Tag Archives: #clinicalbiomechanics

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).

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

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

Visualising Coordination Patterns during human movement

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Here’s an introduction and highlights of our work

  • Proposed coordination pattern classification can offer an interpretation of the CA that provides either in-phase or anti-phase coordination information, along with an understanding of the direction of segmental rotations and the segment that is the dominant mover at each point in time.

Introduction to Vector Coding

  • The traditional approach of reporting time-series data from vector coding can be problematic when overlaying multiple trials on the same illustration.
  • The use of colour mapping and profiling techniques highlighted differences in coordination pattern and coordination variability data across several participants that questions the interpretation and relevance of reporting group data.

Coordinatiion Mapping

  • Colour mapping and profiling techniques are ideal reporting methods to compliment prospective multiple single-subject design studies and to classify commonalities and differences in patterns of coordination and patterns of control between individuals or trials.
  • The data visualisation approaches in the current study may provide further insight on overuse injuries, exercise prescription and rehabilitation interventions.
  • Our approach can have important implications in demonstrating gait coordination data in an easily comprehensible fashion by clinicians and scientists alike.

Key References

Needham, R., Naemi, R. and Chockalingam, N., 2014. Quantifying lumbar–pelvis coordination during gait using a modified vector coding technique. Journal of biomechanics, 47(5), pp.1020-1026. https://doi.org/10.1016/j.jbiomech.2013.12.032

Needham, R.A., Naemi, R. and Chockalingam, N., 2015. A new coordination pattern classification to assess gait kinematics when utilising a modified vector coding technique. Journal of biomechanics, 48(12), pp.3506-3511. https://doi.org/10.1016/j.jbiomech.2015.07.023

Needham, R.A., Naemi, R., Hamill, J. and Chockalingam, N., 2020. Analysing patterns of coordination and patterns of control using novel data visualisation techniques in vector coding. The Foot, p.101678.  https://doi.org/10.1016/j.foot.2020.101678

Our latest work shows that children with Cerebral Palsy have more energy to play and be physically active for longer!

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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: