Exploring stroke survivors' and physiotherapists' perspectives of the potential for markerless motion capture technology in community rehabilitation.

INTRODUCTION: Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery. Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation. AIMS: This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context. METHODS: Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis. RESULTS: Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback. CONCLUSIONS: Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs.

The national profile of the prosthetic and orthotic workforce in the UK: Sociodemographics and employment characteristics.

BACKGROUND: Prosthetists and orthotists (POs) are essential members of the health care workforce and one of the United Kingdom's (UK's) allied health professions. There is a paucity of information on their demographics, which is essential for the development of the profession. To fill this void, this study has attempted to comprehensively explore the sociodemographics and work-related characteristics of the entire workforce. METHODS: Data were collected in 2022 through multiple sources, including surveys of POs, private companies employing POs, and freedom of information requests to National Health Service Trusts/Health Boards and higher education institutes offering programs leading to registration as a prosthetist/orthotist. RESULTS: The workforce survey had 641 respondents (74% response rate). The estimated national ratio of POs per million population was 13, with all bar of the 12 regions below the World Health Organization minimum recommendation of 15 POs per million population. Most of the survey respondents were female (47.6%) and younger than male respondents, were British (75.8%), and in the White ethnic group (74.3%). Most of them were employed by private companies (59.9% vs. 31.4% employed by the National Health Service) and had clinical duties (94%), permanent contracts (90%), worked full-time (75%), and treated a wide range of clinical conditions. CONCLUSIONS: The national UK prosthetist and orthotist ratio falls below the recommended international standards. The versatility and broad skill set of POs highlight their crucial role in multidisciplinary teams. Establishing a centralized prosthetist and orthotist workforce database system is recommended for data-driven strategic planning.

The UK prosthetic and orthotic workforce: current status and implications for the future.

BACKGROUND: Prosthetists and orthotists (POs) are the smallest of the 14 allied health profession (AHP) workforces within NHS England. Obtaining data on the workforce has always been challenging due to this information being held across different organisations. An understanding of the prosthetic and orthotic (P&O) workforce is essential to ensure that it is adequately equipped to meet the evolving needs of users of P&O services. The study aims to estimate the size and composition, for the first time, of the UK P&O workforce and P&O service provision. METHODS: To gather the required information, two surveys (one for the UK P&O workforce and one for UK P&O private company) and two freedom of information (FOI) requests [one for all NHS Trusts and Health Boards (HB) in the UK and one for the higher education institutes in the UK offering programmes leading to registration as a PO were developed and distributed from September to December 2022. RESULTS: The P&O workforce survey received a 74% response rate (863 POs) and 25 private companies reported employing one or more P&O staffing groups. From the FOI requests, 181 of a potential 194 Trusts/Health Boards and all four higher education institutions responded. The study indicated a total of 1766 people in the UK P&O workforce, with orthotists and orthotic technicians representing the largest percentage of the workforce at 32% and 30%, respectively. A greater percentage of prosthetists (65%) and orthotists (57%) were employed by private companies compared to the NHS. Only 34% of POs stated that they "definitely" planned to remain in the workforce for the next 5 years. The current UK PO employment levels are 142 to 477 short of the World Health Organisation's (WHO) recommendation. CONCLUSIONS: The low job satisfaction amongst many POs and the projected increase in the number of people who will require prosthetic and/or orthotic care in the UK are challenges for future UK P&O services. Strategies are required to create a sustainable and resilient workforce that can meet the needs of a changing healthcare landscape.

Effectiveness of conservative non-pharmacological interventions in people with muscular dystrophies: a systematic review and meta-analysis.

INTRODUCTION: Management of muscular dystrophies (MD) relies on conservative non-pharmacological treatments, but evidence of their effectiveness is limited and inconclusive. OBJECTIVE: To investigate the effectiveness of conservative non-pharmacological interventions for MD physical management. METHODS: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, CINHAL, Embase, AMED and Cochrane Central Register of Controlled Trial (inception to August 2022). Effect size (ES) and 95% Confidence Interval (CI) quantified treatment effect. RESULTS: Of 31,285 identified articles, 39 studies (957 participants), mostly at high risk of bias, were included. For children with Duchenne muscular dystrophy (DMD), trunk-oriented strength exercises and usual care were more effective than usual care alone in improving distal upper-limb function, sitting and dynamic reaching balance (ES range: 0.87 to 2.29). For adults with Facioscapulohumeral dystrophy (FSHD), vibratory proprioceptive assistance and neuromuscular electrical stimulation respectively improved maximum voluntary isometric contraction and reduced pain intensity (ES range: 1.58 to 2.33). For adults with FSHD, Limb-girdle muscular dystrophy (LGMD) and Becker muscular dystrophy (BMD), strength-training improved dynamic balance (sit-to-stand ability) and self-perceived physical condition (ES range: 0.83 to 1.00). A multicomponent programme improved perceived exertion rate and gait in adults with Myotonic dystrophy type 1 (DM1) (ES range: 0.92 to 3.83). CONCLUSIONS: Low-quality evidence suggests that strength training, with or without other exercise interventions, may improve perceived exertion, distal upper limb function, static and dynamic balance, gait and well-being in MD. Although more robust and larger studies are needed, current evidence supports the inclusion of strength training in MD treatment, as it was found to be safe.

Convergent Validity of the Timed Walking Tests with Functional Ambulatory Category in Subacute Stroke.

Determining the walking ability of post-stroke patients is crucial for the design of rehabilitation programs and the correct functional information to give to patients and their caregivers at their return home after a neurorehabilitation program. We aimed to assess the convergent validity of three different walking tests: the Functional Ambulation Category (FAC) test, the 10-m walking test (10MeWT) and the 6-minute walking test (6MWT). Eighty walking participants with stroke (34 F, age 64.54 ± 13.02 years) were classified according to the FAC score. Gait speed evaluation was performed with 10MeWT and 6MWT. The cut-off values for FAC and walking tests were calculated using a receiver-operating characteristic (ROC) curve. Area under the curve (AUC) and Youden's index were used to find the cut-off value. Statistical differences were found in all FAC subgroups with respect to walking speed on short and long distances, and in the Rivermead Mobility Index and Barthel Index. Mid-level precision (AUC > 0.7; p < 0.05) was detected in the walking speed with respect to FAC score (III vs. IV and IV vs. V). The confusion matrix and the accuracy analysis showed that the most sensitive test was the 10MeWT, with cut-off values of 0.59 m/s and 1.02 m/s. Walking speed cut-offs of 0.59 and 1.02 m/s were assessed with the 10MeWT and can be used in FAC classification in patients with subacute stroke between the subgroups able to walk with supervision and independently on uniform and non-uniform surfaces. Moreover, the overlapping walking speed registered with the two tests, the 10MeWT showed a better accuracy to drive FAC classification.

Incidence and risk factors for patellofemoral dislocation in adults with Charcot-Marie-Tooth disease: An observational study.

BACKGROUND AND PURPOSE: Patellofemoral (PF) dislocation is frequently encountered in clinical practice among people with Charcot-Marie-Tooth disease (CMT), but the frequency and risk factors for PF dislocation in adults with CMT are unknown. This study aimed to establish the incidence of PF dislocation in adults with CMT and to explore the risk factors associated with PF dislocation. METHODS: This is a cross-sectional study involving adults with a diagnosis of CMT, attending their outpatient clinics at a specialist neuromuscular centre in the United Kingdom. Eighty-one individuals were interviewed about any PF dislocation and underwent a lower-limb assessment, with a focussed knee examination, to identify possible risk factors for PF dislocation. The incidence of PF dislocation was expressed as a percentage (number of individuals with a positive history of patellar dislocation/overall sample) and the association between different risk factors and PF dislocation was explored using logistic regression analysis. RESULTS: The incidence of PF dislocation was 22.2% (18/81). PF dislocation was associated with a younger age at the time of the assessment (p = 0.038) and earlier disease onset (p = 0.025). All people bar two who dislocated had CMT1A (88.9%), but there was no difference in terms of CMT distribution with the non-dislocation group (p = 0.101). No association was found between PF dislocation and CMT severity measured by CMTSS (p = 0.379) and CMTES (p = 0.534). Patella alta (p = 0.0001), J-sign (p = 0.004), lateral patellar glide (p = 0.0001), generalised joint hypermobility (p = 0.001) and knee flexors weakness (p = 0.008) were associated with an increased risk of dislocation. Patella alta (p = 0.010) and lateral patellar glide (p = 0.028) were independent PF dislocation predictors. CONCLUSIONS: PF dislocation was common in this cohort with CMT and was associated with multiple risk factors. Future studies should be conducted to confirm the present findings so that the identified risk factors may be addressed by clinicians through preventive, supportive and corrective measures.

Do UK Allied Health Professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations?

OBJECTIVES: The COVID-19 pandemic caused a rapid shift to remote consultations. United Kingdom (UK) NHS Allied Health Professional (AHP) services may have been unprepared for telehealth implementation. This study explored these services' organisational readiness regarding telehealth guidelines implementation and staff training. METHODS: A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK AHPs and AHP service managers between May and June 2021. RESULTS: 658 participants answered the survey (119 managers and 539 clinicians). Most services, in which telehealth was in place, had implemented telehealth guidelines (clinicians, 64%; managers, 82%), with most guidelines produced by the NHS staff who use them for their consultations. Most clinicians reported that guidelines had ambiguous areas (e.g., regarding protection from litigation and dealing with emergencies), whereas most managers reported the opposite opinion. Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients, while recommended consultation length and how to conduct telehealth with certain population groups were least reported. Clinicians lacked training in most telehealth aspects, while managers reported that staff training focused on telehealth software and hardware. For both clinicians and managers, training is needed on how to deal with emergencies during telehealth. CONCLUSIONS: UK NHS AHP services are not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities and hinder the success of the NHS digital transformation. The absence of national guidelines highlights the need for uniform AHP telehealth guidelines.

Exploring the Potential of Immersive Virtual Reality in the Treatment of Unilateral Spatial Neglect Due to Stroke: A Comprehensive Systematic Review.

The present review aims to explore the use of Immersive Virtual Reality (IVR) in the treatment of visual perception in Unilateral Spatial Neglect (USN) after a stroke. PubMed, Scopus, Embase and Pedro databases were searched, from inception to 1 February 2022. All studies that investigated the effect of IVR on USN, such as outcome in the stroke population, have been included. The current comprehensive systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database [CRD42022311284]. Methodological quality was assessed through JBI critical appraisal tool. A total of 436 articles were identified through the database searches. A total of 10 articles, with a heterogeneous study design, which involved 77 patients with USN with low-to-moderate methodological quality, have been selected. Five out the included studies tested usability of IVR for assessed or treated visual perception deficits in USN, comparing the results with 134 healthy subjects. In the rest of studies that tested IVR such as treatment, three showed statistical positive results (p < 0.05) in visual perception outcome. To date, the literature has suggested the potential benefits in the use of IVR for the treatment of visual perception disorders in USN. Interestingly, IVR motivates patients during the rehabilitation process improving compliance and interest. The heterogeneity in the studies' design and in IVR treatments indicate the need of future investigations in the consideration of potentiality and low-cost of this technology.

The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment.

BACKGROUND: The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. METHODS: Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May - June 2021. RESULTS: 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient's ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. CONCLUSIONS: The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment.

The Effects of Sternocleidomastoid Muscle Taping on Postural Control in Healthy Young Adults: A Pilot Crossover Study.

BACKGROUND: Postural control is a complex ability, also controlled by the somatosensory connection of the neck muscles with the vestibular nuclei. This circuit seems to be interested in maintaining head stabilization during movements. The sternocleidomastoid (SCM) muscle is the dominant source of the vestibular afferents as confirmed by neurophysiological acquisition. The aim of this study is to evaluate whether the application of kinesio-tape on the SCM muscle can induce a perturbation of the standing postural control by altering the somatosensory system of the neck muscles. METHODS: Thirteen healthy participants (age: 24.46 ± 3.04 yrs; 9 female) were enrolled, and the four kinesio-tape (KT) conditions were performed in a random order: without KT application (Ctrl); right KT application (R-SCM); left KT application (L-SCM); and bilateral KT application (B-SCM). All conditions were performed three times with open eyes and closed eyes. RESULTS: There was a significant increase in the length of the centre of pressure (CoP), in the maximal oscillation, and in the anteroposterior root mean square between the three tape application conditions with respect to the Ctrl condition with open eyes. The same parameters were statistically different when the participants were blindfolded in the B-SCM condition with respect to the Ctrl condition. A statistical decrease in the difference in weight distribution between the two feet was observed in the B-SCM group with respect to the Ctrl group in both open and closed eyes conditions. CONCLUSIONS: Our results suggest that KT on the SCM muscles may involve some space-time parameters of postural control. Bilateral KT improved the weight distribution between the feet but showed a parallel increase in anteroposterior oscillations and in the length of the CoP with respect to the Ctrl condition. The perturbation seems to be greater in the somatosensory system when it is working coupled with visual afferences during an upright position.

Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies' guidance.

OBJECTIVES: The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies' guidelines. DESIGN: Scoping review following Aksey and O' Malley methodological framework. DATA SOURCES: CINHAL and MEDLINE were searched from inception to March 2021 using terms related to 'telehealth', 'guidelines' and 'AHPs'. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. STUDY SELECTION: Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review. DATA EXTRACTION: One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. RESULTS: 2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family's and caregiver's roles and the costs. There was lack of clarity on the AHPs' registration requirements, costs and coverage, and legal aspects. CONCLUSION: This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world's leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.

Effect of dual-task training on balance in patients with multiple sclerosis: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effects of dual-task training on static and dynamic balance in patients with multiple sclerosis. DATA SOURCES: PubMed/MEDLINE, EMBASE, Scopus, and PEDro databases were searched from inception to March 1, 2021. METHODS: This study was conducted in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers assessed studies for inclusion and extracted data. We used the Physiotherapy Evidence Database scale to evaluate the methodological quality and the risk-of-bias. Randomized clinical trial data were pooled for the meta-analysis. The effect sizes and 95% confidence interval (CI) were calculated by random-effect models. Egger regression and Begg-Mazumdar rank correlation test were used for publication bias. RESULTS: A total of 13 studies involving 584 patients (42.3 ± 9 years mean ± SD; 377 females) met the inclusion criteria for the systematic review, while nine were included in the meta-analysis. People who received dual-task training interventions showed significant improvements in the Timed Up & Go test 0.44 [(95% CI = 0.22; 0.65), P-value<0.001], and in the Berg Balance scale 0.46 [(95% CI = 0.07; 0.85), P-value = 0.02]. Low and moderate heterogeneity between the studies was found for the Timed Up & Go test and the Berg Balance scale, respectively. CONCLUSION: The findings from the current meta-analysis support dual-task training as a beneficial therapy for improving dynamic balance and functional mobility in patients with multiple sclerosis. The limited number of studies that investigated static balance performance after dual-task training do not currently allow us to draw a conclusion about any possible improvements in this ability.