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Reliability of Pressurestat™ for measuring plantar foot pressures in patients with rheumatoid arthritis
670
Abstracts / Clinical Biomechanics 23 (2008) 662–720
repeated runs. The effects of creep were significantly less marked than with FSA. Differences between measured and applied average pressures ranged from 4% to 6.8% of the applied pressure with the Novel system, compared with a range of 18.4% to 20.2% with FSA. Readings of average pressure with the Novel system increased by up to 3.7% of the initial pressure reading over a period of 30 min compared with 20.9% with FSA. Differences between measured and applied peak pressures ranged from 4.3% to 68.8% of the applied pressure with the FSA system, compared with a range of 3.1– 31.2% with Novel. Averaged over the five runs and the 30-min test period, error in peak pressure for the FSA system was between 28.7% and 56.7% compared with a range of 8.6–18.7% for Novel. Conclusion The superior accuracy and repeatability of the Novel system indicate that it should be considered the pressure mapping device of choice in clinical and research settings. References Fuhrer, M.J., Garber, S.L., Rintala, D.H., Clearman, R., Hart, K.A., 1993. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Archives of Physical Medicine and Rehabilitation 74 (11), 1172–1177. O’Connor, K., 2005. Pressure ulcers. In: DeLisa, J.A., et al. (Eds.), Physical Medicine and Rehabilitation: Principles and Practice, Lippincott Williams & Wilkins 4th ed., vol. 2. pp. 1605–1618.
rider and the horse. For measurements, the pressure measuring pad (Pliance System, Novel) was used directly on the horse’s back. We measured a group of five healthy subjects without earlier riding experience (in a healthy subject we assume normal motor abilities, without the bias of any health deficiency) at the first and the sixth sessions of hippotherapy at the walk. In each session the physiotherapist assisted from behind and corrected the posture of each subject. Results The cycle of pressure distribution in hippotherapy has similar characteristics as the pressures occurring during athletic horse riding. In the first measurement the range of total power is between 568 and 406 N, the maximal pressure varies from 1.31 to 1.84 N m 2 and minimum from 0.38 to 0.44 N m 2. Six hippotherapy sessions later, the results of the second measurement were in the range of total power between 639 and 453 N, the maximal pressure varied from 1.59 to 2.1 N m 2 and minimum from 0.41 to 0.49 N m 2. Discussion The effect of six sessions of training was an increase in forces on the horse’s back, which we assume is due to the increased contact between horse and rider as the excitement and stress of the new situation and movement activity recedes.
doi:10.1016/j.clinbiomech.2008.03.010 doi:10.1016/j.clinbiomech.2008.03.011
Pressure forces created by the contact of a rider’s body on the horse’s back during hippotherapy T. Dvorakova a, Ch Peham b, M. Janura a,b a
Palacky University Olomouc, Department of Biomechanics and Engineering Cybernetics, Faculty of Physical Culture, Czech Republic b University of Veterinary Medicine Vienna, Clinic of Orthopaedics in Ungulates, Austria Introduction One of the most important tasks of a therapist practicing hippotherapy is to induce ‘‘a movement dialogue” between the horse and the client. It takes some time until the client adapts to the movement of the horse. The appropriate movement pattern of the client is built over time. As soon as this happens, we can say that the therapy has a neuro-physiological effect. Aims and method Our study describes how the increasing experience of the rider changes the cyclic pressure distribution between the
Reliability of PressurestatTM for measuring plantar foot pressures in patients with rheumatoid arthritis Jill Firth a, Deborah E. Turner b, Wendy Smith b, Philip S. Helliwell c, Jim Woodburn d a
School of Health Care Studies, University of Leeds, Leeds, United Kingdom b Department of Podiatry, University of Huddersfield, Huddersfield, United Kingdom c Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, United Kingdom d HealthQWest, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
Introduction Plantar pressure measurement (PPM) is used to assess foot function and as a screening tool to establish risk for tissue injury in the ‘at risk’ foot. The routine use of PPM is yet to be fully realized and one barrier may be the perceived reliance on costly specialist equipment. More recently, several semi-quantitative PPM systems have been
Abstracts / Clinical Biomechanics 23 (2008) 662–720
developed for the purpose of wider routine clinical use. These systems are relatively inexpensive and easy to use. Some reliability work has been undertaken in the area of the identification of high plantar pressures (potential risk sites for ulceration) in the diabetic foot (Van-Schie et al., 1999) but reliability of these pressure measurement systems in the RA foot has not been established. Objectives (1) Establish the inter and intra-tester reliability of peak pressure quantification using PressurestatTM (a semiquantitative method). (2) Establish the relationship between peak pressures collected using PressurestatTM and EMED-ST systems.
671
0.51, 0.33 and 0.43 for observers 1–4, respectively. Agreement varied by region assessed. For the forefoot, observers had 62% complete agreement, for the mid-foot 45%, and the rearfoot 51%. Conclusion Pressure data obtained with the PressurestatTM system in patients with rheumatoid arthritis is imprecise. This study has shown fair to moderate intra- and inter-observer agreement when reading the PressurestatTM prints with some evidence of a learning effect. References Van-Schie et al., 1999. Diabetic Medicine 16, 154–159. doi:10.1016/j.clinbiomech.2008.03.012
Materials and methods Ten RA patients were recruited. Simultaneous barefoot plantar pressure measurements were recorded from the PressurestatTM (Footlogic Inc., NY, USA) and EMED-ST (Novel, GmbH, Munich, Germany) systems using a first step method. Six regions of foot were selected for analysis (two each for the forefoot, midfoot and rearfoot). Four independent examiners quantified the peak pressure in each of the regions on the PressurestatTM using the calibration card provided on two separate occasions at least one week apart. The absolute peak pressure values in each mask region were determined from the EMED-ST platform by masking in the same manner using a real size plantar pressure printout. Inter- and intra-tester reliability were established for each subject using j statistics. Results The raw PressurestatTM readings consistently exceeded those obtained by the Emed system, whether average (the mean of the range given by the PressurestatTM) or maximum values were used (median differences 266 kPa and 370 kPa for mean and maximum readings). Correcting the PressurestatTM scores for ‘background noise’ (not suggested by manufacturer) inverted and improved these figures (median differences: 100 kPa and 55 kPa for mean and maximum). Inter-observer j values are provided in Table 1 (first and second readings). Intra-observer kappa values were 0.57,
Does diabetes interfere with ankle-joint function? C. Giacomozzi a, V. Macellari a, E. D’Ambrogi b, L. Uccioli a a
Department of Technology and Health, Istituto Superiore di Sanita`, Rome, Italy b Department of Internal Medicine, University of Rome ‘‘Tor Vergata”, Rome, Italy
Introduction The biomechanics of the diabetic foot undergo significant changes due to anatomical and functional alterations of somatosensory, muscular, tendinous, ligamentous and bony structures of the foot–ankle complex. Such changes might seriously impair gait and heavily contribute to the development of abnormal foot loading. Measurement equipments and protocols were purposely set up and specialised in the present study to assess the function of the diabetic foot–ankle complex under controlled conditions. With the patient seated and the foot unloaded, the measurements were taken of 3D ranges of motion and of 3D moments of force during maximal voluntary isometric contractions. Alterations of ankle-joint function were then associated with alterations of peak vertical forces during walking. While isokinetic studies had already been disseminated which deal with diabetes, results of isometric investigations, if present, are still unknown. Materials and methods
Table 1 Inter-observer j values at first and second reading
Obs1 Obs2 Obs3
Obs2
Obs3
Obs4
0.45/0.59
0.26/0.38 0.27/0.30
0.37/0.49 0.43/0.47 0.38/0.21
Sixty-one diabetic patients and 21 controls were included in the study. Patients were divided into four groups: 27 diabetics without neuropathy (D), 19 with neuropathy (DN), 15 with previous neuropathic ulcers (DPU). The level of neuropathy was assessed by using
Abstracts / Clinical Biomechanics 23 (2008) 662–720
repeated runs. The effects of creep were significantly less marked than with FSA. Differences between measured and applied average pressures ranged from 4% to 6.8% of the applied pressure with the Novel system, compared with a range of 18.4% to 20.2% with FSA. Readings of average pressure with the Novel system increased by up to 3.7% of the initial pressure reading over a period of 30 min compared with 20.9% with FSA. Differences between measured and applied peak pressures ranged from 4.3% to 68.8% of the applied pressure with the FSA system, compared with a range of 3.1– 31.2% with Novel. Averaged over the five runs and the 30-min test period, error in peak pressure for the FSA system was between 28.7% and 56.7% compared with a range of 8.6–18.7% for Novel. Conclusion The superior accuracy and repeatability of the Novel system indicate that it should be considered the pressure mapping device of choice in clinical and research settings. References Fuhrer, M.J., Garber, S.L., Rintala, D.H., Clearman, R., Hart, K.A., 1993. Pressure ulcers in community-resident persons with spinal cord injury: prevalence and risk factors. Archives of Physical Medicine and Rehabilitation 74 (11), 1172–1177. O’Connor, K., 2005. Pressure ulcers. In: DeLisa, J.A., et al. (Eds.), Physical Medicine and Rehabilitation: Principles and Practice, Lippincott Williams & Wilkins 4th ed., vol. 2. pp. 1605–1618.
rider and the horse. For measurements, the pressure measuring pad (Pliance System, Novel) was used directly on the horse’s back. We measured a group of five healthy subjects without earlier riding experience (in a healthy subject we assume normal motor abilities, without the bias of any health deficiency) at the first and the sixth sessions of hippotherapy at the walk. In each session the physiotherapist assisted from behind and corrected the posture of each subject. Results The cycle of pressure distribution in hippotherapy has similar characteristics as the pressures occurring during athletic horse riding. In the first measurement the range of total power is between 568 and 406 N, the maximal pressure varies from 1.31 to 1.84 N m 2 and minimum from 0.38 to 0.44 N m 2. Six hippotherapy sessions later, the results of the second measurement were in the range of total power between 639 and 453 N, the maximal pressure varied from 1.59 to 2.1 N m 2 and minimum from 0.41 to 0.49 N m 2. Discussion The effect of six sessions of training was an increase in forces on the horse’s back, which we assume is due to the increased contact between horse and rider as the excitement and stress of the new situation and movement activity recedes.
doi:10.1016/j.clinbiomech.2008.03.010 doi:10.1016/j.clinbiomech.2008.03.011
Pressure forces created by the contact of a rider’s body on the horse’s back during hippotherapy T. Dvorakova a, Ch Peham b, M. Janura a,b a
Palacky University Olomouc, Department of Biomechanics and Engineering Cybernetics, Faculty of Physical Culture, Czech Republic b University of Veterinary Medicine Vienna, Clinic of Orthopaedics in Ungulates, Austria Introduction One of the most important tasks of a therapist practicing hippotherapy is to induce ‘‘a movement dialogue” between the horse and the client. It takes some time until the client adapts to the movement of the horse. The appropriate movement pattern of the client is built over time. As soon as this happens, we can say that the therapy has a neuro-physiological effect. Aims and method Our study describes how the increasing experience of the rider changes the cyclic pressure distribution between the
Reliability of PressurestatTM for measuring plantar foot pressures in patients with rheumatoid arthritis Jill Firth a, Deborah E. Turner b, Wendy Smith b, Philip S. Helliwell c, Jim Woodburn d a
School of Health Care Studies, University of Leeds, Leeds, United Kingdom b Department of Podiatry, University of Huddersfield, Huddersfield, United Kingdom c Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, United Kingdom d HealthQWest, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
Introduction Plantar pressure measurement (PPM) is used to assess foot function and as a screening tool to establish risk for tissue injury in the ‘at risk’ foot. The routine use of PPM is yet to be fully realized and one barrier may be the perceived reliance on costly specialist equipment. More recently, several semi-quantitative PPM systems have been
Abstracts / Clinical Biomechanics 23 (2008) 662–720
developed for the purpose of wider routine clinical use. These systems are relatively inexpensive and easy to use. Some reliability work has been undertaken in the area of the identification of high plantar pressures (potential risk sites for ulceration) in the diabetic foot (Van-Schie et al., 1999) but reliability of these pressure measurement systems in the RA foot has not been established. Objectives (1) Establish the inter and intra-tester reliability of peak pressure quantification using PressurestatTM (a semiquantitative method). (2) Establish the relationship between peak pressures collected using PressurestatTM and EMED-ST systems.
671
0.51, 0.33 and 0.43 for observers 1–4, respectively. Agreement varied by region assessed. For the forefoot, observers had 62% complete agreement, for the mid-foot 45%, and the rearfoot 51%. Conclusion Pressure data obtained with the PressurestatTM system in patients with rheumatoid arthritis is imprecise. This study has shown fair to moderate intra- and inter-observer agreement when reading the PressurestatTM prints with some evidence of a learning effect. References Van-Schie et al., 1999. Diabetic Medicine 16, 154–159. doi:10.1016/j.clinbiomech.2008.03.012
Materials and methods Ten RA patients were recruited. Simultaneous barefoot plantar pressure measurements were recorded from the PressurestatTM (Footlogic Inc., NY, USA) and EMED-ST (Novel, GmbH, Munich, Germany) systems using a first step method. Six regions of foot were selected for analysis (two each for the forefoot, midfoot and rearfoot). Four independent examiners quantified the peak pressure in each of the regions on the PressurestatTM using the calibration card provided on two separate occasions at least one week apart. The absolute peak pressure values in each mask region were determined from the EMED-ST platform by masking in the same manner using a real size plantar pressure printout. Inter- and intra-tester reliability were established for each subject using j statistics. Results The raw PressurestatTM readings consistently exceeded those obtained by the Emed system, whether average (the mean of the range given by the PressurestatTM) or maximum values were used (median differences 266 kPa and 370 kPa for mean and maximum readings). Correcting the PressurestatTM scores for ‘background noise’ (not suggested by manufacturer) inverted and improved these figures (median differences: 100 kPa and 55 kPa for mean and maximum). Inter-observer j values are provided in Table 1 (first and second readings). Intra-observer kappa values were 0.57,
Does diabetes interfere with ankle-joint function? C. Giacomozzi a, V. Macellari a, E. D’Ambrogi b, L. Uccioli a a
Department of Technology and Health, Istituto Superiore di Sanita`, Rome, Italy b Department of Internal Medicine, University of Rome ‘‘Tor Vergata”, Rome, Italy
Introduction The biomechanics of the diabetic foot undergo significant changes due to anatomical and functional alterations of somatosensory, muscular, tendinous, ligamentous and bony structures of the foot–ankle complex. Such changes might seriously impair gait and heavily contribute to the development of abnormal foot loading. Measurement equipments and protocols were purposely set up and specialised in the present study to assess the function of the diabetic foot–ankle complex under controlled conditions. With the patient seated and the foot unloaded, the measurements were taken of 3D ranges of motion and of 3D moments of force during maximal voluntary isometric contractions. Alterations of ankle-joint function were then associated with alterations of peak vertical forces during walking. While isokinetic studies had already been disseminated which deal with diabetes, results of isometric investigations, if present, are still unknown. Materials and methods
Table 1 Inter-observer j values at first and second reading
Obs1 Obs2 Obs3
Obs2
Obs3
Obs4
0.45/0.59
0.26/0.38 0.27/0.30
0.37/0.49 0.43/0.47 0.38/0.21
Sixty-one diabetic patients and 21 controls were included in the study. Patients were divided into four groups: 27 diabetics without neuropathy (D), 19 with neuropathy (DN), 15 with previous neuropathic ulcers (DPU). The level of neuropathy was assessed by using