Use of gait analysis to demonstrate benefits of footwear assessment in elderly people Finley O, van de Meer DC and Beringer TRO Gait analysis is a practice issue that nurses are rarely involved in. Yet when helping a patient to mobilize, their footwear will have a direct effect on their confidence, balance, stability and functional ability. This study of 60 older people indicates the important benefits that are gained from using gait analysis as part of the physiotherapy assessment along with an evaluation of the footwear used. The research was carried out at the Royal Victoria Hospital in Belfast. The clients underwent a footwear assessment on their first contact with the physiotherapy department, were given advice on appropriate footwear and new footwear was supplied if appropriate. This increased the maximum potential of the physiotherapy sessions and probably reduced the risk of falls due to poor footwear. The article includes a literature-based guideline to appropriate footwear for older people and a review-based table on the 'important elements of function of the foot'. The study was carried out over a 2-week period, evaluating each participant's gait comparing their walking in no shoes, their normal footwear and the recommended supplied footwear. The participants' functional ability was assessed along with the use of a mental test questionnaire and the Barthel index of activities of living. Although approximately 25% of the sample were not willing to buy the recommended shoes, 60% of those who were supplied, continued to wear their shoes. This reflects previous studies on compliance with NHS footwear. This study has three key messages: 9 'for elderly people appropriate footwear improves foot stability and increases the walking speed'. 9 we need to give 'guidelines on suitable footwear for older people'. 9 that a 'well managed footwear service within the physiotherapy department, supplying ready to wear shoes, is much less costly than NHS prescribed shoes'. While the participants in this study, were older people who presented with a variety of reasons for reduced mobility, the implications for improving the mobility of orthopaedic patients, particularly the elderly, are clear. While this is a physiotherapy remit in most hospitals, orthopaedic nurses should equally understand the implications.
Physiotherapy 1998; 5(8) 451-456 I of Orthopaedic Nursing (I 999) 3, 230-231 9 1999Harcourt PublishersLtd
Patient perceptions of rheumatoid arthritis Bath J, Hooper J, Steel D, Reed E, Giles M and Woodland J The educational programme ASMP (arthritis serfmanagement programme) is based on improving the client's feeling of control over their lives. It focuses on:
9 pain management 9 9 9 9
fitness and mobility understanding medications dealing with depression the d o c t o r - patient relationship.
The programme appears to be having a very positive effect and benefit for patients. This article is an overview of the research that evolved from the use of this programme. It is part of a larger study aimed at assessing the psychological needs of the patient and the role of the rheumatology nurse in this provision. Rheumatology nurses were first asked what they perceived as the issues faced by patients with rheumatoid arthritis. These were the basis of semistructured interviews with 15 patients who were asked about medication, pain, well being, social support, activity and mobility, information and work. The qualitative data obtained offers an insight into the problems and experiences of daily life for these individuals. This is presented in an appropriate format using the patients' own words. The potential and actual roles of the rheumatology nurse are not discussed and the issues of psychological care are not explored in this is part of the study. The conclusion is that the interaction between key concerns need to be seen as being individually important, as well as the potential for each aspect to have an impact on the others. This appears to be self-evident but confirms the assumptions made in practice.
Nursing Standard 1999; 14(3): 35-38
The brittle bone syndrome; an update Smith R This article is aimed at medical staff. The biochemistry, molecular changes, bone biology and collagen pathology content may be an initial distracter for some readers. However, the material is of interest and is related to the diagnosis, treatments and rehabilitation of clients with osteogenesis imperfect (OI). The article discusses each of these areas briefly in relation to the developments over the last 4 years.