Foot ulcer recurrence, plantar pressure and footwear adherence in people with diabetes and Charcot midfoot deformity: A cohort analysis.

AIMS: To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. METHODS: Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors. RESULTS: Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001). CONCLUSIONS: Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.

Predicting Mobility Limitations in Patients With Total Knee Arthroplasty in the Inpatient Setting.

OBJECTIVE: To develop a prediction model for postoperative day 3 mobility limitations in patients undergoing total knee arthroplasty (TKA). DESIGN: Prospective cohort study. SETTING: Inpatients in a tertiary care hospital. PARTICIPANTS: A sample of patients (N=2300) who underwent primary TKA in 2016-2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Candidate predictors included demographic variables and preoperative clinical and psychosocial measures. The outcome of interest was mobility limitations on post-TKA day 3, and this was determined a priori by an ordinal mobility outcome hierarchy based on the type of the gait aids prescribed and the level of physiotherapist assistance provided. To develop the model, we fitted a multivariable proportional odds regression model with bootstrap internal validation. We used a model approximation approach to create a simplified model that approximated predictions from the full model with 95% accuracy. RESULTS: On post-TKA day 3, 11% of patients required both walkers and therapist assistance to ambulate safely. Our prediction model had a concordance index of 0.72 (95% confidence interval, 0.68-0.75) when evaluating these patients. In the simplified model, predictors of greater mobility limitations included older age, greater walking aid support required preoperatively, less preoperative knee flexion range of movement, low-volume surgeon, contralateral knee pain, higher body mass index, non-Chinese race, and greater self-reported walking limitations preoperatively. CONCLUSION: We have developed a prediction model to identify patients who are at risk for mobility limitations in the inpatient setting. When used preoperatively as part of a shared-decision making process, it can potentially influence rehabilitation strategies and facilitate discharge planning.

Strategies to improve the medical device life cycle in Mexico.

OBJECTIVE: To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. MATERIALS AND METHODS: The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. RESULTS: Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. CONCLUSIONS: Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health system's performance.

Prospective comparative study of knee laxity with four different methods in anterior cruciate ligament tears.

BACKGROUND AND PURPOSE: Anterior knee laxity can be evaluated using different devices, the most commonly used being the Telos®, KT1000®, Rolimeter®, and GNRB®. However, the laxity values obtained with these devices have never been compared to one another. As such, the outcomes of studies using these different knee laxity measurement devices may not be comparable. The primary purpose of this study was to determine the side-to-side laxity difference in patients with one ACL-injured knee, using each of these devices, and to compare the values obtained from each. We hypothesized that the measurements of laxity would vary depending on the device used. METHODS: This was a prospective study. All patients with an ACL injury, in which surgical reconstruction was planned, underwent pre-operative knee laxity measurements using four different devices. The concordance correlation coefficient (CCC) of the results was compared between the four devices. RESULTS: The study enrolled 52 patients. With regard to the values of the side-to-side differences, the KT1000® and the GNRB® obtained the most similar values (CCC = 0.51, 95% CI 0.37-0.63). The two devices with the lowest correlation were the Telos® and the Rolimeter® (CCC = 0.04, 95% CI - 0.14-0.23). The comparability was considered average for the KT1000® and GNRB® and poor for the other devices. CONCLUSIONS: The knee laxity devices used in regular practice are not comparable to one another. As a result, caution must be taken when comparing results from studies using these different devices.

Biomechanical comparisons of current suspensory fixation devices for anterior cruciate ligament reconstruction.

PURPOSE: Cortical suspensory devices are routinely used for femoral side fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the biomechanical properties of a new adjustable loop device (GraftMax®) compared with established devices (EndoButton® and TightRope®) in ACL reconstruction and to investigate whether knotting the free end of TightRope could improve biomechanical properties. METHODS: The three cortical suspensory devices (GraftMax® Button; Conmed, EndoButton® CL; Smith & Nephew, and TightRope® RT; Arthrex) were tested under cyclic load (50-250 N for 1000 cycles) and pull-to-failure conditions at 50 mm/h in a device-only setup using a tensile testing machine. The TightRope was additionally tested with its free suture ends knotted. The statistical analyses were done with one-way analysis of variance (ANOVA) and post hoc Tukey HSD tests. RESULTS: There are significant differences in the load-to-failure among the devices. The EndoButton showed the highest mean failure load at 1204.7 N compared to other devices (GraftMax (914.2 N), knotted TightRope (868.1 N) and TightRope (800.1 N) (p < 0.001). The mean total displacement after 1000 cycles was 0.76 mm, 2.11 mm, 1.56 mm and 1.38 mm for the EndoButton, GraftMax, TightRope, and knotted TightRope, respectively. The EndoButton showed significantly better properties than both the GraftMax (p = 0.000) and the TightRope (p = 0.020) but not the knotted TightRope (p = n.s.) in total displacement. However, there was no significant difference between the TightRope and GraftMax (p = n.s.). CONCLUSION: The fixed loop (EndoButton) showed significantly better mechanical properties in failure load and displacement than TightRope or GraftMax in this biomechanical study. However, the mechanical properties of the GraftMax is comparable to the TightRope. Moreover, the knotting of TightRope improved mechanical properties in total displacement more than TightRope, but not in failure load. CLINICAL RELEVANCE: The biomechanical properties of the GraftMax are comparable to the TightRope. The TightRope, when knotted, shows an improvement both in load to failure and cyclic displacement, though the differences are not significant.

Latent Class Growth Analysis predicts long term pain and function trajectories in total knee arthroplasty: a study of 689 patients.

OBJECTIVE: To characterize groups of subjects according to their trajectory of knee pain and function over 1 to 5 years post total knee arthroplasty (TKA). METHODS: Patients from one centre who underwent primary TKA (N = 689) between 2006 and 2008. The Knee Society Score (KSS) was collected pre-operatively and annually post-operatively. Latent Class Growth Analysis (LCGA) was used to classify groups of subjects according to their trajectory of knee pain and function over 1-5 years post-surgery. RESULTS: LCGA identified a class of patients with persistent moderate knee pain (22.0%). Predictors (OR, 95% CI) of moderate pain trajectory class membership were pre-surgery SF12 mental component summary (MCS) per 10 points (0.65, 0.54-0.79) and physical component summary (PCS) per 10 points (0.50, 0.33-0.76), Charlson Comorbidity Index (CCI) one (1.70, 1.07-2.69) and ≥two (2.82, 1.59-4.81) and the absence of computer-navigation (2.26, 1.09-4.68). LCGA also identified a class of patients with poor function (23.0%). Predictors of low function trajectory class membership were, female sex (3.31, 1.95-5.63), advancing age per 10 years (2.27, 1.69-3.02), pre-surgery PCS per 10 points (0.50, 0.33-0.74), obesity (1.69, 1.05-2.72), morbid obesity (3.12, 1.55-6.27) and CCI ≥two (2.50, 1.41-4.42). CONCLUSIONS: Modifiable predictors of poor response to TKA included baseline co-morbidity, physical and mental well-being and obesity. This provides useful information for clinicians in terms of informing patients of the expected course of longer term outcomes of TKA and for developing prediction algorithms that identify patients in whom there is a high likelihood of poor surgical response.

Functional impairment in patients with sporadic Inclusion Body Myositis.

INTRODUCTION: We conducted a retrospective chart review of 53 patients diagnosed with sporadic Inclusion Body Myositis (sIBM) who have been followed at the McMaster Neuromuscular Clinic since 1996. OBJECTIVES: We reviewed patient medical histories in order to compare our findings with similar cohorts, and analyzed quantitative strength data to determine functionality in guiding decisions related to gait assistive devices. METHODS: Patient information was acquired through retrospective clinic chart review. RESULTS: Our study found knee extension strength decreased significantly as patients transitioned to using more supportive gait assistive devices (P < 0.05). A decline to below 30 Nm was particularly indicative of the need for a preliminary device (i.e. cane)(P < 0.05). Falls and fear of falling poses a significant threat to patient physical well-being. The prevalence of dysphagia increased as patients required more supportive gait devices, and finally a significant negative correlation was found between time after onset and creatine kinase (CK) levels (P < 0.01). CONCLUSION: This study supports that knee extension strength may be a useful tool in advising patients concerning ambulatory assistance. Further investigations concerning gait assistive device use and patient history of falling would be beneficial in preventing future falls and improving long-term patient outcomes.

The silicone ring tourniquet in orthopaedic operations of the extremities.

Tourniquets provide a bloodless field in limb operations and their introduction in orthopaedic operative technique has been considered as a landmark. A new tourniquet device, a silicone ring tourniquet (SRT) (HemaClear or S-MART, OHK Medical Devices, Haifa, Israel), was introduced into clinical practice a few years ago. A few clinical studies as well as comparative studies in volunteers have reported its use in a relatively small number of cases. The aim of this prospective study is to report the clinical use of this device in a large number of patients, including all possible applications of a tourniquet. The SRT was used in 536 cases including 337 male and 119 female patients with a mean age of 43.7 years (range 6 to 87 years). The average tourniquet time was 58.5 minutes (range 6 to 180 minutes). It was applied in 362 (67.5%) elective and in 174 (32.5%) trauma cases including fractures (n:109, 62.6%) and soft-tissue injuries (n:65, 37.4%). The most frequent application site was the femur (n:255, 47.6%), followed by the forearm (n:154, 28.7%), humerus (n:65, 12.1%), and calf (n:62, 11.6%). Because the device is sterile it was possible to use it in operations in which the pneumatic tourniquet cannot be used, such as open reduction and internal fixation of humeral shaft and femoral supracondylar fractures. In 14 patients (2.6%), the tourniquet failed intraoperatively, and the cause was an unexpected raised blood pressure. The SRT - with a pre-set pressure according to the size and the tension model - is easy to apply. It is sterile, and occupies a narrow area of the limb. Its application combines three functions at the same time: exsanguination, tourniquet, and stockinet application. Although it cannot entirely replace the classic pneumatic tourniquet, it is a safe and useful device in orthopaedic operations because of its advantages.

A national survey of United Kingdom trauma units on the use of pelvic binders.

PURPOSE: Major pelvic injuries resulting from high-energy trauma require emergency hospital treatment, and part of the initial management includes mechanical stabilisation of the pelvis. Controversies include binder position, use in lateral compression injuries and application during radiological assessment. We present the results of a survey of both emergency department and orthopaedic specialties. METHODS: A telephone survey of all 144 trauma units in the UK accepting adult pelvic trauma patients was carried out in July 2012. The duty registrar for the emergency and orthopaedic departments was contacted and asked to complete a questionnaire. RESULTS: A response rate of 100% was achieved. Pelvic binders were available for use in approximately three quarters of the trauma units surveyed. Eight-five emergency department (59%) and 79 orthopaedic (54.9%) registrars had been given training on pelvic binder application. Fifty-six emergency department (38.9%) and 114 orthopaedic (79.1%) registrars identified the level of the greater trochanters as the most suitable position for the binder. Forty-five emergency department (31.3%) and 58 orthopaedic (40.3%) registrars used pelvic binders in suspected lateral compression injuries. One hundred and twenty-six emergency department (87.5%) and 113 orthopaedic (78.5%) registrars would not release the binder during radiological assessment of the pelvis in a haemodynamically stable patient. CONCLUSION: There is great variability in practice amongst trauma units in the UK. Training must be formalised and provided as a mandatory part of departmental induction. The use of standardised treatment algorithms in trauma units and the Advanced Trauma and Life Support (ATLS) framework may help decision making and improve patient survival rates.

Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults.

OBJECTIVE: To investigate the clinimetric properties of the de Morton Mobility Index (DEMMI) in healthy, community-dwelling older adults. DESIGN: Cohort study. SETTING: Retirement village and Returned and Services League (RSL) club in Melbourne, Australia. PARTICIPANTS: All participants were 65 years or older, healthy, and living within the community. The validation study included participants recruited from a retirement village (n=61), and the reliability studies included participants recruited from an RSL club and a subset of participants from the retirement village. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility was assessed using the DEMMI. The percentage of participants who scored the highest and lowest possible score on the DEMMI was calculated to determine whether a floor or ceiling effect occurred. The minimal clinically important difference (MCID) was estimated using a distribution-based method. Reliability was assessed independently and concurrently using the minimal detectable change at 90% confidence (MDC90). RESULTS: Evidence of convergent and discriminant validity was obtained for the DEMMI by examining correlations with measures of related constructs, the Lower Extremity Functional Scale (r=.69) and Quality of Life Scale scores (r=.28), respectively. Participants who ambulated without a gait aid (82.62±10.63) had significantly higher (P<.0) DEMMI scores than those who ambulated with an aid (64.1±12.40), providing evidence of known groups validity. No floor or ceiling effect was identified. The MCID was 7 points. The MDC90 was 13 (95% CI, 8.76-17.05) points on the 100-point scale. CONCLUSION: DEMMI scores in healthy, community-dwelling older adults are both valid and reliable.

Primary care management for isolated limb injury: referral to orthopedic surgery in a trauma center.

INTRODUCTION: Musculoskeletal injuries affect up to 13% of adults annually. Despite this high incidence, quality of primary care, including analgesia, may be sub-optimal. The goal of this study is to describe the quality of primary care for ambulatory patients with isolated limb injury and to identify related factors. METHODS: A cross sectional study was undertaken prospectively on 166 consecutive ambulatory adult patients with isolated limb injury who presented to orthopedics service in a Level one Trauma Centre. Quality of care was assessed by evaluating analgesia, walking aids, immobilization, and quality of referral diagnosis according to actual expert recommendations. RESULTS: This study revealed low quality of primary care for 82 (53.2%) of injured patients. Seventy-three patients (50.3%) had pain level over 5/10 and 45 cases (28.5%) had insufficient/absent analgesia prescriptions. Fifty-one (32.3%) had unacceptable immobilization and 21/59 (35.6%) patients with a lower limb injury did not receive a walking aid prescription. A total of 61 patients (36.7%) had an absent or inadequate referral diagnosis. Factors associated with lower quality depended on the specific quality indicator and included: living further away from the hospital, younger age, initially consulting at another health care center, having a fracture, and being a smoker. CONCLUSION: The high frequency of low quality of care underlines the necessity for orthopedic surgeons to be involved in primary care education. Identifying factors associated with lower quality of care will orient efforts to improve medical care of patients with isolated traumatic injury.

Demographics and trends in wheeled mobility equipment use and accessibility in the community.

This article presents a profile of household-resident U.S. adults using wheeled mobility equipment (WME) in 2005, trends in WME use from 1990 to 2005, and data on accessibility features and problems from 1994-97. Data were obtained from the Survey of Income and Program Participation (SIPP) and the National Health Interview Survey on Disability (NHIS-D). Compared to the general population, WME users are more likely to be older, female, and in poor health. Forty-four percent are working-aged, with twice the rate of poverty of the general population, and only 17% are employed. Mobility difficulty is the most significant predictor of WME use, but gender, race, poverty, and educational attainment are also significant predictors. From 1990-2005, WME use grew 5% per year, while mobility difficulty declined among the elderly and remained steady among working-age persons. This contrast suggests a reduction in unmet need for WME. In 1994-97, more than half of WME users had difficulty entering or exiting their homes, and one-third had accessibility problems outside their homes. Usage of home modification was low, with substantial unmet need. Regular national data collection on the use of WME and other mobility aids, their financing, and accessibility issues is warranted.

Assistive walking devices in nonambulant patients undergoing rehabilitation after stroke: the effects on functional mobility, walking impairments, and patients' opinion.

OBJECTIVE: To assess the immediate effects of assistive walking devices on functional mobility, walking impairments, and patients' opinions in nonambulant patients after stroke. DESIGN: Randomized crossover trial. SETTING: Inpatient rehabilitation units of 3 United Kingdom hospitals. PARTICIPANTS: Twenty nonambulant patients with stroke undergoing rehabilitation to restore walking. INTERVENTIONS: Five walking conditions: (1) Walking with no device (the control condition), (2) walking with a walking cane, (3) ankle foot orthosis, (4) slider shoe, and (5) a combination of all 3 devices. MAIN OUTCOME MEASURES: Functional mobility (functional ambulation categories), walking impairments (speed, step length of the weak leg), and patients' opinions. RESULTS: Functional mobility improved with all assistive devices (P<.0001-.005; effect sizes 1.68-0.52; number needed to treat=2-5). Walking impairments were unchanged (P<.800-.988). Participants were generally positive about the devices. They felt their walking, confidence, and safety improved and found the appearance and comfort of the devices acceptable. They would rather walk with the devices than delay walking until a normative gait pattern was achieved without them. CONCLUSIONS: Assistive walking devices improved functional mobility in nonambulant rehabilitation patients with stroke. No changes in walking impairments were found. Participants were generally positive about using the devices. The results support the use of assistive walking devices to enable early mobilization after stroke; 2 patients would need to be treated with a cane or combined devices for 1 to improve functional mobility.

Orthostatic hypotension following spinal cord injury: impact on the use of standing apparatus.

INTRODUCTION: Upright posture confers numerous medical and social benefits to a spinal cord injured (SCI) patient. Doing so is limited by symptoms of orthostatic hypotension. This is a common secondary impairment among tetraplegic sufferers. OBJECTIVE: Establish the proportion of SCI patients who are restricted from using standing apparatus, such as standing frames and standing wheelchairs, because of inducing symptomatic orthostatic hypotension or the fear of developing these disabling symptoms. STUDY DESIGN: Survey conducted by Internet-accessible electronic questionnaire. Questionnaire validated for reliability and accuracy. RESULTS: 293 respondents. Mean age 44.6; 76% male. Median time from injury: 7 years. 38% suffered with orthostatic hypotension; majority were complete injuries and all (except one - T12) were T5 or above level. 52% replied that they were using standing wheelchairs or frames. Of these, 59 (20% of total) stated that orthostatic hypotension symptoms were limiting the use of their upright apparatus. Of those who did not use standing wheelchairs or frames, 16 (5.5% of total) reported that this was because of the fear of worsening their orthostatic hypotension. CONCLUSION: Orthostatic hypotension restricts standing apparatus use in a large proportion (a total of 25.5% of respondents in this survey) of SCI patients.

Client-centred home modifications improve daily activity performance of older adults.

BACKGROUND: Remaining at home is a high priority for many older adults, but the capacity to "age in place" often is threatened by environmental barriers. PURPOSE: To describe a client-centred occupational therapy home modification intervention program and examine the impact of the intervention on daily activity performance over time. METHODS: Using a competence-environmental press framework, a client-centred home modification program for older adults was implemented. In this quasiexperimental, single group prospective study, participants'subjective ratings of daily activity performance were evaluated before and after the intervention (baseline/post/post). FINDINGS: After home modification, participants'perception of their daily activity performance at home improved significantly and was maintained 2 years post-modification. IMPLICATIONS: Home modification may benefit older adults attempting to age in place.

Exploring potential prejudice toward older adult mobility device users.

Many older adults require assistive technology to maintain mobility (e.g., canes, walkers, wheelchairs, or scooters), but concerns about experiencing prejudice because of mobility devices can deter use. We explore this potential prejudice in a sample recruited through online crowdsourcing. Overall, prejudice toward older adult mobility device users was not observed. Older adult mobility device users were evaluated more positively than common prejudice target groups. However, heightened prejudice toward older adult mobility device users was observed among those higher in authoritarianism or social dominance orientation. This was explained by perceptions that older adult mobility device users are a greater threat to resources (e.g., health care spending, time, attention) among those higher in these qualities. This pattern was present at all ages assessed but was stronger for those who were younger versus older. Relationships between ideology and heightened threat from older adult mobility device users were not present for those older than 60 years of age. Our results demonstrate that concerns about this prejudice are not completely unwarranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors.

Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.

National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence.

BACKGROUND: Guidelines for the treatment of lower limb osteoarthritis (LLOA) include non-pharmacological (NPM) and pharmacological modalities (PM). In France, general practitioners (GPs) are the main prescribers of pharmacological treatment for LLOA but little is known about the non-pharmacological modalities they usually prescribe. OBJECTIVE: To determine how French GPs prescribe non-pharmacological modalities of LLOA treatment in daily practice. METHODS: A four-point questionnaire (systematically, frequently, rarely, never) was built to assess the French GPs' opinion regarding the NPM of LLOA treatment (10 questions). The questionnaire was given between April and June 2005 to 3000 GPs, all over the French regions. The percentage reported in this abstract are those of the systematic and frequent responses. RESULTS: 59.2% of the questionnaires (n=1775) could be retrieved. Weight reduction recommendations (76%), joint sparing (71.7%), physical activity development (61.7%), rehabilitation (57.8%), self-exercise (46%) were the more frequently prescribed NPM. Sticks (36%), insoles (35.6%), bed relief (25.4%) and knee bracing (10.5%) were far less regularly proposed. However weight reduction and physical activity development appeared to be the patients less-well observed NPM. The main means used to improve the efficacy of the diet were the support of a nutritionist (74.5%) and the support of the GPs (70.7%) far beyond the support group and familial intervention (both 36,6%). The large majority of GPs considered that a good physical activity was essential (51.7%) or useful (43.3%) to the success of the weight reduction programme. The main recommended physical activities were walking (84.3%), swimming (74.3%), cycling (47%) and water-gymnastics (40.4%). To improve the success of the physical activity development, analgesics were recommended by 93% of GPs, settling up through rehabilitation by 57.4%, support through GPs appointments by 50%. Lastly, 68.4% of GPs recommended a systematic analgesic consumption, since a non-steroidal anti-infammatory drug (NSAID) prescription was proposed by only 30.5%, and NSAID treatment before or after physical activities by 19% and 9.3% respectively. CONCLUSION: This large survey shows that non-pharmacological modalities are frequently prescribed by French GPs in the treatment of LLOA, in addition to analgesic therapy. However, most GPs consider that some of them are difficult to follow in the long term.

Services, systems, and policies affecting mobility device users' community mobility: A scoping review: Services, systèmes et politiques influençant la mobilité dans la communauté des utilisateurs d'aides à la mobilité : examen de la portée.

BACKGROUND: Opportunities to travel from one place to another in the community, or community mobility, are especially important for mobility device users' ability to participate fully in society. However, contextual challenges to such mobility exist. PURPOSE: This study summarizes the literature on existing community mobility barriers and facilitators of mobility device users created by services, systems, and policies as defined by the International Classification of Functioning, Disability, and Health (ICF). METHOD: Arksey and O'Malley's approach for scoping studies was used for the review. The extraction chart was organized following the ICF, and frequency counts were used to report the data. FINDINGS: The findings suggest that certain factors, such as transportation, open-space planning, and architecture and construction, influence community mobility opportunities. However, little attention has been paid to services, systems, and policies in the research literature, limiting the knowledge on the subject. IMPLICATIONS: Further research is needed to examine the relationship between specific services, systems, and policies and mobility device users' mobility within their communities.