Adherence of patients to treatment and appropriateness of prescribed footwear are mandatory for successful prevention of Diabetic foot ulceration. In a Public Healthcare Service, footwear approval is under the respons...Adherence of patients to treatment and appropriateness of prescribed footwear are mandatory for successful prevention of Diabetic foot ulceration. In a Public Healthcare Service, footwear approval is under the responsibility of the clinician. In some cases kinetic measurements are taken inside the shoes to support the clinical decision;however, an overall agreement is still missing with respect to a simple, reliable and effective test protocol based on proper threshold values. Authors’ past experiences, specific needs of the Diabetic outpatient service, and suggestions from valuable literature led to an instrumental test protocol based on reference peak pressure (PP) thresholds and gait line (GL) specific for each level of risk. Permission was obtained for one preliminary validation session at the Authors’ outpatient service, during which 11 patients at high/very high risk of ulceration were examined—9 for testing new footwear, 2 for monitoring 12-month-old footwear. The protocol was well accepted by patients and operators, fast and easy to be used. Based on the instrumental, clinical and visual inspection data;4 new footwear did not pass the test;5 passed the test but integration or minor changes were requested;the 2 old footwear were found no more effective. As a first positive feedback, after 4 months of wearing the modified prescriptions none of the patients had developed plantar ulcers or signs of tissue damage. Successive data processing proved that in all patients altered PPs and deviated GLs did correlate with alterations of other kinetic parameters. The protocol, which is proved to be sensitive and valuable for the Diabetic foot care, may have a general validity;the delivered specific PP thresholds and reference data, instead, can be reliably used if the test is performed with a calibrated Pedar Insole System and with the wide Insoles in the range UW-YW (EU size 36 - 45).展开更多
目的:研究爱丁堡观察性步态评估量表(Edinburgh visual gait score,EVGS)的信度,并与三维步态分析进行比较,评价其有效性;同时分析EVGS各项内部以及与脑性瘫痪(cerebral palsy,CP)儿童粗大运动功能分级系统(gross motor function classi...目的:研究爱丁堡观察性步态评估量表(Edinburgh visual gait score,EVGS)的信度,并与三维步态分析进行比较,评价其有效性;同时分析EVGS各项内部以及与脑性瘫痪(cerebral palsy,CP)儿童粗大运动功能分级系统(gross motor function classification system,GMFCS)的相关性,为EVGS在临床应用提供客观依据。方法:从2019年至2021年所有在同济大学附属养志康复医院三维步态分析实验室进行三维步态分析的727例痉挛型CP儿童中随机抽取20例CP,分别由4名不同经验背景的评估者采用EVGS对20例CP的步行视频进行评估,并在间隔1个月后再次评估同一视频。采用同类相关系数分析(intragroup correlation coefficient,ICC)检验4名评估者的间信度,以及同一评估者的重测信度;采用Spearman等级相关系数检验EVGS总分及各项与三维步态分析数据和GMFCS之间的相关性。结果:评估者间第一次评估ICC值为0.947(P<0.001),第二次评估ICC值为0.952(P<0.001),两次评定结果均显示不同评估者对同一组视频采用EVGS的一致性结果较好。各评估者前后两次重测结果显示ICC系数均≥0.75(P<0.0010),表明间隔1个月,同一评估者前后两次评估结果具有较高一致性。相关性分析结果发现,EVGS与三维步态分析结果为中等相关,在校学生评估的总分与校标相关性最大。EVGS与GMFCS等级具有相关性。EVGS各项内相关性分析结果表明,足、骨盆及躯干控制的评估分项对EVGS评估整体步态的结果具有影响。结论:EVGS量表的评估者间信度以及同一评估者重测信度均具有较高可信性,未有丰富的临床经验背景下的评估者使用EVGS同样可以达到较高信效度。相关性分析结果表明,EVGS评估结果的准确性仍存在不足,EVGS评估结果与CP儿童运动功能障碍水平具有相关性,在设备有限情况下,EVGS可以作为步态分析的替补工具,是目前较为可靠的观察性步态评估量表之一。展开更多
文摘Adherence of patients to treatment and appropriateness of prescribed footwear are mandatory for successful prevention of Diabetic foot ulceration. In a Public Healthcare Service, footwear approval is under the responsibility of the clinician. In some cases kinetic measurements are taken inside the shoes to support the clinical decision;however, an overall agreement is still missing with respect to a simple, reliable and effective test protocol based on proper threshold values. Authors’ past experiences, specific needs of the Diabetic outpatient service, and suggestions from valuable literature led to an instrumental test protocol based on reference peak pressure (PP) thresholds and gait line (GL) specific for each level of risk. Permission was obtained for one preliminary validation session at the Authors’ outpatient service, during which 11 patients at high/very high risk of ulceration were examined—9 for testing new footwear, 2 for monitoring 12-month-old footwear. The protocol was well accepted by patients and operators, fast and easy to be used. Based on the instrumental, clinical and visual inspection data;4 new footwear did not pass the test;5 passed the test but integration or minor changes were requested;the 2 old footwear were found no more effective. As a first positive feedback, after 4 months of wearing the modified prescriptions none of the patients had developed plantar ulcers or signs of tissue damage. Successive data processing proved that in all patients altered PPs and deviated GLs did correlate with alterations of other kinetic parameters. The protocol, which is proved to be sensitive and valuable for the Diabetic foot care, may have a general validity;the delivered specific PP thresholds and reference data, instead, can be reliably used if the test is performed with a calibrated Pedar Insole System and with the wide Insoles in the range UW-YW (EU size 36 - 45).
