Tag Archives: nachichockalingam

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.

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

Devices that help people function in every day life are costly in Africa: here’s why

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More than 200 million Africans need at least one assistive device. Lucian Coman/Shutterstock

Tolu Olarewaju, Keele University; Aoife Healy, Staffordshire University, and Nachiappan Chockalingam, Staffordshire University

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.The Conversation

Tolu Olarewaju, Lecturer in Management, Keele University; Aoife Healy, Associate Professor of Human Movement Biomechanics, Staffordshire University, and Nachiappan Chockalingam, Professor of Clinical Biomechanics, Staffordshire University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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 

 

Our work on Scoliosis recognised at a prestigious international conference (#IRSSD2021)

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This year, Children’s Wisconsin and their academic partners, The Medical College of Wisconsin, were the hosts for the 2021 International Research Society for Spinal Disorders conference.

The Society was founded in 1992 with the tenet to integrate basic science with clinical care to benefit patients from across around the world. IRSSD conferences provide interaction between clinicians and researchers with interests in spinal biomechanics, imaging and measurement, genetics aetiopathogenesis, growth and metabolism, innovations in conservative and surgical therapies, and quality of life and functional outcomes, to mention just some of the areas of activity.

The pandemic de-railed the physical conference with just short of 200 attendees spent a fascinating, insightful, and very well run virtual event in late January. Professor Nachi Chockalingam, Dr Rob Needham, and Professor Tom Shannon presented work and opinion within a symposium entitled Gait and Posture Analysis in Scoliosis-Implications for Clinical Practice, with Dr Ram Haddas from the Texas Back Institute. After the presentations, Nachi hosted a very lively and interesting questions session.

 

 

 

 

 

Nachi, Tom and Nikola Jevtić from the Scolio Centar, Novi Sad, Serbia presented our work in Cosmetic changes in patients following a Schroth Exercise Regime: a two year follow-up. The primary objective of our longitudinal study has been to investigate the relationship between scoliosis spinal deformity measures, clinic reports, images, curve classifications, and back shape data with the goal to develop, test and validate some new cosmetic deformity metrics. Our work is starting to show encouraging results, and we were hugely honoured to be awarded one of the two poster prizes.

This exciting work continues in Serbia and Bulgaria with donated equipment now also installed in Banja Luka, Bosnia and Herzegovina to expand the research efforts in that country as well.

 

 

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: