Postsurgical Analysis of Gait, Radiological, and Functional Outcomes in Children with Developmental Dysplasia of the Hip.

BACKGROUND: Children undergoing DDH correction surgery may experience gait abnormalities following soft tissue releases and bony procedures. The purpose of this study was to compare the residual gait changes, radiological outcomes, and functional outcomes in children who underwent DDH surgery with those in healthy controls. METHODS: Inertial motion sensors were used to record the gait of 14 children with DDH and 14 healthy children. Pelvic X-ray was performed to determine the Severin classification and the presence of femoral head osteonecrosis (Bucholz-Odgen classification). For functional evaluation, the Children's Hospital Oakland Hip Evaluation Scale (CHOHES) was used. RESULTS: There was no difference in spatial parameters between the two groups. In terms of temporal parameters, the DDH-affected limbs had a shorter stance phase (p < 0.001) and a longer swing phase (p < 0.001) than the control group. The kinematic study showed that the affected limb group had smaller hip adduction angle (p = 0.002) and increased internal rotation (p = 0.006) with reduced upward pelvic tilt (p = 0.020). Osteonecrosis was graded II, III, and IV in five, three, and one patients, respectively. Five patients had no AVN changes. The Severin classification was grade I, II, and III for six, three, and five patients, respectively. Most patients had good functional outcomes on the CHOHES, with a mean total score of 96.64 ± 5.719. Multivariate regression analysis revealed that weight, height, and femoral osteotomy were independent predictors for gait, radiological and functional outcome. CONCLUSION: Despite good functional scores overall, some children had poor radiological outcomes and gait abnormalities. Our results identified the risk factors for poor outcomes, and we recommend specified rehabilitative strategies for long-term management.

Persons with disability perception of facilities management service quality: hospital buildings in Malaysia.

PURPOSE: This study aims to discover the perception of persons with disabilities (PWDs) towards facilities management (FM) service quality at hospital buildings in Malaysia. DESIGN/METHODOLOGY/APPROACH: A questionnaire survey was conducted with 99 respondents in selected hospitals in Selangor, Malaysia. FINDINGS: This study aims to discover the perception of PWDs towards FM service quality, and it has found a gap for improvement. The area that requires the highest attention includes the importance of (1) assurance on accessibility despite maintenance activity being conducted (2) criticality of facilities maintenance itself, (3) assurance on comfort and safety, (4) reliable medium to ask for assistance or giving feedback, (5) signage that is clearly seen and easily understood and (6) staff responsiveness. RESEARCH LIMITATIONS/IMPLICATIONS: This instrument is validated by PWDs under the physical disability category only, specifically in the hospital context. Future research is recommended to identify the FM service quality aspect for different categories of disability (sensory, mental or intellectual impairment). PRACTICAL IMPLICATIONS: The findings provide evidence for FM to consider PWDs' perceptions in FM strategy development. Even FM provides a healthcare support system. FM service quality partly reflects healthcare service quality. SOCIAL IMPLICATIONS: Accommodating the need of PWDs through the improvement of FM service quality aspect will partly fulfil the right of PWDs for equality of access to healthcare. ORIGINALITY/VALUE: This SERVQUAL tools can be improvised and used to measure the perception of PWDs on FM service quality systematically and holistically. Understanding the service quality aspect is important for a facility manager to precisely measure and prioritise what is truly important to the building users with special needs and try to accommodate this need in the management activity.

Stepease™ diabetic socks: An answer to efficacious indoor foot pressure relief- A prospective study.

BACKGROUND: Diabetic foot ulcer is commonly seen in people with diabetes mellitus. Inadequate plantar pressure offloading has been identified as a contributing factor to development of diabetic foot ulcers. Various pressure off-loading footwear are widely available in the market but poor compliance has been reported especially for indoor usage. StepEase™ diabetic socks have been designed using Ethylene Vinyl Acetate (EVA) microspheres for better redistribution of plantar pressure. The objective of this study was to determine the efficacy of StepEase™ in redistributing the foot plantar pressure and to assess patients' satisfaction on the usage of the socks. METHODS: This was a prospective non randomized clinical trial conducted on 31 patients with diabetes mellitus with high risk foot (King's classification stage II) over a 12 weeks period. Dynamic foot plantar pressure reading was recorded at day 0, 6 weeks and 12 weeks intervals, both barefoot and with StepEase™, using Novel Pedar-X system (Novel GmbH, Munich, Germany). Patients' satisfaction and usage practice were assessed by a questionnaire. RESULTS: The mean age of subjects was 57.9 years with mean body mass index (BMI) of 26 kg/m2. The mean duration of diagnosis with diabetes mellitus was 10.2 years. The mean peak plantar pressure was found to be highest at the right forefoot and left heel region, 267.6 kPa (SD113.5 kPa) and 266.3 kPa (SD 94.6 kPa) respectively. There was a statistically significant reduction of mean peak pressure (P < 0.0001 to P = 0.024) in all masked regions except the left toe region ranging from 22.3 to 47.5% (53.2-117.4 kPa). The highest reduction was seen in the right toe region (47.5%). The reduction of peak pressure was still significant (P < 0.0001 to P = 0.034) at 6 weeks ranging from 24.7% to 46.8% (46.1-100.6 kPa) and at 12 weeks, which was 22.2-49.2% (40.6-91.9 kPa). Mean usage of the socks was 4.39 days per week (SD 1.82), with the mode of 4-6 h per day. Most of the subjects were satisfied or very satisfied with the StepEase™ socks (77.4%) while 87.1% agreed to continue using the socks. None had any new ulcer development or fall during the study period. CONCLUSION: StepEase™ was significantly effective as an indoor foot pressure relieving footwear. It resulted in significant peak plantar pressure reduction by up to 49.2% and the effect was maintained for at least 12 weeks duration.

Rehabilitation in Malaysia.

This article reviews the epidemiology, rehabilitation intervention strategies, and rehabilitation resources for persons with disabilities (PWD) in Malaysia. Currently, the registered number of PWD is 409,269 individuals, 1.3% of the total population, which is far less than the World Health Organization estimation of 10%. The rehabilitation implementation strategies include health policies, health promotion, and prevention programs. Health-related services for PWD are provided by many government agencies, including health, welfare, education, manpower, housing, and the private sector and nongovernment organizations. It is hoped national health programs can ensure special care and rehabilitation for PWD, optimizing self-reliance and social integration.

Facilitators and Barriers to the Rehabilitation Workforce Capacity Building in Low- to Middle-Income Countries.

An increase in population and chronic conditions leading to disability require increasing emphasis on rehabilitation and health intervention. Poorer countries do not usually have the rehabilitation workforce needed to promote societal inclusion and participation. The roles of the rehabilitation workforce were often not clearly defined, leading to task shifting among rehabilitation professionals. Barriers to capacity building were poor availability of human resources and insufficient training program/supports for their professional development. Facilitators were local government support and international non-governmental organizations collaboration. Recommendations for capacity building effort are for collaboration with the developed nations to encourage funding, training, education, and sharing of resources.

Optimising the Bariatric Patients' Outcome through Cardiac Rehabilitation Approach.

Bariatric surgery offers a therapeutic alternative with favourable weight management, cardiovascular, metabolic and functional outcomes. Bariatric individuals often have functional impairments pre-operatively that can be addressed to improve post-operative results and eventual functional independence. Multidisciplinary team offers the best approach to address peri-operative needs and sustainable weight loss thereafter. We exemplified the application of cardiac rehabilitation therapeutic model in managing two bariatric clients with specific bariatric-related challenges. Our approach focuses on adaptive physical activity, sustainable lifestyle changes to promote post-operative weight loss through education and problem solving as well as secondary prevention of cardiovascular disease. Putting emphasis on addressing physical and psychosocial barriers towards physical activity alongside nutritional aspects potentially confers sustained if not better outcomes on weight reduction and functional improvement.