The Efficacy of Trunk Bracing With an Instrumented Corrective Exercise on Spinal Deformity, Pulmonary Function, Trunk Muscle Endurance, and Quality of Life in Adolescent Idiopathic Scoliosis: Protocol for a Parallel Groups Clinical Study.

BACKGROUND: Adolescent idiopathic scoliosis is a 3D spine distortion with an unidentified etiology. It results in noticeable trunk deformity, decreased muscle strength and endurance at the trunk, changes in chest volume, breathing issues, and ultimately a decline in the quality of life. Trunk bracing and corrective exercises make up most of the treatment of patients with scoliosis when their deformity is between 20° and 45°, and they have not yet attained skeletal maturity. Evidence suggests that spinal deformity in people with scoliosis may result from improper motor control. Automatic response training is an exercise therapy technique that can modify the pattern of trunk muscle control for supporting the spinal column in normal alignment. An apparatus called a cantilever device is required for this type of exercise, which facilitates training at home. In spite of research showing the benefit of braces and therapeutic exercise in adolescents with scoliosis, less emphasis has been given to the impact of home-based training, especially when this intervention is paired with braces. OBJECTIVE: We aim to compare the efficacy of bracing and a conventional exercise program to a combination treatment that includes trunk bracing and exercises with a cantilever device performed at home on the degree of spine curvature, pulmonary function, trunk muscular endurance, and quality of life. METHODS: This study was a 2-arms parallel-group clinical study. A total of 16 adolescents with idiopathic scoliosis and single lumbar and thoracolumbar curves of 20°-45° were recruited and randomly assigned into 2 groups. Group A received a combination of trunk bracing and exercise using an instrument known as a "cantilever." Group B (controls) received trunk bracing and a conventional exercise program (without a tool). The study outcomes were the Cobb angle of the scoliotic curve, pulmonary function, the endurance of the trunk muscles, and quality of life. The study outcomes were measured at 2 time points: before the intervention (T1) and 12 weeks following the start of the intervention (T2; at this time, the intervention period has been completed). Multivariate analysis of variance was used to test between- and within-group differences. RESULTS: Recruitment for this study began in fall 2022 and is expected to be completed by the end of summer 2023. CONCLUSIONS: We studied the efficacy of a combined trunk bracing program and postural response exercises using a cantilever device in treating adolescent idiopathic scoliosis and compared it with trunk bracing and conventional home exercises. Exercises performed at home using a cantilever device are anticipated to raise the endurance of trunk muscles, which will help reduce trunk deformity, enhance pulmonary function, and improve the quality of life of participants. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20220330054371N1; https://www.irct.ir/trial/62811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43265.

Cross-Cultural Adaptation and Validation of the Bad Sobernheim Stress Questionnaire in Iranian Adolescents with Idiopathic Scoliosis Using Thoracolumbar Orthoses.

Background: The assessment of the emotional consequences of having a spinal deformity and orthotic management in people with idiopathic scoliosis is essential. This study was aimed to translate and culturally adapt the Bad Sobernheim Stress questionnaire (BSSQ-Brace) for Iranian adolescents with idiopathic scoliosis using thoracolumbar orthoses. Materials and Methods: The BSSQ was translated into Persian according to a standard guideline. The Persian BSSQ-Brace was completed by 55 Iranian subjects with spinal deformities who agreed to participate in this research. The validity was determined by correlating the Persian BSSQ-Brace questionnaire (BrQ) and the revised Scoliosis Research Society-22 patient questionnaire (SRS-22r). To assess test-retest reliability, all participants completed the BSSQ-Brace twice, with a gap of 1-week. Intraclass Correlation Coefficient and Cronbach's alpha were measured to report reliability. Results: All population revealed items in the Persian BSSQ-Brace were easily understood, and there was no difficulty completing them. The psychometric properties of the Persian version of BSSQ-Brace demonstrated excellent test-retest reliability (interclass correlation coefficient = 0.94), excellent internal consistency (Chronbach's alpha = 0.94), and high construct validity with SRS-22r (r = 0.74). Conclusions: The Persian BSSQ-Brace is a reliable and valid instrument to assess the emotional domains in subjects wearing a spinal orthosis.

The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial.

BACKGROUND: Pregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP. OBJECTIVE: This study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP. METHODS: This study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences. RESULTS: Recruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022. CONCLUSIONS: This study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40553.

A comparison of the efficacy of textured insoles on balance performance in older people with versus without plantar callosities.

BACKGROUND: Textured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied. RESEARCH QUESTION: Firstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group. METHODS: Thirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions. RESULTS: Older people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples' feet. The insole-callosity interaction was not significant for any study outcome. SIGNIFICANCE: Textured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility.

A comparison of the effectiveness of three types of trunk orthoses on the balance performance of older people with osteoporotic hyperkyphosis: A cross-over study.

BACKGROUND: Orthotic immobilization is an early treatment for osteoporotic vertebral fracture at the hyperkyphotic thoracic spine. OBJECTIVE: This exploratory study compared the immediate impact of three types of trunk orthoses on the balance parameters of older people with osteoporosis hyperkyphosis. METHODS: Twenty older people (aged 60-65 years) with osteoporosis kyphosis and a history of falls participated in a pilot cross-over study. Four randomized comparisons were carried out, including either soft, semi-rigid, and rigid trunk orthoses worn on the participants compared to "no orthosis" as the control condition. Kyphosis angle, Forward Reach Test, Timed Up and Go test, and postural stability during standing on a force plate were recorded and compared between study conditions using one-way repeated measures analysis of variance test. RESULTS: All orthoses significantly reduced the kyphosis angle (p < 0.01). None of the orthoses has a significant change in the Timed Up and Go test (p > 0.01). Rigid orthosis significantly reduced the forward reach compared to "no orthosis" (p = 0.003, 95% CI: 1.08-6.3 cm). None of the orthosis induced a significant change in postural sway velocity in anteroposterior and mediolateral directions compared to the control condition (p > 0.01). CONCLUSION: These findings suggest that using rigid orthosis in older people with osteoporosis hyperkyphosis reduces the balance performance.

The Patient-Rated Tennis Elbow Evaluation Questionnaire was successfully translated to Persian.

INTRODUCTION: The Patient-Rated Tennis Elbow Evaluation (PRTEE) is designed to evaluate pain and disability in subjects with lateral elbow tendinopathy. This questionnaire is available in Swedish, Italian, and some other languages. A Persian language version of the questionnaire is needed for both research and clinical purposes. PURPOSE OF THE STUDY: The purpose of this study was to translate and cross-culturally adapt the PRTEE questionnaire into the Persian language and to determine its validity and reliability. METHODS: The PRTEE was translated and culturally adapted from English into Persian (PRTEE-P) according to the established guidelines. The PRTEE-P was completed by 68 Iranian subjects (44 women, 24 men) diagnosed with chronic lateral elbow tendinopathy. To assess test-retest reliability, all subjects filled out the PRTEE-P on a second admission within one week. The intraclass correlation coefficient (ICC) and Cronbach's alpha were measured to report reliability. The validity was determined by correlating the PRTEE-P questionnaire with the Persian version of the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS: The Persian version of the PRTEE showed a high internal consistency with a Cronbach's alpha of 0.99, demonstrating good test-retest reliability (ICC = 0.99). It was well correlated with Disabilities of the Arm, Shoulder, and Hand (r = 0.80). CONCLUSION: The PRTEE-P is a reliable and valid tool designed for measuring pain and disability in subjects with lateral elbow tendinopathy.

Effect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study.

BACKGROUND: The lower limb spasticity after stroke can affect the balance and gait of patients with stroke. OBJECTIVE: The aim of this study is to assess the effects of ankle plantar flexor spasticity level on balance in patients with stroke. METHODS: Patients with stroke were recruited from neurology and physiotherapy clinics in Tehran, Iran. Based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS), the eligible patients with stroke were divided into 2 groups: high spasticity (MMAS score≥2) and low spasticity (MMAS score<2). The primary outcome measures were the MMAS scores, Activities-Specific Balance Confidence questionnaire scores, eyes-open and eyes-closed posturography measures, and Timed Up and Go test results. The secondary outcome measures were the ankle passive range of motion and ankle joint proprioception. The t test, mixed model univariate analysis of variance, and Spearman rank correlation were used for statistical analysis. RESULTS: Data collection and statistical analysis are complete. The interpretation of results is underway. We expect the results to be published in winter 2020. CONCLUSIONS: We believe that patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction, which will worsen with impaired proprioception, passive range of motion, and eyes closed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/16045.

The immediate effects of pelvic compression belt with a textured sacral pad on the sacroiliac function in pregnant women with lumbopelvic pain: A cross-over study.

BACKGROUND: Pelvic belt is being used to alleviate the symptoms of lumbopelvic pain. OBJECTIVE: To investigate the immediate effects of a pelvic belt with a textured sacral pad in pregnant women with lumbopelvic pain. METHODS: Twenty-eight pregnant women participated in a randomized crossover study. Hip joint position sense, maximum hip flexion force, and perceived effort during the active straight leg raising test were measured in twenty-eight pregnant women with lumbopelvic pain. Outcomes were measured in three randomized conditions including no pelvic belt (control), with a pelvic belt, and while a sacral pad was used with the pelvic belt. Data were analyzed using a one-way repeated measures analysis of variance for each variable. RESULTS: Improvements in all study outcomes have been shown with a pelvic belt compared with the control condition. The addition of a textured sacral pad to the pelvic belt improved all study outcomes compared with the pelvic belt: hip joint position sense (p < 0.001; 95% confidence interval:1.3to2.3), perceived effort (p = 0.003; 95% confidence interval: 0.35 to 1.86), and maximum flexion force (p < 0.001; 95% confidence interval:2.77to6.47) in the active straight leg raising. CONCLUSION: Further improvements were noted with the addition of the textured pad for all outcome measures. This finding may inform new benefits in adding a textured sacral pad to pelvic compression belts.

The Effect of Total Body Resistance Exercise on Mobility, Proprioception, and Muscle Strength of the Knee in People With Multiple Sclerosis.

CONTEXT: Muscle weakness and sensory deficits cause impaired balance and walking abilities that are prerequisites for independent activity of daily living in people with multiple sclerosis (MS). Recent physical exercises tailored to improve the activity of daily living people with MS have focused on the functional training. OBJECTIVE: To investigate the effect of total body resistance exercise suspension training on mobility, proprioception, and muscle strength of the knee in people with MS. DESIGN: Single-blind pretest and posttest control group design. SETTING: Referral Center of Multiple Sclerosis Society. PARTICIPANTS: Thirty-four women with relapsing-remitting MS were participated in this study. The mean (SD) of their age was 36.44 (4.88) years, and the Expanded Disability Status Scale was 2.35 (0.94). The participants were divided into 2 groups: control group (n = 15) and training group (n = 19). INTERVENTION: The training group performed the total body resistance exercise program for 8 weeks, 3 sessions per week. The control group received their usual care and daily activities. Outcomes were measured presessions and postsessions. MAIN OUTCOME MEASURES: Mobility was assessed with Timed Up and Go test, 10-m walk maximum test, 2 minute walk test, and 5-time sit-to-stand test. Knee proprioception absolute error and isometric strength of knee flexor and extensor muscles were measured by using a biodex isokinetic dynamometer. RESULTS: In the training group, mobility (P = .001), maximal voluntary isometric contraction of knee flexor and extensor muscles in both legs (P > .05), and the knee proprioception absolute error in nondominant leg at 60° knee flexion (P = .02) improved significantly compared with the control group. CONCLUSION: Total body resistance exercise is a functional and safe intervention that can improve the mobility and muscles strength of the knee in a short period in people with MS.

The immediate sensorimotor effects of elbow orthoses in patients with lateral elbow tendinopathy: a prospective crossover study.

BACKGROUND: Counterforce orthoses are used to manage lateral elbow tendinopathy, and their effectiveness in improving motor function has been documented. Little is known about the impact of bracing on sensory function. The objective of this study was to investigate the immediate effectiveness of 2 counterforce orthoses in improving the sensorimotor abilities of the hand in patients with lateral elbow tendinopathy. METHODS: In this crossover, randomized controlled trial, elbow proprioception, pain severity, pain-free grip strength, and finger dexterity were measured in 50 participants with a diagnosis of lateral elbow tendinopathy. Outcomes were measured in 3 randomized conditions (no brace, forearm band, or elbow sleeve). Data were analyzed using 1-way repeated-measures analysis of variance for each outcome measure. RESULTS: Better scores were observed with the forearm band, as compared with no orthosis, for multiple outcomes including joint position reproduction score at 70° of elbow flexion (P = .006), pain (P < .001), grip strength (P = .01), and dexterity (P < .001). The elbow sleeve yielded better scores than no orthosis for the following outcomes: joint position reproduction score at 110° (P < .001), pain (P < .001), and grip strength (P = .012). No statistically significant difference was found between the orthoses' effects on pain reduction and grip strength (P > .05). The forearm band showed better scores on joint position reproduction at 70° compared with the elbow sleeve (P = .006), whereas the elbow sleeve showed better scores at 110° (P < .001). CONCLUSION: Our results support the mechanisms occurring with the use of either of the described orthotic interventions. Future randomized trials with longer-term outcomes that include sensorimotor mechanisms might enhance our understanding of the comparative effectiveness.

Prevalence of pathological flatfoot in school-age children.

BACKGROUND: Prevalence of pathological flatfoot has not been well defined in the literature. The objective of this study was to establish the prevalence of pathological flatfoot in school-age children and investigate the factors associated with this deformity. METHODS: A total of 667 children (327 girls and 340 boys) were recruited for this cross-sectional study with multi-stage clustered random sampling. The diagnosis of flatfoot was based on clinical observations and measurements using a suggested systematic protocol. Pathological flatfoot in this study did not merely screen for structural flatfoot, it included symptomatic conditions as well as musculoskeletal risk factors predisposing a progressive flatfoot in children. RESULTS: Prevalence of pathological flatfoot was 10.3% in children aged 7-14 years, but this prevalence decreased with age. There was no difference in prevalence of pathological flatfoot between the genders. Children with high BMI were more likely to have pathological flatfoot. Heel valgus (r=0.1; p=0.01) and dorsiflexion range (r=0.14; p<0.001) were both significantly associated with the presence of pathological flatfoot in children; but with only small correlations. CONCLUSIONS: Pathological flatfoot was a prevalent condition in school-age children in Iran. Forty six percent of the flatfeet observed in school-age children were classified as pathological.

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review.

BACKGROUND: Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. OBJECTIVE: This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? STUDY DESIGN: Scoping review. METHODS: A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. RESULTS: Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. CONCLUSION: Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

OBJECTIVES: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" MATERIALS AND METHODS: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. RESULTS: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. DISCUSSION AND CONCLUSION: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

Somatosensory impairment and its association with balance limitation in people with multiple sclerosis.

BACKGROUND: Somatosensory impairments are common in multiple sclerosis. However, little data are available to characterize the nature and frequency of these problems in people with multiple sclerosis. OBJECTIVE: To investigate the frequency of somatosensory impairments and identify any association with balance limitations in people with multiple sclerosis. METHODS: The design was a prospective cross-sectional study, involving 82 people with multiple sclerosis and 30 healthy controls. Tactile and proprioceptive sensory acuity were measured using the Rivermead Assessment of Somatosensory Performance. Vibration duration was assessed using a tuning fork. Duration for the Timed Up and Go Test and reaching distance of the Functional Reach Test were measured to assess balance limitations. The normative range of sensory modalities was defined using cut-off points in the healthy participants. The multivariate linear regression was used to identify the significant predictors of balance in people with multiple sclerosis. RESULTS: Proprioceptive impairments (66.7%) were more common than tactile (60.8%) and vibration impairments (44.9%). Somatosensory impairments were more frequent in the lower limb (78.2%) than the upper limb (64.1%). All sensory modalities were significantly associated with the Timed Up and Go and Functional Reach tests (p<0.05). The Timed Up and Go test was independently predicted by the severity of the neurological lesion, Body Mass Index, ataxia, and tactile sensation (R2=0.58), whereas the Functional Reach test was predicted by the severity of the neurological lesion, lower limb strength, and vibration sense (R2=0.49). CONCLUSIONS: Somatosensory impairments are very common in people with multiple sclerosis. These impairments are independent predictors of balance limitation.

Flatfoot in school-age children: prevalence and associated factors.

BACKGROUND: Flatfoot has been shown to cause abnormal stresses on the foot and lower extremity. The altered mechanical stresses on these structures can aggravate the foot deformity. Screening of the flatfoot and its associated factors helps detect underlying risks influencing the stresses on the foot. The purpose of this study was to analyze the structure of the medial foot arch and investigate its associated factors in students, aged 7 to 14 years. METHODS: Multistage cluster sampling was used and each cluster included 2 other random sampling levels. A total of 667 Iranian school children were recruited and their feet were bilaterally evaluated using a static footprint while standing in a fully weightbearing position. The footprint, an observational measurement, and a questionnaire were used for the foot assessment. RESULTS: The prevalence of flatfoot was 17.1% in the population studied. There was no gender difference but the prevalence of flatfoot did decrease with age. The significant differences were observed in the prevalence of flatfoot between normal-weight, overweight, and obese groups (P < .01); more overweight participants had flatter feet. CONCLUSION: This study demonstrated that development of the longitudinal plantar arch in school-age children is influenced by age and weight. Age and weight were the primary predictive factors of flatfoot. LEVELS OF EVIDENCE: Prognostic, Level IV: Case series.

A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part two: research and outcomes.

BACKGROUND: Despite the activities of many orthotic and prosthetic provision organizations in resource-limited environments, there is still a great need and there are several areas for improvement, as identified in Part One of this series. OBJECTIVES: Our goal was to examine outcomes and conclusions of research studies to produce an evidence base for determining factors that may lead to successful provision of orthoses and prostheses in resource-limited environments. STUDY DESIGN: Literature review. METHODS: We conducted a scoping literature review of all information related to orthotic and prosthetic provision in resource-limited environments published from 2000 to 2010. We extracted measured outcomes reported in all types of articles and analyzed conclusions from research studies. RESULTS: Reported outcomes included durability, cost, satisfaction, use/nonuse of device, amount of utilization, walking speed, discomfort, pain, fit, misalignment, capacity for service provision, number of devices produced or delivered, and number of graduates from training programs. CONCLUSIONS: There are many gaps in the evidence base, notably in measuring inclusion, participation, and quality of life for orthosis and prosthesis users in resource-limited environments. There is a paucity of reported outcomes for orthotics. Valid, reliable, and standard methods of data collection and reporting are needed to advance the field and enhance the evidence base.

A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success.

STUDY DESIGN: Literature Review BACKGROUND: We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. OBJECTIVES: Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. METHODS: We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. RESULTS: We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. CONCLUSIONS: Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two.

The immediate effects of orthoses on pain in people with lateral epicondylalgia.

Objective. Tennis elbow is a common cause of upper limb dysfunction and a primary reason for pain at the lateral aspect of the elbow. The purpose of this study was to investigate the effects of three commonly used orthoses on pain severity. An elbow band, an elbow sleeve, and a wrist splint were assessed for their ability to reduce the level of reported pain. Method. A crossover randomized controlled trial was used. The orthoses were worn in a randomized order, and all participants were required to complete a control trial for which they wore a placebo orthosis. 52 participants with lateral epicondylalgia were recruited, and the level of pain at their elbow was recorded using the visual analogue scale (VAS). Results. The reported pain for all orthoses was lower than that of the placebo (P < 0.05). Pain reduction was significantly greater with a counterforce elbow band or a counterforce elbow sleeve compared to a wrist splint (P < 0.01). There was no significant difference between a counterforce elbow band and a counterforce elbow sleeve (P = 0.23). Conclusion. All the types of orthoses studied showed an immediate improvement on pain severity in people with lateral epicondylalgia. The counterforce elbow orthoses (elbow band and elbow sleeve) presented the greatest improvement, suggesting that either of them can be used as a first treatment choice to alleviate the pain in people with tennis elbow.