Author Archives: comms

Professor recognised for services to podiatry profession

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A Staffordshire University Professor has received a top honour recognising his contribution to the advancements of the podiatry profession.

Professor Nachiappan Chockalingam, Director of the Centre for Biomechanics and Rehabilitation Technologies, received an Honorary Fellowship from the Royal College of Podiatry at an event in the House of Lords.

This fellowship is conferred upon individuals who have made a substantive and significant contribution to the advancement of the podiatric profession in clinical practice, education, service management or research.

With support from colleagues and collaborators within the profession, Professor Chockalingam has contributed to the development of musculoskeletal podiatry in the United Kingdom. He has supervised and trained numerous podiatrists through the University’s post-graduate provision.

His globally recognised research on foot and footwear biomechanics has helped in scientific understanding of the mechanics of the foot and has provided evidence for clinical practice.

Receiving the honour, Professor Chockalingam said: “Receiving this fellowship is not just my own achievement; it represents the hard work of all the people I have worked with, from the podiatry profession and all those students for their dedication and unwavering belief in the power of knowledge and the pursuit of excellence.

“Throughout my academic and professional journey at Staffordshire University, I have been fortunate to work with some brilliant podiatrists who engaged with me in critical debates on scientific aspects of their clinical skill set. Some of these conversations have led to the development of seminal publications to provide evidence for practice.

He added: “With this honour comes a duty to contribute to the advancement of knowledge, to address pressing societal challenges, and to inspire others to follow their academic passions.”

Earlier this year, Professor Chockalingham was named a fellow of the International Society of Biomechanics (ISB) at their 29th global meeting in Fukuoka, Japan.  This fellowship recognised his distinguished professional achievement in biomechanics,  support for young researchers and his work to promote inclusive research amongst Allied Health Professionals.

Staffordshire University Vice-Chancellor Professor Martin Jones said: “We would like to extend our heartfelt congratulations to Professor Chockalingam on these latest honours which are so richly deserved. Nachi and his team are exponents of research excellence, he makes a huge contribution to our research culture here at Staffordshire University and we are enormously proud of all has achieved.

“Nachi brings together practicing clinicians and researchers with a view to improving patient care and the Staffordshire Conference in Clinical Biomechanics, now in its 21st year, is a big part of this. To have him recognised by his peers both here in the UK and internationally is the icing on the cake!”

Landmark study reveals critical shortage in UK prosthetic and orthotic workforce

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A Staffordshire University study has revealed a significant deficit in the number of prosthetists, orthotists, prosthetic and orthotic technicians, and support workers in the UK.

The report by the Center for Biomechanics and Rehabilitation Technologies (CBRT) was formally launched on 6 November 2023.

This research, commissioned by the British Association of Prosthetists and Orthotists (BAPO), found there are currently 631 orthotists and 295 prosthetists employed nationwide. However, an additional 142 to 477 prosthetists/orthotists are needed to meet World Health Organization standards of care.

“This workforce shortage is worrying,” said Professor Nachi Chockalingam, Director of CBRT and a senior author of the study. “With our aging population, demand for prosthetic and orthotic services will only increase. We urgently need strategies to grow and sustain this profession.”

The study also identified a lack of qualified technicians and support workers to support prosthetist/orthotist teams, with a shortage of 1,133 to 1,803 individuals by WHO benchmarks. Significant recruitment challenges were reported by both NHS and private sector employers.

“This landmark report provides the hard evidence we need to take action,” said Dr. Nicky Eddison, lead researcher. “Working with professional bodies, higher education institutions and the industry we must inspire the next generation and make prosthetics/orthotics an attractive career choice.”

The report highlighted concerning retention issues as well, with one in five prosthetists/orthotists indicating they may leave the field in the next five years. Key factors driving attrition include lack of career progression, poor work-life balance and lack of flexibility.

Another senior author Dr. Aoife Healy, added, “Prosthetist/orthotist is an incredibly skilled profession that allows for a high degree of creativity combined with cutting-edge technology to transform patients’ lives.”

Mr. Peter Illif, the Chair of the British Association of Prosthetists and Orthotists said, “We need to nurture these professionals so they feel valued and able to thrive throughout their careers. BAPO has pledged to implement the report’s recommendations around enhanced educational programs, expanded roles for prosthetic/orthotic associates, and greater collaboration to sustain the workforce.”

“With commitment from all stakeholders, we can build the prosthetic/orthotic workforce needed to provide quality care to all who require it,” Professor Chockalingam said. “We look forward to partnering across the health sector to make this vision a reality.”

The full report “Exploration of the UK Prosthetic and Orthotic Workforce’ which is also available on the BAPO website.

Watch the report launch event to hear more about the research from the study’s authors.

Professor Chockalingam attends a key stakeholder meeting at the WHO, Geneva.

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A gathering was hosted by the WHO Assistive Technology team in Geneva on March 28th and 29th, with the objective of evaluating the process, results, and distribution of the WHO rapid Assistive Technology Assessment (rATA) survey, as well as devising strategies to enhance this significant means of collecting data.

The rATA survey is designed to gather information from households at a population level, which includes assessing self-reported requirements, obstacles and demand related to assistive technology. This survey was conducted worldwide between 2019 and 2021 in 35 countries and contributed to the WHO-UNICEF Global Report on Assistive Technology, which was released in May 2022.

At the meeting, 28 stakeholders hailing from 18 different countries were assembled, all of whom were involved in the creation, delivery, and interpretation of rATA data. The participants shared their individual experiences and insights gained from collecting rATA data and collectively identified key measures to enhance the questionnaire’s effectiveness, streamline rATA implementation, offer more robust support for country implementation, fortify data management and analysis, and broaden the dissemination of rATA results.

To inform evidence-based policies and programs, measure progress in improving access to quality assistive products and services, and guarantee equal access to assistive technology for those in need, it is essential to invest in effective and efficient assistive technology data collection. Stakeholder representatives attending the meeting identified key measures to enhance the rATA questionnaire’s effectiveness and ensure equitable access to assistive technology for all. The outcome of this meeting will guide further development of rATA through the GATE Global Network on Measuring Access to Assistive Technology.

(The team at StaffsBiomech conducted the first UK rATA and the data were included in the WHO-UNICEF Global Report on Assistive Technology).

Policy framework to guide allied health professional telehealth patient consultation guidelines and training

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Allied Health Professionals (AHPs) make up the third largest healthcare workforce in the UK National Health Service (NHS) and play a vital role in the health and care of patients. However, new research shows that current telehealth guidelines and training programmes for AHPs are not sufficiently comprehensive and lack information on key telehealth aspects.

A program of work, conducted by a team of researchers at Staffordshire University, found that many AHPs are not adequately supported in the delivery of remote patient consultations. This is a concern as telehealth has become increasingly important in the current climate, with the pandemic forcing many healthcare providers to shift to remote consultations.

Based on these studies a policy brief has been created in partnership with various stakeholders to guide the creation of telehealth patient consultation guidelines and training for AHPs.

This policy brief, which was launched on 18th January 2023 aims to outline crucial telehealth elements to consider when creating guidelines for patient consultations and to highlight areas where AHPs should receive training before conducting telehealth consultations.

Download the policy brief here.

The publications which informed this policy can be found at:

  • Leone E, Eddison N, Healy A, Royse C, Chockalingam N. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance. BMJ Open. 2021 Dec 27;11(12):e055823. doi: 10.1136/bmjopen-2021-055823. https://bmjopen.bmj.com/content/11/12/e055823.long

This work uncovered deficiencies in current guidelines for telehealth consultations by allied health professionals (AHPs). These guidelines demonstrated both similarities and discrepancies with the guidance for non-AHP healthcare professionals. The findings indicated that the current guidelines do not provide sufficient support for AHPs to deliver telehealth consultations. It is suggested that future research and collaboration among AHP groups and leading health institutions be undertaken to develop common guidelines that will enhance AHP telehealth services.

In this study, 658 participants were surveyed (119 AHP service managers overseeing 168 AHP services, and 539 clinicians). Among the clinicians and services represented, 87.4% and 89.4%, respectively, were using telehealth consultations to deliver healthcare, and most of these services planned to continue using telehealth after COVID-19 restrictions were lifted. The most significant barrier reported by participants as impacting a patient’s ability to conduct a telehealth consultation was a lack of technological skills, followed by a lack of technology for patients. These were also identified as the primary disadvantages of telehealth for patients. Many clinicians reported that telehealth consultations reduced the cost of parking and transportation for patients attending hospital appointments. The benefits reported by clinicians included saving on travel time and costs and enabling flexible working, while the benefits to AHP services included increased flexibility for patients in how appointments are conducted and reduced potential exposure of staff to contagious diseases. We concluded that widespread adoption of telehealth in its current form in NHS AHP services may exacerbate inequalities in healthcare access for vulnerable groups with limited digital literacy or access. As a result, telehealth may be deemed inappropriate and underutilized, nullifying the potential benefits such as sustainability, patient empowerment, and reduced treatment burden. This could increase disparities in healthcare.

In this paper we examined the organizational readiness of AHP services regarding the implementation of telehealth guidelines and staff training. Results showed that UK NHS AHP services lack clear and comprehensive guidelines and the necessary skills to effectively deliver telehealth. Vulnerable individuals are excluded from current guidelines, which could exacerbate health inequalities and hinder the success of the NHS digital transformation. The lack of national guidelines underscores the need for consistent AHP telehealth guidelines.

  • Eddison N, Royse C, Healy A, Leone E, Chockalingam N. Telehealth provision across allied health professions (AHP): An investigation of reimbursement considerations for its successful implementation in England. Health Sci Rep. 2022 Dec 13;6(1):e991. doi: 10.1002/hsr2.991. https://onlinelibrary.wiley.com/doi/10.1002/hsr2.991

This study investigated the potential barriers to the adoption of telehealth posed by differences in the NHS tariff. To understand the effect of these changes on reimbursement for AHP telehealth consultations because of the pandemic, a Freedom of Information (FOI) request was sent to all Clinical Commissioning Groups (CCGs) in England in April 2021, to request information on the current tariffs for face-to-face and telehealth consultations for AHP services. Findings showed significant variations across the NHS in England, with some CCGs paying the same amount regardless of the mode of delivery, some paying 6.5 times more for in-person consultations, and only a few paying more for telehealth consultations.

UK Prosthetic and Orthotic Workforce Survey: We need your help!

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Why are we conducting this survey?

We are undertaking research to gather information on the prosthetic and orthotic workforce in the UK. The study aims to capture a wide variety of demographic and work-related information about the UK prosthetic and orthotic workforce. Currently, workforce data for people working within the prosthetics and orthotics profession is incomplete resulting in an unknown national workforce picture, which prevents accurate service planning and projection requirements. The project has been funded by Health Education England through the British Association of Prosthetists and Orthotists (BAPO). The findings of the study have the potential to influence future service planning.

Who do we want to complete the survey?

We want to gather information on all individuals working within the prosthetic and orthotic profession which includes:

•            Prosthetists/Orthotists

•            Prosthetic/Orthotic technician

•            Prosthetic/Orthotic support worker

•            Prosthetic/Orthotic student/apprentice

Survey update

  • The survey has now been running for 4 weeks but we need your help to get more responses, from all professions across the UK. We know that there are 1,124 registered Prosthetists/Orthotists in the UK today and so far, we have only had responses from 30% of this population.
  • We have a low response from technicians, support workers, students, and apprentices.
  • We have a low response from Northern Ireland, Wales, and Scotland.

To complete the survey, click here or scan the QR code:

There is a chance to win a £100 retail voucher, the survey closes 18/11/22.

Staffordshire University Professor is set to deliver a keynote lecture at the next ISPO world congress in Mexico.

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International Society for Prosthetics and Orthotics (ISPO) organises biennial World Congresses. This is ISPO’s flagship conference and is a unique forum where the global community of professionals involved in the care of persons in need of prosthetic, orthotic, mobility and assistive devices comes together to learn about the latest scientific and clinical advances, products, innovative technologies, designs and materials in P&O care provision with the global health services.

The next world congress in 2023 is titled “Art and the Science” and will be held in Guadalajara, Mexico.

Four renowned international professionals Rosielena Jované, Sophie de Oliveira Barata, Professor Stefania Fatone and Professor Nachiappan Chockalingam will present keynote lectures around the congress theme The Art and the Science.

For more information on the congress please visit: www.ispo-congress.com/en/news/inspiring-keynote-speakers-expected-at-the-ispo-19th-world-congress

Here’s the preview from our own Nachi Chockalingam.

Classification System for Bespoke Thermoplastic Ankle Foot Orthoses

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Everyone agrees that not all Ankle Foot Orthoses (AFOs) are the same and they do not treat the same pathologies. Also different designs have varying effects on biomechanical function. However, the terms used to describe the different types of AFOs have not been fully classified and defined. This has led to the use of varying descriptions and acronyms resulting in poorly designed research studies (1,2) and a misunderstanding of research outcomes. The lack of classification has also resulted in generalisation on the effects of AFOs from research studies which have not been clear on the design of the AFO used or the presenting pathology it was used for (2), with some studies describing the AFO as “a standard AFO”, for which there is no definition. Standardised terminology and definitions for AFOs are critical in clinical practice, without these, there may be serious negative consequences, with the potential to cause harm.

We have now developed and validated a new classification system for different designs of bespoke thermoplastic AFOs.

Figure 1: Bespoke thermoplastic AFO classification chart.

The proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care.

Read the full paper at:

https://www.sciencedirect.com/science/article/pii/S0958259222000219

References:

  1. Figueiredo EM, Ferreira GB, Maia Moreira RC, Kirkwood RN, Fetters L, Figueiredo E, Ferreira G, Moreira R, Kirkwood R FL. Efficacy of Ankle-Foot Orthoses on Gait of Children with Cerebral Palsy: Systematic Review of Literature. Pediatr Phys Ther. 2008;20(3):207-223. doi:10.1097/PEP.0b013e318181fb34
  2. Eddison N, Mulholland M, Chockalingam N. Do research papers provide enough information on design and material used in ankle foot orthoses for children with cerebral palsy? A systematic review. J Child Orthop. Published online July 3, 2017:1-9. doi:10.1302/1863-2548.11.160256

A practical tool for Footwear Assessment in clincs

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Footwear advice created from footwear assessment is often anecdotal based on individual clinical experience and interest. There is often no structured way to evaluate the shoe worn to clinic and a generalised opinion on footwear choice is given.

Isolated assessment of footwear can provide a number of challenges for clinicians as wider footwear choices made by patients often do not reflect the shoes worn to appointments. This creates an unrealistic view for the clinician and inaccurate assumptions are often made when issuing advice.

To assist clinicians in assessing shoes we have developed a simple valid clinical footwear tool.

This tool has been designed to help clinicians quantify and measure a full range of footwear in one appointment. The footwear tool also provides a systematic view to assess the quality of fit and design of the shoe whilst channelling the clinician towards developing individual footwear advice for the patient. The tool is multifaceted and addresses a number of parameters associated with good fit and footwear choice.

Our validation of the tool shows that it is reliable to use in the clinic and can be applied to a number of styles of shoes. There is minimal equipment required to use the tool and completion of the assessment takes a short period of time.

For further details read our publication in JFAR:

https://link.springer.com/article/10.1186/s13047-022-00519-6https://link.springer.com/article/10.1186/s13047-022-00519-6

Please contact Dr Branthwaite or Professor Chockalingam to download the tool and the instructions for use

Our latest report provides standardised terminology for “therapeutic footwear” and will improve treatment for children with walking difficulties across the globe

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Our recent paper has established recognised terms, definitions, design characteristics and prescription criteria for off-the-shelf stability footwear for the first time.

Numerous terms have been used in the literature concerning clinical footwear interventions, including orthopaedic shoes, rehabilitative boots, modified shoes, supportive shoes and special shoes. There is also no standardised set of agreed outcome measures, both physical and psychosocial, to ascertain the effectiveness of this footwear.

A group of multinational professionals, from clinicians to those involved in the footwear industry, were recruited to take part in an online survey and to provide further insights through a series of open-ended questions.

“Therapeutic footwear” was the agreed term to represent children’s footwear interventions, with grouping and subgrouping of therapeutic footwear being dependent on their intended clinical outcomes: accommodative, corrective or functional. Design characteristics of off-the-shelf footwear were also grouped under three themes: stability, ergonomics and aesthetics.

This is believed to have many benefits including:

  • A common understanding of therapeutic footwear terminology to facilitate communication between clinicians, researchers and manufacturers.
  • Research-informed evidence for selection of appropriate off-the-shelf stability therapeutic footwear based on identified design characteristics.
  • Research-informed evidence for dispensing off-the-shelf stability therapeutic footwear to patients.
  • Standardised outcome measures for clinical assessment of the effectiveness of off-the-shelf stability therapeutic footwear interventions.

This study has achieved an expert consensus where none previously existed, which is important from both a manufacturing and clinical perspective. This is a huge step forward which we hope will lead to quicker, more personalised and more effective treatment for children with mobility issues.

Read the full paper published in BMJ Open – Defining and grouping children’s therapeutic footwear and criteria for their prescription: an international expert Delphi consensus study

Our latest paper provides a “step-change”!

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Our latest paper titled “A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living” published in Royal Society Open Science has attracted a substanital attention from the industry and the clinicians. 

We have developed a novel concept to assess plantar laoding using 3D-printed, tuneable structures. This will help clinicians better understand the cause of foot ulcer development in patients with diabetes and lead to improved clincal outcomes.

Dr Chatzistergos, who led the study, said: “Our work has demonstrated a method to reliably detect overloading using a low-cost non-electronic technique. We have used a 3D-printed thin-wall structure that changes its properties when repeatedly loaded above or below a tuneable threshold. We believe that this is a step change from current practice.”

https://www.eurekalert.org/pub_releases/2021-06/su-nra060921.php