aged 16 or less who were enumerated, 3648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7–7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6000-33,000) children in need of orthopaedic surgery. Low parents’ educational level was one factor associated with an increased risk of MSI.ConclusionThis survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country.

Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity. To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants. Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age. Extremely preterm birth. Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices. The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment. Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

21the Wheelchair Project Case Study: Leveraging Collaborative Efforts and Partnerships to Provide Assitive Devices for People Affected by Disability in Thailand and Southeast Asia

Many people affected by disability require assistive devices, particularly mobility aids, in order to live independently and fully integrate into their communities. Throughout the world, numerous methods have been implemented in facilitating the provision of these devices to people affected by disabilities. This case study intends use the Rajanagarindra Institute of Child Development Wheelchair Project, located in Chiang Mai, Thailand, to evaluate the viability and efficacy of mobility-provision programs which adapt wheelchairs and other assistive devices not originally intended for the end user. Programs which must “retro-adapt” equipment, like the Wheelchair Project, rely heavily on medical and mechanical expertise to identify the recipients’ needs and safely modify the device accordingly. By examining the distribution statistics from the Wheelchair Project over its 20 years of operation and the needs of the disability community reported by the National Statistics Office of Thailand alongside a cost-benefit analysis of the declared value provided versus operational cost, this case-study systematically details the scope and financial viability of this approach. While not without constraints, this model succeeds in effectively capitalizing on available resources (both in regard to physical equipment as well as professional expertise) to meet the needs of those affected by disabilities in Thailand and Southeast Asia. Although still limited in size and reach, the Wheelchair Project demonstrably shows its viability and the potential this approach presents given the right circumstances.

Feasibility evaluation of a dual-mode ankle exoskeleton to assist and restore community ambulation in older adults.

Age-related deficits in plantar flexor muscle function during the push-off phase of walking likely contribute to the decline in mobility that affects many older adults. Isolated strengthening of the plantar flexor muscles has failed to improve push-off power or walking economy in this population. New mobility aids and/or functional training interventions may help slow or prevent ambulatory decline in the elderly. The overarching objective of this study was to explore the feasibility of using an untethered, dual-mode ankle exoskeleton for treating walking disability in the elderly; testing the device in assistance mode as a mobility aid to reduce energy consumption, and as a resistive gait training tool to facilitate functional recruitment of the plantar flexor muscles. We recruited 6 older adults between the ages of 68 to 83 years to evaluate the feasibility of the dual-mode exoskeleton across two visits. On the first visit, we quantified acute metabolic and neuromuscular adaption to ankle exoskeleton assistance during walking in older adults, and subsequently determined if higher baseline energy cost was related to an individual's potential to benefit from untethered assistance. On the second visit, we validated the potential for push-off phase ankle resistance combined with plantar pressure biofeedback to facilitate functional utilization of the ankle plantar flexors during walking. We also conducted a twelve-session ankle resistance training protocol with one pilot participant to explore the effects of gait training with wearable ankle resistance on mobility and plantar flexor strength. Participants reached the lowest net metabolic power, soleus variance ratio, and soleus iEMG at 6.6 ± 1.6, 19.8 ± 1.6, and 5.8 ± 4.9 minutes, respectively, during the 30-minute exoskeleton assistance adaptation trial. Four of five participants exhibited a reduction (up to 19%) in metabolic power during walking with assistance relative to baseline, but there was no group-level change. Participants who had greater baseline metabolic power exhibited a greater reduction during walking with assistance. Walking with resistance increased stance-phase soleus iEMG by 18 - 186% and stance-phase average positive ankle power by 9 - 88% compared to baseline. Following ankle resistance gait training, the participant exhibited a 5% increase in self-selected walking speed, a 15% increase in fast walking speed, a 36% increase in 6-min-walk-test distance, and a 31% increase in plantar flexor strength compared to pre-intervention measurements. Our results suggest that dual-mode ankle exoskeletons appear highly applicable to treating plantar flexor dysfunction in the elderly, with assistance holding potential as a mobility aid and resistance holding potential as a functional gait training tool. We used an untethered design to maximize the relevance of this for informing the design of intervention studies that may take place at home and in the community to improve mobility and quality of life in older adults. Future studies with larger sample sizes are recommended to expand on the results of this feasibility investigation.

Hereditary Spastic Paraplegia in Koreans: Clinical Characteristics and Factors Influencing the Disease Severity.

Background and PurposeHereditary spastic paraplegia (HSP) progresses over time and is associated with locomotive dysfunction. Understanding the factors affecting disease severity and locomotive function is important in HSP. This study investigated the factors influencing disease severity and ambulation status of HSP.MethodsWe consecutively enrolled 109 Korean patients (64 males, and 45 females)from 84 families with a clinical diagnosis of HSP. HSP was primarily diagnosed based on clinical criteria including clinical findings, family history, and supported by genetic studies. Epidemiological and clinical features of the patients were analyzed, and the Spastic Paraplegia Rating Scale (SPRS) score and ambulatory status were used to evaluate disease severity.ResultsNinety-two (84.4%) patients had pure HSP, and 55 (50.4%) had a dominant family history. Thirty-one (28.4%) patients required a mobility aid for locomotion. A Kaplan-Meier analysis showed that HSP patients lost their independent gait ability after a median disease duration of 34 years. Those with an age at onset of ≤18 years had a longer median independent walking time. Pure HSP is characterized by predominant bilateral lower extremity weakness and spasticity, whereas complicated HSP presents more complex neurological findings such as ocular and bulbar symptoms, ataxia, and cognitive impairment. Complicated HSP was significantly correlated with the SPRS mobility score (β=3.70, 95% confidence interval=0.45–6.94). The age at onset and disease duration were significantly correlated with disease severity, and they were significant predictors of the use of a mobility aid (p<0.05).ConclusionsThese findings suggest that a later age at onset and longer disease duration are significant factors affecting the disease severity and ambulatory function in patients with HSP. These findings can help clinicians to identify subjects at risk of locomotive impairment.

Declínio da deambulação funcional e fatores associados na esclerose lateral amiotrófica

Abstract Introduction: Amyotrophic lateral sclerosis (ALS) is a disabling neurodegenerative disease, which compromises locomotion and functional independence. As the goal of physical therapy is to maintain the individual's locomotion capacity and independence as long as possible, it is necessary to gain a better understanding of the possible factors associated with the loss of this capacity. Objective: To evaluate functional ambulation in patients with ALS and possible factors associated with its decline. Methods: A cross-sectional study was conducted with sporadic ALS patients. Demographic and clinical/functional aspects were evaluated. ALS Functional Rating Scale-Revised (ALSFRS-R), Functional Ambulation Category, Medical Research Council scale and Fatigue Severity Scale were used. Descriptive and comparative analyses were conducted of the groups capable and incapable of functional ambulation. Binary logistic regression (stepwise forward method) was performed to determine potential factors associated with the loss of functional ambulation. Results: Among the 55 patients (mean age: 56.9 ± 11.2 years), 74.5% were able to walk functionally. Differences were found between groups regarding time of diagnosis, number of falls, pain, use of noninvasive ventilation, gastrostomy, ability to turn in bed, mobility aids, home adaptations, functional performance, muscle strength and fatigue. The possible predictors of walking disability were overall muscle strength (OR = 0.837; p = 0.003) and fatigue (OR =1.653; p = 0.034). Conclusion: Muscle strength and fatigue are associated with the decline in ambulation capacity in patients with ALS. In view of the complexity of elements involved in walking, further studies are needed to investigate the influence of these aspects in this population.

A Comparative Study of Assistive Technologies for Physically challenged peoples for usability of Powered Wheelchair Mobility Aid

A Comparative Study of Assistive Technologies for Physically challenged peoples for usability of Powered Wheelchair Mobility Aid

WearROBOT: An Energy Conservative Wearable Obstacle Detection Robot With LP Multi-Commodity Graph

Human activity wearable obstacle detection for the visually impaired (VI) is developed for routine monitoring and observation of surrounding events. Environmental observation, home surveillance, and assistive supports are now built on wearable devices using Inertia-based sensors, such as accelerometers, linear acceleration, and gyroscopes. Previous assisted living system (ALS) still faces challenges in energy management and resource allocation when performing daily activities, particularly with ambulation. Legacy systems cannot fully improve self-esteem, hence, WearROBOT. It detects rearview obstacles and has an audio feedback system incorporated for voicing out once an obstacle is detected. Linear programing (LP) multi-commodity graph (LMCG) learning model is proposed while coupling the shortest path resource allocation for space diversity linearization. An Infrared sensor problem function that minimizes link utilization is derived. Angle-Intensity analysis (AIA) is carried out on various use case scenarios to enable the user to know the best angle to consider depending on its usage and battery conservation. The work showed how intensity differs at various angles at 5°,15°,20° 35°, and 45° respectively. Also, the reflectivity of different materials and how it affects the battery life are studied. As the wearable robot moves away from the node-obstacle, the LMCG narrow-band sensor node (LMCG-NB-IoT) drops energy significantly. The Low Power WAN (LP-WAN), Bluetooth Low-Energy (BLE) and proposed LMCG-NB-IoT offered 51.28%, 33.33%, and 15.39% respectively. In terms of energy latency, the schemes gave 65.63%, 31.25%, and 3.12% respectively. Similarly, the proposed LMCG-NB-IoT had a 50% battery life profile. Finally, WearROBOT mobility aid minimizes injuries experienced by the visually impaired.

Perceptions of earthquake risks and knowledge about earthquake response among movement challenged persons in Dhaka city of Bangladesh

Dhaka, Bangladesh is one Asian city that is at high risk of earthquakes. Persons with physical disabilities, particularly movement-challenged persons (MCPs), is highly vulnerable to earthquakes because of their mobility impairment. This study aims to explore risk perceptions of earthquakes and knowledge about the response to earthquakes among MCPs in Dhaka through a 2020 survey of 455 respondents. Four risk perception measures are developed: the perceived probability of an earthquake, fear, perceived threat to life and perceived damage to property in the event of an earthquake. Subsequent factor analysis reveals that these four measures are loaded on one factor named risk perception. Measures of knowledge about the response to earthquakes include knowledge of where to seek shelter while being inside and outside of the home during an earthquake, location of critical facilities, and the existence of evacuation route in the locality as well as their knowledge about National Plan for Disaster Management (NPDM) of Bangladesh. This study finds that mobility aid, age, income, education, building structure, previous experience with an earthquake are significantly related to risk perceptions. MCPs who have participated in the training know what they should do in the event of an earthquake irrespective of being outside or inside of the home. MCPs with more education are more likely to know about NPDM and the existence of fault lines in Bangladesh. Lack of accessibility in training centers and lack of dissemination of information about training are key reasons behind MCPs not participating in the training.

Knee scooter related injuries and satisfaction in patients following foot and ankle surgery

BackgroundKnee scooters have become popular amongst foot and ankle surgeons for patients who are required to be non-weight bearing. Information is limited regarding falls and injuries sustained while using a knee scooter and potential contraindications to their use are ill-defined. No study has assessed patient reported injuries and satisfaction. This study aims to evaluates the patient’s perspective with regards to the use of a knee scooter. As a secondary aim we assessed for risk factors associated with knee scooter related injuries to try make recommendations for the safe use of a knee scooter. MethodsPatients who used a knee scooter during 2018–2020 were emailed a questionnaire assessing (1) demographic data, (2) medical history, (3) falls and injuries sustained, including the management of these injuries, and (4) patient satisfaction. This study is a descriptive, cross-sectional survey analysis. Results101/196 (51,5%) responses were received, which included 32 males and 69 females. The cohort had a mean age of 56.4 years, and BMI of 28.5. Mean time spent using the scooter was 6.7 weeks. Twenty-five respondents had fallen off the scooter, with 5 reporting injuries. One patient required medical attention for a shoulder injury. Cause of falls included hitting an obstacle, making a sharp turn, moving too fast, and moving downhill. There was no correlation between falls and patient comorbidities. Ninety-six percent of respondents reported a high satisfaction and preferred the scooter to crutches. ConclusionThe knee scooter is a safe, and well-tolerated, mobility aid for patients requiring non-weight bearing during their recovery, with a high satisfaction rate. Educating patients on correct use and common causes for falling is important as a preventative measure. Level of evidenceIV, retrospective case series.

Ten-Second Tandem Stance Test: A Potential Tool to Assist Walking Aid Prescription and Falls Risk in Balance Impaired Individuals

ObjectiveTo assess the utility of a 10-second tandem stance test in predicting gait impairment and the need for a mobility aid. DesignCross-sectional study. SettingPublic hospital ambulatory and hospitalized care. ParticipantsParticipants were drawn from referrals to the physiotherapy service and patients identified by health care staff as needing mobility assessment. Eighty-seven people were referred to the study. Sixty-one individuals (N=61) consented to participate; mean age was 76±9.8 years and 61% were female. All participants were community dwelling. InterventionThe 10-second tandem stance test and gait parameters were measured while walking with no walking aid, a walking stick, and a 4-wheeled walker were assessed. Main Outcome MeasuresAssociations between the 10-second tandem stance test performance with prescribed walking aids (primary outcome variable), gait parameters (gait cycle time, cadence, stance phase, swing phase, double support, stride length, speed, peak angle velocity, maximal heel clearance), falls history, falls risk (Falls Risk for Older People in the Community [FROP-Com]), and walking aid use. ResultsInability to maintain tandem stance for 10 seconds significantly increased the odds of requiring a prescribed walking aid (odds ratio [OR], 5.19; P=.01). Tandem stance test time was positively correlated with stride length, gait speed, peak angle velocity, and maximal heel clearance during the gait cycle. Correlation between tandem stance time and number of falls was weak but significant (ρ=−0.31, P=.01), and FROP-Com score for falls risk was negative and moderate for nonpreferred foot behind (ρ=−0.58, P<.01). The 10-second tandem stance with nonpreferred foot behind was associated with falling in previous 12 months (P=.04). Walking aid use history in subgroups with the individuals who cannot maintain the tandem stance with nonpreferred foot behind for 10 seconds was associated with falling in previous 12 months (OR, 55.00; 95% CI, 2.44-1238.46; P=.01). ConclusionsThe 10-second tandem stance test was associated with professionally prescribed walking aids, gait parameters with prescribed walking aids, falls, and walking aid use history, indicating the test may be useful to guide the prescription of walking aids.

The factors influencing community nurses' usage of electronic health records: findings from focus groups.

Electronic health records (EHRs) are integral to community nursing, and mobile access aids seamless, responsive care, prevents repetition and reduces hospital admissions. This saves time and money, enabling smoother workflows and increased productivity. Common practice among community nurses is to return to workbases to access EHRs. This research was conducted to explore what leads to inconsistency in EHR use. Focus groups were held with community nurses, and reflexive thematic analysis of the data was undertaken. Nurses who used EHRs during consultations described the practice as integrative and informed, promoting collaborative care. Those who did not described EHRs as time-consuming, template-laden and a barrier to nurse-patient communication. One barrier to mobile working is the threat to collegiate teamworking and the social and clinical supports it provides. This study suggests specific strategies could increase mobile EHR engagement: role-specific training for effective EHR use; clear organisational directives; innovative team communication; and peer-to-peer coaching.