Factors predictive of Ponseti casting for treating clubfoot: analysis of Bayesian Poisson regression model

OBJECTIVE

Clubfoot is a growing public health concern in Bangladesh, with the incidence of approximately 0.64 to 6.8 in every 1000 live births. For over a decade, Ponseti method has been considered a gold standard for treating the clubfoot. Despite few studies have been estimating the number of casts required to correct the clubfoot deformities by Ponseti method, the subject of interest has always remained. Therefore, this current study aimed to investigate the significant predictive factors for the number of casts required to correct congenital clubfoot.

PATIENTS AND METHODS

In this retrospective cohort study, we used Bayesian Poisson Regression Model to investigate the influencing factors that could predict how many casts are needed to correct the clubfoot. We included 69 patients with 99 affected feet, who completed their corrective phase of treatment in the Ponseti method. For this cohort study, we integrated only pre-tenotomy casting data with no age restrictions. We used Bayesian Poisson regression analysis technique to estimate the predictive factors.

RESULTS

In Bayesian Poisson model, age was the most influencing predictive factor (24.3%) for increasing the number of castings to correct the clubfoot deformity. The clubfoot offspring of the ≤1-year-old was positive, and the incidence rate increased significantly with the casting number. The number of Ponseti casts in male clubfoot children was 28% higher than in female, and this was marginally statistically significant. There was no marked change estimated in the pattern of clubfoot, foot involvement and Pirani score of the severity.

CONCLUSIONS

We concluded that the age factor may influence the number of casts required for the correction of clubfoot and specifically ≤ 1-year-old children are highly impacted. Treating clubfoot at an early age is suggested in this study to increase the success of clubfoot treatment and decrease the risk of relapse.

Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study

OBJECTIVE

COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown.

MATERIALS AND METHODS

Online cross-sectional survey was conducted between April 2020 and May 2020.

RESULTS

114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing.

CONCLUSIONS

The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.

Ambient assisted living technologies for older adults with cognitive and physical impairments: a review

The global number of people over the age of 60 years is expected to increase from 970 million to 2.1 billion in 2050 and 3.1 billion in 2100. About 80% of the aging population will be in the developing countries. Aging population may suffer from various physical, cognitive, and social problems, due to aging process such as impairment of physical related functions (decreased mobility and walking speed, falls, frailty, decreased walking speed, difficulties in basic, and instrumental activities of daily living), cognitive related functions (memory-related issues), sensory functions (hearing loss, cataracts and refractive errors, presbyopia, decreased vestibular function), behavioural and psychological disorders, social isolation issues, and poor quality of life. Over the period of the last few decades, emerging technologies such as internet of things (IoT), artificial intelligence (AI), sensors, cloud computing, wireless communication technologies, and assistive robotics have given the vision to develop various ambient or active assisted living (AAL) approaches for supporting an elderly people to live safely and independently in their living environment and participate in their daily and community activities, as well as supporting them to maintain their physical, mental health, and quality of their life. The aim of this paper is to review the use of Ambient or Active Assisted Living for older adults with physical, cognitive impairments, and their social participation.

A novel 3D evaluation method for assessing bone to bone relationships in clubfoot

OBJECTIVE

Clubfoot is a complex congenital three-dimensional foot deformity, which affects 150,000-200,000 newborn babies annually around the world. A good understanding of the alignment of the two osseous columns and the lower leg of the ankle and foot complex is essential for evaluating the severity of clubfoot. The purposes of this study were to (1) develop an automated three-dimensional (3D) surface model of severe clubfoot based on two-dimensional (2D) slices of computed tomography (CT) images, (2) evaluate the alignment of foot bones relative to the ankle in severe clubfoot, and (3) examine the structural changes in the shape of the clubfoot.

PATIENTS AND METHODS

Two-dimensional CT image was taken from a four-year-old child with a severe clubfoot. Subsequently, an automated and detailed 3D surface model of the severe clubfoot was developed from the 2D images by using MATLAB software programming. Then, the x, y, and z coordinate angles were automatically calculated for each bone in the foot relative to the ankle (lower end of the tibia) to determine the orientations and relationships among the bones.

RESULTS

The relative position or orientation of each bone of the foot to the ankle of the severe clubfoot was objectively measured which was used to determine the orientation of each bone in the foot. Among the x, y, and z axes of the interested tarsal bones, the z axis represents the smallest moment of inertia, and the results showed that the bones in the x axis shifted medially with higher relative angle.

CONCLUSIONS

This 3D objective measurement method for assessing clubfoot can be used to determine and classify the severity of clubfoot, as well as evaluate and monitor the progress of the clubfoot intervention based on the relative position of the tarsal bones. The method can also be used to quantify the relationship between the tarsal bones of the foot and lower end of the tibia. In addition, angular measurements can be used to assess other pathological conditions of the foot such as pes cavus and pes planus.

The clinical utility, reliability and validity of the Rivermead Behavioural Memory Test-Third Edition (RBMT-3) in Hong Kong older adults with or without cognitive impairments

This study examined the use of the Hong Kong version of the Rivermead Behavioral Memory Test-Third Edition (RBMT-3) for older adults, and by presenting the optimal cut-off scores for patients with cognitive impairments, and for a group of peers who have functional everyday cognition. Hundred older adults residing in community dwellings were recruited from three non-government organisations and completed the RBMT-3: 29 patients with mild to moderate dementia, 34 persons at risk for MCI, and 37 matched older adults with everyday functional cognition for a healthy control group (NC). The test has excellent inter-rater (ICC [2, 1] = 0.997), intra-rater (ICC [3, 1] = 0), and parallel version (ICC [3, 1] = 0.990) reliabilities, as well as satisfactory internal consistency (Cronbach's alpha: 0.643-0.832). The scores of the MCI group were significantly lower than those of NC group in four subtests. The optimal cut-off scaled scores of ≤ 41.5, ≤ 102.5, and ≤ 131.5 are suggested for the RBMT-3 to discriminate between patients with mild and moderate dementia, mild dementia and MCI, and MCI and NC, with sensitivities 73%, 100% and 94.1%, respectively. This version is useful to differentiate those with or without risk of cognitive impairments.

Kinetic and kinematic analysis of gait pattern of 13 year old children with unilateral genu valgum

OBJECTIVE

Genu valgum is a common knee deformity in growing children. It alters the alignment of the lower extremity, body posture, and gait pattern of the children. Understanding of kinematic and kinetic parameters of gait in genu valgum is essential for planning and implementing the intervention to correcting the valgus deformity. The aim of this paper is to investigate the kinetic and kinematic gait differences in children with genu valgum.

PATIENTS AND METHODS

A 13-year old girl with left side unilateral genu valgum and a closely matched healthy counterpart were recruited to compare the kinetic and kinematic parameters of their gait performances, and they were captured by The VICON motion analysis system.

RESULTS

The results showed that the child with genu valgum had lower left and right knee angles (39.6˚; 30.2˚) and higher ankle angles (35.6˚; 28.4˚) than the healthy subject (64.2˚, 60.2˚). In addition, the child with genu valgum had lower moments on the left side of the knee (42.1 mm.N) than unaffected right knee (73.9 mm.N). Also, the ground reaction force was (0.7 N) lower in the affected knee of the child with genu valgum than the normal subject.

CONCLUSIONS

This study revealed that there were decreased knee and ankle moments and lower knee and ankle ground reaction forces in the affected genu valgum extremity when compared with the healthy counterpart. These changes might be responsible for the altering gait pattern of the child with genu valgum.

The effects of problem-solving skills training based on metacognitive principles for children with acquired brain injury attending mainstream schools: a controlled clinical trial

PURPOSE

To investigate the effects of an explicit problem-solving skills training programme based on metacognitive principles for children with acquired brain injury (ABI) who attend mainstream schools.

METHOD

Thirty-two children with moderate to severe ABI studying in mainstream schools were allocated randomly by matched pairs to either an experimental or a comparison group. The participants in the experimental group received problem-solving skills training based on metacognitive principles, while those in the comparison group were on a waiting list to receive the experimental intervention shortly after the intervention in the experimental group had been completed. All participants were measured pre- and post-intervention using measures of abstract reasoning, metacognition, problem-solving functional behaviour in the home environment or social situations and individual goal-directed behaviour.

RESULTS

Significant differences in post-test scores were found for all measurements between children in the experimental group and those in the comparison group, using the baselines of dependent variables, years of schooling and the full IQ scores as the covariates.

CONCLUSION

The results of this study supported the use of explicit problem-solving skills training to improve daily functioning for children with ABI, and the need for a larger-scale, randomised controlled study with long-term follow-up.

Air quality influence on chronic obstructive pulmonary disease (COPD) patients' quality of life

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death. The relationship between urban air pollution and its short-term health effects on patients suffering from COPD is confirmed. However, information about the impact of air pollutants upon the quality of life (QOL) in patients with COPD is lacking. Through a cross-sectional survey, this study investigates such impact in terms of the scores of the (Chinese) chronic respiratory questionnaire (CCRQ) and the measurements of indoor air quality (IAQ), lung function and Moser's activities of daily living (ADL). Using Yule's Q statistic with a cutoff |Q|>0.7 to identify the strong relationships between environmental parameters and CRQ sub-scores, this study reveals that patient emotion is strongly associated with indoor environmental quality although the evidence of a causal relationship between them needs further research.

PRACTICAL IMPLICATIONS

As QOL in patients with COPD and indoor environmental parameters are strongly associated, indoor air pollutants must be monitored for related studies in the future.