Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

Background and purpose: Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs. This study aimed to examine the quality of national CPGs recommending prosthetics and orthotics (P&O), and; quantify agreement between national and regional CPGs in Sweden.

Materials and Methods: National and regional CPGs were identified in public databases and by surveyed local Nurse Practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs were quantified on a four-grade rating scale ("similar", "partially similar", "not similar/not present" and "different").

Results: Of 18 national CPGs, three CPGs (CPGs of Diabetes, Musculoskeletal disorders and Stroke) had nine recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores >60% in all domains and the Diabetes CPG had scores >60% in five out of six domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPG) showed "similar" content for all regions and two national recommendations (in Diabetes CPG) showed "not similar" content for all regions. The remaining four national recommendations (in Diabetes, Musculoskeletal disorders and Stroke CPGs) had varying agreement with regional CPGs.

Interpretation: There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O-related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.

Background: Many healthcare professionals collaborate in the clinical care of individuals who have undergone a Transtibial Amputation (TTA), and a good start to their rehabilitation is essential. The Prosthetist plays a long-term role in patient care, while surgeons often have limited follow-up, typically 1-2 weeks post-surgery.

Objective: This paper aims to present the perspective of two Prosthetists on the subject of TTA: why this perspective is needed, the effect of the limb length, the incision techniques used, new alternatives in postoperative treatment, and its impact on early prosthetic fitting, within a Swedish context.

Methodology: To address this aim, each section was discussed individually, summarizing relevant evidence from a professional perspective, using various evidence sources (e.g., peer-reviewed literature, and national patient registries).

Findings: From the authors' view, when using modern postoperative treatment and prosthetic technology, the Sagittal Incision (SF) incision may be beneficial to Posterior Flap (PF) incision in TTA, if the aim is to reduce the time to prosthetic fitting. New postoperative treatment methods are being made more accessible and recognized. This might not be a valid solution in all places, but they contribute to the evidence base used for decision-making following TTAs.

Conclusion: From a Prosthetist perspective, more could be done to improve the pathway from amputation to prosthetic fitting and ensure the best functional outcome for the patient. Traditional methods from the 1950s have been discussed, and other alternatives have been contrasted.

Introduction

Practice of ankle-foot orthoses (AFO) provision for ambulatory children with cerebral palsy is underreported and the literature is not consistent on choice of AFO-design. This study describes clinical practice of AFO provision for children with cerebral palsy and evaluates how clinical practice aligns with existing recommendations.

Methods

An online, cross-sectional survey was conducted, inviting all Norwegian orthotists working with children with cerebral palsy. Orthotic practice was investigated using a self-reported survey design.

Results

From all eligible orthotists, 54% responded, revealing that AFO provision involves patients, physicians, and physiotherapists at different stages. Patient preference directly influenced the ultimate AFO-design. Shank vertical angle was evaluated by 79%. For children with crouch gait and those with short gastrocnemius, a majority preferred a combination of rigid and articulated/flexible AFO-designs. Instrumented gait analysis was conducted by 51% at AFO delivery stage.

Conclusions

The findings show that AFO provision in Norway is collaborative, involving clinical team members and consideration of patient preferences. A discrepancy between clinical practice and existing recommendations for children with crouch gait and those with short gastrocnemius is observed.

Background: Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown.

Objectives: The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research.

Study design: Mixed methods.

Methods: The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking.

Results: Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students, program evaluation, and clinical education and internship. Protected time and funding, faculty development, and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice, program resources, and program evaluation.

Conclusions: Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.

Balance, postural control and issues related to falling and the fear of falling are major problems for people with leg amputations. Structural changes after an amputation that affect balance and postural control include asymmetry of limb length. The inability to actively control posture via an intact foot and ankle complex on the affected side as well as altered sensory input may affect postural control. Such changes can be considered intrinsic factors as these are specific to the individual. Prosthetic restrictions that attempt to mitigate the above intrinsic limitations can be considered extrinsic factors. These intrinsic and extrinsic factors interact to determine an individual’s balance which is a key determinant of their likelihood of falling and/or fear of falling.

The aim of this symposium is to bring together representatives from a variety of related fields relevant to lower limb amputation to provide a holistic view of the topic and future directions.

As a basis for the symposium, the progress and current results of a scoping review to summarise the current state of research in balance and postural control will be presented. Based on this, we aim to explore future directions in both clinical care and research. The review will be summarised in two categories: intrinsic factors (person/patient-related) and extrinsic factors (prosthesis/environment).

We will also provide additional viewpoints from a variety of perspectives, highlighting the interdisciplinary nature of this issue. These include practical aspects of physical therapy, balance and self-confidence and biomechanics, among others.

Statement of the objective / learning objectivesThe aim of the symposium is to communicate the different approaches to research on this topic, in addition to the issues arising in clinical practice. Participants are be encouraged to join in the discussion. 

Aims: Involvement in arts has shown potential to promote mental health. Thus, arts may be able to complement conventional healthcare to address common mental disorders (CMD). The aim of this study was to evaluate the long-term effect of a 10-week Arts on Prescription program regarding CMD (stress, anxiety, depression), compared to conventional healthcare. The study also aimed to examine whether CMD differed between groups.

Methods: A quasi-experimental prospective design with intervention and control group and 6- and 12-month follow-up was used to evaluate an Arts on Prescription program in Sweden, focusing on the effects on stress, anxiety, and depression. Participants were on sick leave due to CMD and/or musculoskeletal pain. Data was collected using questionnaires.

Results: The study population consisted of 479 participants (n=247 intervention group, n=232 control group). The result indicates a greater effect size (ŋ) in the intervention group compared to the control group for reduction in stress, anxiety, and depression at follow-up after 12 months. The difference in depression was significant.

Conclusions: The results indicate AoP could be an adjunct to conventional healthcare interventions to address CMD, especially depression.

This symposium aims to present the current state of evidence-based practice in education for prosthetic orthotic occupations. Presenters will share the current evidence, best practices and ongoing development of a research plan for prosthetic orthotic educators.

The symposium will follow on from the Global Educators Meeting (GEM) in June 2022 the symposium will present the findings of the educator focus groups held during the GEM and discuss the educators survey.

Presented by educators aimed at educators this symposium offers an opportunity to learn, contribute and discuss how to get the most out of educational time.

The objective of this symposium are to help educators in prosthetic orthotic occupations;

• become more aware of the current evidence, best practices and the work currently ongoing to advance the evidence base for teaching in the field.
• cultivate collaborations among educator peers.
• develop and diversify educational practices to stimulate an effective learning environment.

Statement of the objective/learning objectivesThe objectives of this symposium are to help educators in prosthetic orthotic occupations;

• become more aware of the current evidence, best practices and the evidence base
• cultivate collaborations
• develop and diversify educational practices

Background: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic footulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients,regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitfulapproach.

Purpose: The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUsand suggest avenues for future research and development.

Methods: Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at theDFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices shouldbe developed that aim to optimize these mechanisms according to each individual’s needs. We suggest three differentapproaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, wheredifferent mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from thedevice to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices,thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be usedto provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence.

Conclusions: By the use of these approaches, we could provide patients with personalized devices to optimize plantartissue stress, thereby improving clinical outcomes.