I am a Professor of Clinical Biomechanics at the School of Life Sciences and Education and I lead the biomechanics team. I am also an Affiliate Professor at the Faculty of Health Sciences, University of Malta, a Guest Professor at Guangzhou Sport University, China and a Visiting Professor at the Department of Sports Medicine and Arthroscopy, Sri Ramachandra University, Chennai, India.
The COVID-19 pandemic saw an unprecedented expansion of telehealth with a shift to remote patient consultations across the allied health professions.
Our study published in BMJ Open has examined current guidelines for the 14 Allied Health Professionals (AHPs) in the UK reveals a clear need to solve the disparities in the level of guidance for remote consultations between professions.
While telehealth can be considered an efficient and safe way to deliver consultations, in practice there are barriers which can lead to unintended consequences; these include technological constraints such as inadequate internet bandwidth, lack of skills among users, patient confidentiality, privacy as well as data security issues.
Additionally, concerns have been raised about the risk of patient harm resulting from the lack of diagnostic and therapeutic quality of services delivered through telehealth, as this can lead to highly infectious and life-threatening conditions being missed.
The study revealed that most telehealth guidelines were designed to quickly respond to the need for remote patient consultations during the Covid-19 pandemic and recommends that available guidelines should be reviewed to ensure they meet the long-term needs of patient consultations.
Very few guidelines were specifically designed for certain clinical populations, which acknowledged that telehealth consultations need to be adapted to meet individual needs. It was also found that most guidelines were specifically designed for occupational therapists, physiotherapists and speech and language therapists, leaving the other AHP groups with very few or inadequate guidelines.
Everyone has a right to certain products and devices that can help them function in everyday life. This is the stance of the World Health Organisation (WHO), which has published a list of the most important of these devices. It includes things like walking aids, wheelchairs and braille displays.
But assistive technologies, as they are called, are difficult to access in many parts of Africa. This is a huge problem because the prevalence of disabilities on the continent is estimated at 15.6%. With a population of more than one billion, the number of people in need of at least one assistive product in Africa stands at over 200 million, and that figure is projected to double by 2050.
The WHO estimates that only about 15% to 25% of those in need of assistive technology products in Africa currently have access to them.
Our research sought to find out why and to offer solutions to this problem.
Human rights
Assistive technologies are functional, adaptive, and rehabilitative devices. Not only does the WHO support a global commitment to making them more easily available, the United Nations also regards them as a basic human right. This is because some people need them in order to exercise their rights.
Without access to the assistive technology they need, people can face exclusion and are at risk of poverty. They may also be perceived as a burden to their families and society. The positive impact of assistive technology products goes far beyond improving the health and well-being of users. There are also the socio-economic benefits of reducing direct health costs and having a more productive labour force, indirectly stimulating economic growth.
The 2006 UN Convention on the Rights of Persons with Disabilities and its optional protocol was negotiated quickly and well supported by member states. It was also the first human rights convention to be open for signature by regional integration organisations. But its implementation has been shaky, particularly in Africa.
We believe this is best explained by the idea of economic and political institutional voids. These are basically gaps in political and economic systems, trade policies and markets. An absence of specialised intermediaries, regulatory systems and contract enforcing mechanisms creates higher transaction costs for doing business or even entering markets.
Seeing the problem in this way also helps to show how to solve it and achieve fair access to assistive technologies.
Institutional voids
First, there is little production of assistive technologies in Africa because the parts are generally expensive to make. Many indigenous producers use crude and unstandardised materials.
Second, assistive technologies that are not produced locally are expensive to import. There are no unified tariff structures for them within the continent. This means that costs vary widely from country to country. Often, when assistive technologies do get imported despite high tariffs, they might need to be adapted for the local environment. This increases the costs even further.
Third, assistive technologies are mostly excluded from health financing and insurance schemes on the continent. They are not often included in central medical store catalogues.
Fourth, there aren’t enough people at all levels of the health system with the required knowledge and skills to provide assistive technology services and products.
Fifth, and most crucially, there is no unified governance framework for assistive technologies on the continent. And there’s a widespread lack of awareness about why they are needed and how they can improve the lives of people who need them.
Most African countries do not have national assistive technology policies or programmes. As a result, access to assistive products is difficult and many are left behind.
Solutions
African governments need to provide leadership, coordination and resources to plan and implement policies that increase access to assistive technologies.
Acting on the WHO African regional framework is a good place to start. The framework has modest aims. For instance, it calls for 40% of African member states to have assessed their assistive technology situation and developed a national strategy to improve access by 2024. This will help 40% of the population in Africa that needs assistive products to get them without suffering financial hardship.
The African Union can learn from the European Union. The European Parliamentary Research Service has commissioned and published an in-depth report of assistive technologies. The report covers economic, political and socio-ethical perspectives and it tries to implement the declarations that assistive technologies are a basic human right. Such a focused and thorough evaluation is missing in Africa.
To produce technologies on the continent, the African Union should develop a market strategy. The current market is one where the players are left to fend for themselves, and so face high operating costs. These costs ultimately make assistive technologies expensive.
Producers should also embrace frugal innovation – the process of reducing the complexity and cost of an item and its production, usually by removing nonessential features.
Qualified personnel are another part of the solution.
Finally, but maybe most importantly, there is a need for a structured enquiry to highlight the gaps in economic, political, scientific, and clinical knowledge for assistive technology development and deployment in Africa – and a unified approach to solving the problems.
This would help millions of people in Africa to achieve their basic rights such as access to education, freedom to live, and the right to work.
Our research shows that the appropriate design and tailoring of splints can reduce the energy used by children with CP while increasing their speed and distance, compared with a splint which is not fine-tuned. This is something which could have a significant impact on their quality of life.
During the study, the researchers analysed the walking pattern of children with cerebral palsy at our gait laboratory and participants were assessed while barefoot and with both non-tuned and tuned splints.
Children wearing the fine-tuned splints showed improvements in several areas including hip and pelvic function and knee extension, while a non-tuned splint potentially showed a decrease in hip function.
The full research findings, which were published in the June edition of the Foot Journal, are available below:
The Centre for Biomechanics and Rehabilitation Technologies at Staffordshire University, UK is looking to establish a network of like-minded early career researchers in India interested in the area of rehabilitation and/or mobility assistive devices (e.g. footwear, orthoses, prostheses, wheelchairs) for people with diabetes. The goal of this network will be to establish national collaboration between early career researchers within India and international collaboration with Indian institutions and Staffordshire University.
Ideally you should:
· Have a PhD related to the area of rehabilitation or mobility assistive devices for people with diabete · Be employed at an Indian University or Research based Institution. · Be an early career researcher who is currently within their first five years of academic or other research-related employment. · Ideally with a good range of internationally peer reviewed journal publications. · Below the age of 40 years.
If you are interested please email Dr. Aoife Healy (a.healy(at)staffs.ac.uk) with a short resume including a list of publications or provide a link to your ResearchGate/Google Scholar profile by Monday 22nd July 2019.
One of our classic papers looked at the influence of practitioners and their skills in prescribing foot orthosis which are commonly prescribed and used in treating numerous lower limb problems.
Over the years several studies have reported positive effects and most clinical practitioners would confirm those findings. However, the exact mechanisms in which these orthoses work are not fully understood.
Our results suggest that the type and amount of effects observed is greatly influenced by the practitioners. From a scientific perspective, this indicates that great caution should be taken when studying and reporting the effects of custom foot orthoses (CFO). Had only one practitioner been used for studying CFO effects on kinematics, altogether different conclusions could have been drawn based on a single pair of CFO.
We recommend that future research on foot orthoses should focus on their long-term effect through longitudinal studies. Nevertheless, based on the reported data, it seems improbable that two different devices could yield the exact same results.
Most CFO will induce some systematic changes during gait. Furthermore, this study demonstrated that inter-practitioner variability is a major factor in orthotic intervention in treating a single patient and for a specific pathology. Based on the findings, it is strongly recommended to use caution when drawing general conclusions from research studies using CFO as it has been showed that the practitioner himself or herself will have a great influence on the treatment outcome. In addition, comparing studies on CFO where different practitioners were involved should be done with great caution as the conclusion could vastly differ.
Reference:
Chevalier, T.L. and Chockalingam, N., 2012. Effects of foot orthoses: how important is the practitioner?. Gait & posture, 35(3), pp.383-388.
First paper from the collaborative work between Dr Zulfiqarali G. Abbas and colleagues from the Muhimbili University of Health and Allied Sciences and Abbas Medical Centre in Dar es Salaam, Tanzania and Professor Nachi Chockalingam and colleagues at Staffordshire University has just been published in the Journal of Diabetes and its Complications.
This particular work is part of a wide ranging research focusing on Diabetic foot and its complications and is led by Professor Roozbeh Naemi at Staffordshire. This research was aimed at identifying various parameters that will help explaining the presence of foot ulceration in patients with diabetes.
The work examined the biomechanical, neurological, and vascular parameters along with other demographics and life style risk factors that could explain the presence of foot ulcer in 1270 patients with diabetes. Although the data focused on patients in Tanzania, the results has a global implication.
The results of this study showed that the participants with ulcerated foot exhibit distinct characteristics in some of the foot related clinical observations. Swollen foot, limited ankle mobility, and peripheral sensory neuropathy were significant characteristics of patients with diabetic foot ulcer. In addition, the explanatory model outlined within this research clearly shows that only one out of three patients with ulcerated foot showed common characteristics that are typically considered as contributing factor to ulceration.
