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  • 1.
    Amer, Ahmed
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Jarl, Gustav M
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    The effect of insoles on foot pain and daily activities2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 6, p. 474-480Article in journal (Other academic)
    Abstract [en]

    BACKGROUND:

    Foot pain decreases individuals' ability to perform daily activities. Insoles are often prescribed to reduce the pain which, in turn, may promote return to normal activities.

    OBJECTIVES:

    To evaluate the effects of insoles on foot pain and daily activities, and to investigate the relationship between individuals' satisfaction with insoles and actual use of them.

    STUDY DESIGN:

    A 4-week pre-post intervention follow-up.

    METHODS:

    Brief Pain Inventory, International Physical Activity Questionnaire and Lower Extremities Functional Status were used as outcome measures. Client Satisfaction with Device was used in the follow-up.

    RESULTS:

    A total of 67 participants answered the questionnaires (81% women). Overall, a reduction in Pain Severity (p = 0.002) and Pain Interference (p = 0.008) was shown. Secondary analyses revealed a significant effect only in women. No changes in daily activities (Walking, p = 0.867; Total Physical Activity, p = 0.842; Lower Extremities Functional Status, p = 0.939) could be seen. There was no relation between Client Satisfaction with Device measures and duration of insole use. A difference in sex was shown; women scored higher than men on Pain Severity.

    CONCLUSION:

    Insoles reduce pain and pain interference with daily activities for women with foot pain. Satisfaction with the insoles is not a predictor of actual insole use. The effect of insoles on activity performance needs further study.

    CLINICAL RELEVANCE:

    This study provides evidence for prescribing insoles to people with foot pain. Nonetheless, insoles are not enough to increase their physical activity level in the short term. Satisfaction with insoles and duration of use are not correlated and cannot be inferred from each other.

  • 2.
    Amer, Ahmed
    et al.
    University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Kakooza-Mwesige, A.
    Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda; Mulago Hospital, Kampala, Uganda; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Jarl, Gustav
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Tumwine, J. K.
    Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda; Mulago Hospital, Kampala, Uganda.
    Forssberg, H.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Eliasson, A.-C.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    The Ugandan version of the Pediatric Evaluation of Disability Inventory (PEDI-UG). Part II: Psychometric properties2018In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 44, no 4, p. 562-571Article in journal (Refereed)
    Abstract [en]

    Background: The Pediatric Evaluation of Disability Inventory (PEDI) has been recommended as a gold standard in paediatric rehabilitation. A Ugandan version of PEDI (PEDI-UG) has been developed by culturally adapting and translating the original PEDI. The aim of this study was to investigate the psychometric properties of the PEDI-UG in Ugandan children by testing the instrument's rating scale functioning, internal structure, and test-retest reliability.

    Methods: Two hundred forty-nine Ugandan children (125 girls) aged 6 months to 7.5 years (Mean = 3.4, SD = 1.9) with typical development were tested using the PEDI-UG. Forty-nine children were tested twice to assess test-retest reliability. Validity was investigated by Rasch analysis and reliability by intraclass correlation coefficient.

    Results: The PEDI-UG domains showed good unidimensionality based on principal component analysis of residuals. Most activities (95%) showed acceptable fit to the Rasch model. Six misfit items were deleted from the Functional Skills scales and one from the Caregiver Assistance scales. The category steps on the Caregiver Assistance scales' rating scale were reversed but functioned well when changed from a 6-point to 4-point rating scale. The reliability was excellent; intraclass correlation coefficient was 0.87-0.92 for the domains of the Functional Skills scales and 0.86-0.88 for the domains of the Caregiver Assistance scales.

    Conclusion: The PEDI-UG has good to excellent psychometric properties and provides a valid measure of the functional performance of typically developing children from the age of 6 months to 7.5 years in Uganda. Further analysis of all items, including misfit and deleted items, in children with functional disability is recommended.

  • 3.
    Jarl, Gustav
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Decision trees for risk stratification of the diabetic foot2018In: The Diabetic foot journal, ISSN 1462-2041, Vol. 21, no 4, p. 218-223Article in journal (Refereed)
    Abstract [en]

    Delays in referral from primary to specialist care are a common issue in the clinical management of diabetic foot (DF) disease and are associated with worse clinical outcomes. One of the reasons for the delays may be the complexity of risk stratification, which can leave clinicians who are not specialised in the DF uncertain about when to refer patients for specialist assessment. This article illustrates how risk stratification can be simplified with the use of decision trees. Two decision trees are given as examples: one based on the risk stratification system of the Scottish Diabetes Foot Action Group and one based on the National Institute for Health and Care Excellence guideline. Decision trees can be used to facilitate correct risk stratifications and the referral of people with DF complications, and thereby hopefully contribute to improved outcomes for people with DF disease.

  • 4.
    Jarl, Gustav
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics.
    Methodological considerations of investigating adherence to using offloading devices among people with diabetes2018In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, p. 1767-1775Article in journal (Refereed)
    Abstract [en]

    Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to measure adherence have defined adherence as the number of steps taken with the device, which excludes weight-bearing activities where no steps are taken. Conceptual frameworks are not made explicit in the current quantitative research. It is concluded that future studies should use a longitudinal design with observational studies to identify patient groups prone to nonadherence and factors that influence adherence and experimental studies to evaluate interventions to improve adherence, focusing on these patient groups and factors. Furthermore, adherence should be defined in terms of relative adherence to using offloading devices during all weight-bearing activities, and objective measurement of adherence ( using accelerometers and temperature monitors) should be used whenever possible. Clearly defined conceptual frameworks should guide the choice of factors to include in the study and the analysis of their interactions. By implementing these recommendations, research could provide a stronger evidence base in the future, supporting interventions to increase adherence and thereby improve outcomes for people with diabetic foot complications.

  • 5.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics; University Health Care Research Center.
    Alnemo, John
    Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Tranberg, Roy
    Department of Orthopaedics, Institute of Clinical Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Gender differences in attitudes and attributes of people using therapeutic shoes for diabetic foot complications2019In: Journal of Foot and Ankle Research, ISSN 1757-1146, Vol. 12, article id 21Article in journal (Refereed)
    Abstract [en]

    Background: Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.

    Methods: A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using t-tests, Mann-Whitney U tests and chi-square tests with Fischer's exact tests. P-values<0.05 were considered statistically significant.

    Results: Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2years) were analyzed. More men than women (p<0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non-significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self-efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.

    Conclusions: Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.

  • 6.
    Jarl, Gustav
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Heinemann, Allen W.
    Rehabilitation Institute of Chicago, USA.
    Lindner, Helen Y.N.
    Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden.
    Norling Hermansson, Liselotte M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Northwestern University Feinberg School of Medicine, Chicago, USA.
    Cross-cultural validity and differential item functioning of theOrthotics and Prosthetics Users’ Survey with Swedish and Americanusers of lower limb prosthesisManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users’ Survey (OPUS), to investigate differential item functioning (DIF) in the OPUS related to sex, age, amputation level and amputated sides (unilateral or bilateral), and to determine the known-group validity of the OPUS.

    Design: Cross-sectional study design.

    Setting: 2 outpatient clinics in Sweden and 7 outpatient clinics in the United States.

    Participants: A total of 195 Swedish and 126 American adults using lower limb prosthesis.

    Interventions: Not applicable.

    Main Outcome Measure: 4 modules from the OPUS were used in this study, including the Lower extremity functional status (LEFS), Client satisfaction with device (CSD), Client satisfaction with services (CSS), and Health-related quality of life (HRQoL) modules. Items were scored on 4- or 5-level Likert scales, and a Rasch measure was calculated for each person and module.

    Results: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of the CSD and CSS needed adjustments, and the unidimensionality of the CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for age in the LEFS and for the level of amputation in the CSD.

    Conclusions: This study supports the validity of comparing OPUS measures between Sweden and USA and between patient groups with different demographic characteristics. The OPUS can, to some extent, discriminate between patient groups known to be different. The unidimensionality of the CSD and CSS modules is weaker than the other modules and these need further development and evaluation.

  • 7.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hellstrand Tang, Ulla
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nordén, Erika
    Ottobock, Medical Care Sweden, Stockholm, Sweden.
    Johannesson, Anton
    Össur Clinics Scandinavia, Stockholm, Sweden.
    Rusaw, David Francis
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument2019In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality.

    OBJECTIVES: The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries.

    STUDY DESIGN: Systematic review.

    METHODS: Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated.

    RESULTS:  < 0.001).

    CONCLUSION: Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation.

    CLINICAL RELEVANCE: The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.

  • 8.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Department of Prosthetics and Orthotics.
    A modified walk-in system versus scheduled appointments in a secondary-care prosthetic and orthotic clinic2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 483-489Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Waiting is common in health care, delays intervention, and has negative effects on satisfaction with services.

    OBJECTIVES: To evaluate effects of a modified walk-in system, where patients were invited consecutively from the waiting list to attend the clinic on a walk-in basis, on waiting times, services, and work environment.

    STUDY DESIGN: Parallel-group trial.

    METHODS: In all, 1286 consecutive patients in need of shoe insoles were randomized to waiting lists for modified walk-in ( n = 655) or a scheduled appointment ( n = 631). Seven staff members also participated.

    RESULTS: The median indirect waiting time to first appointment was 40 days shorter for modified walk-in (135 days) than for scheduled appointment (175 days; p < 0.001); 17% of those randomized to modified walk-in did not attend the clinic compared to 6% for scheduled appointment ( p < 0.001). Mean direct waiting time in the waiting room was 9.9 min longer for modified walk-in than for scheduled appointment ( p < 0.001). Patients attending modified walk-in or a scheduled appointment reported similar levels of satisfaction with services. Staff reported more support from co-workers with modified walk-in than with scheduled appointment ( p = 0.041).

    CONCLUSION: The modified walk-in can reduce indirect waiting times without any substantial worsening of direct waiting times, service quality, or work environment. Studies are needed to investigate why many patients drop out from modified walk-in. Clinical relevance A modified walk-in system can cut the queues and create more timely interventions by reducing indirect waiting times. This system can therefore be recommended in secondary-care prosthetic and orthotic clinics to reduce patients' suffering from their health condition.

  • 9.
    Jarl, Gustav
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey2014In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Background: The Orthotics and Prosthetics Users' Survey consists of five modules to assess outcomes of orthotic and prosthetic interventions: lower extremity functional status, upper extremity functional status, client satisfaction with device, client satisfaction with services and health-related quality of life.

    Objectives: To investigate the test-retest reliability and calculate the smallest detectable difference for all modules of the Swedish Orthotics and Prosthetics Users' Survey.

    Study design: Test-retest reliability study design.

    Methods: A total of 69 patients at a Department of Prosthetics and Orthotics completed Orthotics and Prosthetics Users' Survey on two occasions separated by a 2-week interval, giving 18 answers on lower extremity functional status, 41 on upper extremity functional status, 53 on client satisfaction with device, 12 on client satisfaction with services and 67 answers on health-related quality of life. Raw scores were converted into Orthotics and Prosthetics Users' Survey units on a 0-100 scale. Intra-class correlation coefficients, Bland-Altman plots, common person linking plots and t-tests of person mean measures were used to investigate the reliability. The 95% confidence level smallest detectable differences were calculated.

    Results: The intra-class correlation coefficients ranged from 0.77 to 0.96 for the modules, and no systematic differences were detected between the response occasions. The smallest detectable differences ranged from 7.4 to 16.6 units.

    Conclusions: The test-retest reliability was satisfactory for all Orthotics and Prosthetics Users' Survey modules. The smallest detectable difference was large on all modules except the health-related quality of life module.

    Clinical relevance: The Orthotics and Prosthetics Users' Survey modules are reliable and, thus, can be recommended for repeated measurements of patients over time. Relatively large changes are needed to achieve statistical significance when assessing individual patients.

  • 10.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Adherence to wearing therapeutic shoes among people with diabetes: a systematic review and reflections2016In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 10, p. 1521-1528Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Therapeutic shoes are prescribed to prevent diabetic foot ulcers, but adherence to wearing the shoes is often poor.

    Aim: The aim of this study was to review the literature on factors that are associated with adherence to wearing therapeutic shoes and construct a model of adherence to aid future research and development in the field.

    Methods: We conducted a systematic search in PubMed, CINAHL, and PsycINFO for quantitative studies on factors associated with adherence to wearing therapeutic shoes among people with diabetes.

    Results: Six studies were included in the review. The studies focused mainly on patient-, therapy-, and condition-related adherence factors. There is some evidence (three to five studies) that sex, diabetes duration, and ulcer history are not associated with adherence. The evidence for or against the other factors was weak (only one or two studies) or conflicting.

    Conclusion: There is no conclusive evidence for using any factor to predict adherence to wearing therapeutic shoes, but there is some evidence against using certain factors for predicting adherence. Future studies should include a broader range of factors, including health system and social/economic factors, and they should investigate perceived costs and benefits of wearing therapeutic shoes in comparison with other shoes or no shoes. A seesaw model is presented illustrating the complex phenomenon of adherence. Further research is needed to identify factors associated with adherence to wearing therapeutic shoes, to enable the development of interventions to improve adherence and thereby reduce ulceration rates among people with diabetic foot complications.

  • 11.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    An alternative perspective on assistive technology: the Person-Environment-Tool (PET) model2018In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614Article in journal (Refereed)
    Abstract [en]

    The medical and social models of disability are based on a dichotomy that categorizes people as able-bodied or disabled. In contrast, the biopsychosocial model, which forms the basis for the International Classification of Functioning, Disability and Health (ICF), suggests a universalistic perspective on human functioning, encompassing all human beings. In this article we argue that the artificial separation of function-enhancing technology into assistive technology (AT) and mainstream technology might be one of the barriers to a universalistic view of human functioning. Thus, an alternative view of AT is needed. The aim of this article was to construct a conceptual model to demonstrate how all human activities and participation depend on factors related to the person, environment, and tools, emphasizing a universalistic perspective on human functioning. In the Person-Environment-Tool (PET) model, a person's activity and participation are described as a function of factors related to the person, environment, and tool, drawing on various ICF components. Importantly, the PET model makes no distinction between people of different ability levels, between environmental modifications intended for people of different ability levels, or between different function-enhancing technologies (AT and mainstream technology). A fictive patient case is used to illustrate how the universalistic view of the PET model lead to a different approach in rehabilitation. The PET model supports a universalistic view of technology use, environmental adaptations, and variations in human functioning.

  • 12.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences.
    Beyond dichotomous thinking: a process perspective on diabetic foot disease2017In: Diabetic Foot & Ankle, ISSN 2000-625X, Vol. 8, no 1, article id 1380477Article in journal (Refereed)
    Abstract [en]

    Background: Diabetic foot (DF) disease causes severe suffering around the world, and appropriate self-care activities are needed to prevent and treat this condition. However, all too often, self-care activities are less than optimal and clinicians find themselves unable to influence them in a positive direction. Clinicians' and researchers' mental models of the DF tend to be dichotomous: either the patient has or does not have an active ulcer or other DF disease. This mode of thinking hides the long-term perspective of DF disease, where patients' previous experiences and expectations for the future influence their current behavior. Thus, there is a need for a different perspective on DF disease to better understand patients' perspectives and thereby improve self-care, leading to more effective prevention and treatment.

    Objective: To present a novel framework, the process perspective on the DF, which can explain inadequate self-care behaviors not easily understood with a dichotomous perspective, and how they can be changed.

    Results: Three fictive clinical examples are used to illustrate how the process perspective on the DF can be used to understand how patients' previous experiences and expectations for the future influence their current behavior. In particular, this process perspective is used to understand how patients' beliefs and behaviors are sometimes self-reinforcing, resulting in stable behavior patterns, here referred to as 'DF cycles'. These cycles are quite common in clinical practice but are difficult to analyze using a dichotomous perspective on DF disease. The process perspective on the DF is used to analyze specific 'vicious' DF cycles of inadequate patient behavior and to find ways to transform them into 'virtuous' DF cycles, resulting in effective prevention and treatment.

    Conclusions: The process perspective on the DF seems suitable for understanding inadequate patient behaviors not easily understood with a dichotomous perspective on DF disease, opening up new avenues for clinical practice and research to help patients live a life with long remission phases, few relapses, and a high quality of life.

  • 13.
    Jarl, Gustav M.
    Örebro University, School of Health and Medical Sciences.
    Den ortopedtekniska processen2011In: Ortopedteknik 2011, 2011Conference paper (Refereed)
  • 14.
    Jarl, Gustav M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The Orthotics and Prosthetics Users' Survey: translation and validity evidence for the Swedish version2014Doctoral thesis, comprehensive summary (Other academic)
    List of papers
    1. Translation and linguistic validation of the Swedish version of Orthotics and Prosthetics Users' Survey
    Open this publication in new window or tab >>Translation and linguistic validation of the Swedish version of Orthotics and Prosthetics Users' Survey
    2009 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 33, no 4, p. 329-338Article in journal (Refereed) Published
    Abstract [en]

    There is an increasing need for outcome measures in the orthotic and prosthetic field and specifically a lack of outcome measures in Swedish. The Orthotics and Prosthetics Users' Survey (OPUS) was developed in the USA for assessment of the outcome of orthotic and prosthetic interventions, and could potentially also be used for shoe insoles and orthopaedic shoes. The aims of this study were to translate OPUS into Swedish and test the translated version's linguistic validity in a Swedish context. The Orthotic and Prosthetic Users' Survey was translated into Swedish and back-translated into English, following a modified version of the World Health Organization guidelines. After revision of the Swedish version, 39 Swedish clients (12 men, 27 women) answered the OPUS questionnaires and were systematically debriefed afterwards. Most items were understood correctly by the respondents, but some words and expressions had to be changed to avoid misunderstandings or unintended interpretations. The resulting Swedish version of OPUS, OPUS-Swe, showed acceptable linguistic validity and has potential for use in both clinical practice and scientific settings. Nevertheless, before OPUS-Swe can be fully implemented, its psychometric properties need to be evaluated.

    National Category
    Medical and Health Sciences Surgery Orthopaedics
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-11990 (URN)10.3109/03093640903168123 (DOI)000276373400005 ()19961294 (PubMedID)
    Available from: 2010-10-04 Created: 2010-10-04 Last updated: 2019-03-27Bibliographically approved
    2. Validity evidence for a modified version of the Orthotics and Prosthetics Users' Survey
    Open this publication in new window or tab >>Validity evidence for a modified version of the Orthotics and Prosthetics Users' Survey
    2012 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 7, no 6, p. 469-478Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To evaluate the validity of a modified version of the Orthotics and Prosthetics Users' Survey (OPUS) with persons using different prosthetic and orthotic (P&O) devices.

    Method: Two-hundred-and-eighty-two adults using prosthesis, orthosis, shoe insoles or orthopaedic shoes completed OPUS. OPUS comprises five modules - Lower and Upper Extremity Functional Status, respectively (LEFS and UEFS), Client Satisfaction with Device and Services, respectively (CSD and CSS), and, Health-Related Quality of Life (HRQoL). Eight new items were added to LEFS and six to UEFS. Rasch analysis was used for data analyses.

    Results: Rating scales functioned satisfactory after some modifications. All modules demonstrated a ceiling effect. Unidimensionality was satisfactory after deleting some items and dividing HRQoL into two subscales, although somewhat weak on CSD and CSS. Item reliability was excellent for all modules and person reliability good for all but CSD and CSS. Some items demonstrated differential item functioning related to sex and age, but the impact on person measures was small.

    Conclusions: This study supports the validity of a modified version of OPUS for persons using different P&O devices, but also reveals limitations to be addressed in future studies. OPUS could be useful in clinical rehabilitation and research to evaluate P&O outcomes.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Taylor & Francis, 2012
    Keywords
    Activities of daily living, artificial limbs, orthotic devices, patient satisfaction, quality of life, treatment outcome, validation studies
    National Category
    Medical and Health Sciences Other Medical Sciences not elsewhere specified
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-26631 (URN)10.3109/17483107.2012.667196 (DOI)22439801 (PubMedID)2-s2.0-84867260774 (Scopus ID)
    Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2019-03-27Bibliographically approved
    3. Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey
    Open this publication in new window or tab >>Test-retest reliability of the Swedish version of the Orthotics and Prosthetics Users' Survey
    2014 (English)In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 38, no 1, p. 21-26Article in journal (Refereed) Published
    Abstract [en]

    Background: The Orthotics and Prosthetics Users' Survey consists of five modules to assess outcomes of orthotic and prosthetic interventions: lower extremity functional status, upper extremity functional status, client satisfaction with device, client satisfaction with services and health-related quality of life.

    Objectives: To investigate the test-retest reliability and calculate the smallest detectable difference for all modules of the Swedish Orthotics and Prosthetics Users' Survey.

    Study design: Test-retest reliability study design.

    Methods: A total of 69 patients at a Department of Prosthetics and Orthotics completed Orthotics and Prosthetics Users' Survey on two occasions separated by a 2-week interval, giving 18 answers on lower extremity functional status, 41 on upper extremity functional status, 53 on client satisfaction with device, 12 on client satisfaction with services and 67 answers on health-related quality of life. Raw scores were converted into Orthotics and Prosthetics Users' Survey units on a 0-100 scale. Intra-class correlation coefficients, Bland-Altman plots, common person linking plots and t-tests of person mean measures were used to investigate the reliability. The 95% confidence level smallest detectable differences were calculated.

    Results: The intra-class correlation coefficients ranged from 0.77 to 0.96 for the modules, and no systematic differences were detected between the response occasions. The smallest detectable differences ranged from 7.4 to 16.6 units.

    Conclusions: The test-retest reliability was satisfactory for all Orthotics and Prosthetics Users' Survey modules. The smallest detectable difference was large on all modules except the health-related quality of life module.

    Clinical relevance: The Orthotics and Prosthetics Users' Survey modules are reliable and, thus, can be recommended for repeated measurements of patients over time. Relatively large changes are needed to achieve statistical significance when assessing individual patients.

    Place, publisher, year, edition, pages
    Sage Publications, 2014
    Keywords
    Outcome assessment, reproducibility of results, activities of daily living, quality of life
    National Category
    Orthopaedics
    Identifiers
    urn:nbn:se:oru:diva-33756 (URN)10.1177/0309364613485113 (DOI)000329831700003 ()23652919 (PubMedID)2-s2.0-84896781609 (Scopus ID)
    Note

    Funding Agencies:

    Centre for Rehabilitation Research at Orebro County Council, Sweden  

    Research Committee at Orebro County Council, Sweden  

    Norrbacka-Eugenia Foundation, Sweden

    Available from: 2014-02-14 Created: 2014-02-14 Last updated: 2019-03-27Bibliographically approved
    4. Cross-cultural validity and differential item functioning of theOrthotics and Prosthetics Users’ Survey with Swedish and Americanusers of lower limb prosthesis
    Open this publication in new window or tab >>Cross-cultural validity and differential item functioning of theOrthotics and Prosthetics Users’ Survey with Swedish and Americanusers of lower limb prosthesis
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objective: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users’ Survey (OPUS), to investigate differential item functioning (DIF) in the OPUS related to sex, age, amputation level and amputated sides (unilateral or bilateral), and to determine the known-group validity of the OPUS.

    Design: Cross-sectional study design.

    Setting: 2 outpatient clinics in Sweden and 7 outpatient clinics in the United States.

    Participants: A total of 195 Swedish and 126 American adults using lower limb prosthesis.

    Interventions: Not applicable.

    Main Outcome Measure: 4 modules from the OPUS were used in this study, including the Lower extremity functional status (LEFS), Client satisfaction with device (CSD), Client satisfaction with services (CSS), and Health-related quality of life (HRQoL) modules. Items were scored on 4- or 5-level Likert scales, and a Rasch measure was calculated for each person and module.

    Results: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of the CSD and CSS needed adjustments, and the unidimensionality of the CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for age in the LEFS and for the level of amputation in the CSD.

    Conclusions: This study supports the validity of comparing OPUS measures between Sweden and USA and between patient groups with different demographic characteristics. The OPUS can, to some extent, discriminate between patient groups known to be different. The unidimensionality of the CSD and CSS modules is weaker than the other modules and these need further development and evaluation.

    Keywords
    rehabilitation, artificial limbs, outcome assessment (health care), validation studies, cross-cultural comparison
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-34968 (URN)
    Note

    Detta manuskript har bearbetats till en artikel som är under publicering i tidskriften Archives of Physical Medicine and Rehabilitation

    Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2019-03-27Bibliographically approved
  • 15.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Heinemann, Allen W
    Rehabilitation Institute of Chicago, Chicago IL, United States; Feinberg School of Medicine, Northwestern University, Chicago IL, United States.
    Lindner, Helen Y
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Cross-cultural validity and differential item functioning of the Orthotics and Prosthetics Users’ Survey with Swedish and American users of lower-limb prosthesis2015In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 96, no 9, p. 1615-1626Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the cross-cultural validity of the Orthotics and Prosthetics Users’ Survey (OPUS), to evaluate differential item functioning (DIF) related to country, sex, age, amputation level, and amputated side (unilateral, bilateral), and to determine known-group validity of the OPUS.

    Design: Survey.

    Setting: Outpatient clinics.

    Participants: The sample (NZ321) consisted of Swedish (nZ195) and U.S. (nZ126) adults using lower-limb prostheses.

    Interventions: Not applicable.

    Main Outcome Measures: Four OPUS modules were used: lower extremity functional status, client satisfaction with device (CSD), client satisfaction with services (CSS), and health-related quality of life. Rasch analysis was used to calculate measures for persons and items.

    Results: The cross-cultural validity was satisfactory. Many items demonstrated DIF related to country and demographic characteristics, but the impact on mean person measures was negligible. The rating scales of CSD and CSS needed adjustments, and the unidimensionality of CSD and CSS was weak. The differences between the mean measures of known patient groups were statistically significant for 2 out of 6 comparisons.

    Conclusions: This study supports the validity of OPUS measure comparisons between Sweden and the United States and between subgroups with different demographic characteristics. Some of the country-related DIF may reflect the different health care financing systems. The findings demonstrate that the OPUS can discriminate between certain patient groups. The results also challenge some of our preconceptions about persons with bilateral amputation, indicating that we might know these persons less well than we think.

  • 16.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    Heinemann, Allen W.
    Rehabilitation Institute, Chicago, USA; Nortwestern University Feinberg School of Medicine, Chicago, USA.
    Norling Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences. Centre for Rehabilitation Research, Örebro County Council, Örebro, Sweden; Department of Prosthetics and Orthotics, Örebro County Council, Örebro, Sweden.
    Validity evidence for a modified version of the Orthotics and Prosthetics Users' Survey2012In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 7, no 6, p. 469-478Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate the validity of a modified version of the Orthotics and Prosthetics Users' Survey (OPUS) with persons using different prosthetic and orthotic (P&O) devices.

    Method: Two-hundred-and-eighty-two adults using prosthesis, orthosis, shoe insoles or orthopaedic shoes completed OPUS. OPUS comprises five modules - Lower and Upper Extremity Functional Status, respectively (LEFS and UEFS), Client Satisfaction with Device and Services, respectively (CSD and CSS), and, Health-Related Quality of Life (HRQoL). Eight new items were added to LEFS and six to UEFS. Rasch analysis was used for data analyses.

    Results: Rating scales functioned satisfactory after some modifications. All modules demonstrated a ceiling effect. Unidimensionality was satisfactory after deleting some items and dividing HRQoL into two subscales, although somewhat weak on CSD and CSS. Item reliability was excellent for all modules and person reliability good for all but CSD and CSS. Some items demonstrated differential item functioning related to sex and age, but the impact on person measures was small.

    Conclusions: This study supports the validity of a modified version of OPUS for persons using different P&O devices, but also reveals limitations to be addressed in future studies. OPUS could be useful in clinical rehabilitation and research to evaluate P&O outcomes.

  • 17.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Heinemann, Allen W
    Rehabilitation Institute, Chicago and Northwestern University Feinberg School of Medicine, Chicago, USA.
    Norling Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Validity of the Swedish version of Orthotics and Prosthetics Users’ Survey2010Conference paper (Refereed)
  • 18.
    Jarl, Gustav M
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hermansson, Liselotte M
    Örebro University, School of Health and Medical Sciences.
    Translation and linguistic validation of the Swedish version of Orthotics and Prosthtics User’s Survey2008In: 5th Regional Central European ISPO Conference, 2008Conference paper (Refereed)
  • 19.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Hermansson, Liselotte M. N.
    Örebro University, School of Health and Medical Sciences.
    Översättning och språklig validering av svenska versionen av Orthotics and Prosthetics Users' Survey2009In: 8:e Nordiska ortopedtekniska kongressen 2009, 2009Conference paper (Refereed)
  • 20.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Holmefur, Marie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hermansson, Liselotte M N
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Test-retest reliability of the Orthotics and prosthetics users´ survey2013In: ISPO 2013 World Congress: Inclusion, Participation & Empowerment, 2013Conference paper (Refereed)
  • 21.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences.
    Norling Hermansson, Liselotte
    Örebro University, School of Health and Medical Sciences.
    Translation and linguistic validation of the Swedish version of Orthotics and prosthetics users’ survey2008Conference paper (Refereed)
    Abstract [en]

    There is a lack of Swedish instruments assessing outcome of orthotic and prosthetic services. The North American derived Orthotics and Prosthetics Users’ Survey (OPUS) consists of five questionnaires assessing common rehabilitation goals. It was translated to Swedish and validated linguistically. Thirty-nine persons answered the questionnaires and were systematically debriefed. In most cases the items were understood as intended. Words and expressions were changed if misunderstood or interpreted in different ways. The resulting Swedish version of OPUS showed acceptable linguistic validity. A study on construct validity and test-retest reliability is in process.

     

    1      Introduction

    Historically, Orthotic and Prosthetic (O&P) services in Sweden have been based on hands-on experience rather than science. Self-report instruments could be used to systematically evaluate the practice, but most of them are developed in English speaking countries and cannot be used in Sweden without translation and validation. Moreover, the only instruments available in Swedish are limited to the smaller group in O&P practice, namely prosthetic clients.

     

    The Orthotics and Prosthetics Users´ Survey (OPUS) was developed and validated in the USA to assess the outcome in both prosthetic and orthotic users [1]. The OPUS consists of five questionnaires assessing i) health related quality of life, ii) satisfaction with device, iii) satisfaction with services, iv) upper extremity function, and v) lower extremity function. If translated, OPUS could be a useful tool for studying the outcome of O&P services in Sweden. Still, validity problems can arise by using direct translations. Therefore, translations’ validity must be tested in the new cultural context.

     

    The aim was to translate OPUS to Swedish and test the linguistic validity in a Swedish context.

     

    2      Methods and subjects

    2.1. Methods

    A modified version of the translation process suggested by the WHO [2] was used. Four medical professionals (P/O, OT, PT, orthopaedic surgeon) independently translated OPUS to Swedish. The translations were merged to a single document by one of the authors (GJ). Translators and authors met twice to discuss the translations and a consensus version was created. A professional translator performed a back-translation to English. The English original, the Swedish consensus version, and the back-translation, were compared by one of the authors (GJ) and a new Swedish version was created.

     

    One intention with the Swedish version of OPUS was to use it for evaluation of insoles. However, many of these clients are relatively fit and a high ceiling effect could be expected in the lower extremity function part of OPUS. Therefore, eight new items assumed to be more difficult were added to the Swedish version of this particular questionnaire.

     

    Linguistic validation was performed by systematically debriefing the clients who answered the five questionnaires. Ten subjects answered each questionnaire (each subject completed one or two different questionnaires).

     

    2.2. Subjects

    Thirty-nine clients (27 women, 12 men, mean age 59,8) at the Department of Prosthetics and Orthotics, Örebro University Hospital, participated. Clients younger than 18 years, and clients unable to understand written Swedish, were excluded. The study was approved by the Regional Ethics Committee review board.

     

    3      Results

    Minor linguistic changes were made during the translation process. Most items were understood as intended but some words and expressions were changed because of misunderstandings or cultural differences between Sweden and the USA.

     

    4      Discussion

    The translation procedure used is well established and has been used in several studies. The quality of the translation was improved by involving people of different professions and experiences.

     

    5      Conclusion

    The translation and validation resulted in a Swedish version of OPUS that may be a reliable and useful contribution to outcome studies in Swedish O&P service. A study assessing construct validity and test-retest reliability is in process and preliminary results will be presented.

     

    6      References

    1.      Heinemann AW, Bode RK, et al. (2003). "Development and measurement properties of the Orthotics and Prosthetics Users' Survey (OPUS): a comprehensive set of clinical outcome instruments." Prosthet Orthot Int 27;3:191-206

     

    2.      WHO (2007). "Process of translation and adaptation of instruments."  2007: http://www.who.int/substance_abuse/research_tools/translation/en/.

     

  • 22.
    Jarl, Gustav M.
    et al.
    Örebro University, School of Health and Medical Sciences. Institution for Rehabilitation, Centre for Rehabilitation Research, Örebro; Örebro University Hospital, Örebro .
    Norling Hermansson, Liselotte Maria
    Institution for Rehabilitation, Centre for Rehabilitation Research, Örebro; Örebro University Hospital, Örebro.
    Translation and linguistic validation of the Swedish version of Orthotics and Prosthetics Users' Survey2009In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 33, no 4, p. 329-338Article in journal (Refereed)
    Abstract [en]

    There is an increasing need for outcome measures in the orthotic and prosthetic field and specifically a lack of outcome measures in Swedish. The Orthotics and Prosthetics Users' Survey (OPUS) was developed in the USA for assessment of the outcome of orthotic and prosthetic interventions, and could potentially also be used for shoe insoles and orthopaedic shoes. The aims of this study were to translate OPUS into Swedish and test the translated version's linguistic validity in a Swedish context. The Orthotic and Prosthetic Users' Survey was translated into Swedish and back-translated into English, following a modified version of the World Health Organization guidelines. After revision of the Swedish version, 39 Swedish clients (12 men, 27 women) answered the OPUS questionnaires and were systematically debriefed afterwards. Most items were understood correctly by the respondents, but some words and expressions had to be changed to avoid misunderstandings or unintended interpretations. The resulting Swedish version of OPUS, OPUS-Swe, showed acceptable linguistic validity and has potential for use in both clinical practice and scientific settings. Nevertheless, before OPUS-Swe can be fully implemented, its psychometric properties need to be evaluated.

  • 23.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Ramstrand, Nerrolyn
    CHILD research group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics2018In: Prosthetics and orthotics international, ISSN 0309-3646, E-ISSN 1746-1553, Vol. 42, no 5, p. 468-475Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The International Classification of Functioning, Disability and Health is a classification of human functioning and disability and is based on a biopsychosocial model of health. As such, International Classification of Functioning, Disability and Health seems suitable as a basis for constructing models defining the clinical P&O process. The aim was to use International Classification of Functioning, Disability and Health to facilitate development of such a model.

    Proposed model: A model, the Prosthetic and Orthotic Process (POP) model, is proposed. The Prosthetic and Orthotic Process model is based on the concepts of the International Classification of Functioning, Disability and Health and comprises four steps in a cycle: (1) Assessment, including the medical history and physical examination of the patient. (2) Goals, specified on four levels including those related to participation, activity, body functions and structures and technical requirements of the device. (3) Intervention, in which the appropriate course of action is determined based on the specified goal and evidence-based practice. (4) Evaluation of outcomes, where the outcomes are assessed and compared to the corresponding goals. After the evaluation of goal fulfilment, the first cycle in the process is complete, and a broad evaluation is now made including overriding questions about the patient's satisfaction with the outcomes and the process. This evaluation will determine if the process should be ended or if another cycle in the process should be initiated.

    CONCLUSION: The Prosthetic and Orthotic Process model can provide a common understanding of the P&O process. Concepts of International Classification of Functioning, Disability and Health have been incorporated into the model to facilitate communication with other rehabilitation professionals and encourage a holistic and patient-centred approach in clinical practice.

    Clinical relevance: The Prosthetic and Orthotic Process model can support the implementation of International Classification of Functioning, Disability and Health in P&O practice, thereby providing a common understanding of the P&O process and a common language to facilitate communication with other rehabilitation professionals.

  • 24.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Tranberg, Roy
    Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    An innovative sealed shoe to off-load and heal diabetic forefoot ulcers - a feasibility study2017In: Diabetic Foot & Ankle, ISSN 2000-625X, Vol. 8, no 1, article id 1348178Article in journal (Refereed)
    Abstract [en]

    Background: Non-removable knee-high devices are the gold standard to treat diabetic foot ulcers located on the plantar forefoot, but they immobilize the ankle, which restricts daily life activities and has negative effects on joint functioning.

    Objective: To investigate the feasibility of sealing a therapeutic shoe to off-load and heal diabetic forefoot ulcers.

    Design: A case series of seven men with type 2 diabetes and a metatarsal head ulcer were prescribed therapeutic shoes and custom-made insoles. The shoe was sealed with a plastic band. Off-loading was assessed with the F-scan pressure measurement system. Adherence to wearing the shoe was assessed with a temperature sensor and by documenting the status of the seal.

    Results: The off-loading was effective and all ulcers healed. Median time to healing was 56 days (range 8-160). Complications were secondary ulcer (n = 1) and plantar hematoma (n = 1). Five of seven participants did not disturb the seal.

    Conclusions: Sealing a therapeutic shoe is a feasible way to off-load and heal forefoot ulcers. A controlled trial is needed to compare the effectiveness and safety of a sealed shoe to other non-removable devices.

  • 25.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics; University Health Care Research Center.
    Tranberg, Roy
    Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
    An innovative sealed therapeutic shoe to off-load and heal diabetic forefoot ulcers2018Conference paper (Refereed)
    Abstract [en]

    Aim: The aim was to investigate the feasibility of using a therapeutic shoe, rendered irremovable,to off-load and heal forefoot ulcers. Non-removable knee-high off-loading devicesare gold standard to treat neuropathic forefoot ulcers. They do however immobilize theankle, affecting joint functioning and daily activities.

    Method: Seven men with diabetes type 2 since >10 years, sensory neuropathy and a metatarsalhead ulcer (table 1) were prescribed extra-depth therapeutic roller shoes and custom-madeinsoles adjusted to off-load the ulcer (fig. 1). Off-loading was assessed with anin-shoe plantar pressure system* measuring plantar peak pressures as the participantswalked. The shoe was then sealed with a plastic band and worn day and night like a cast.Adherence was assessed by documenting the status of the seal (intact/broken) whenchanging ulcer dressings.

    Results / Discussion: All ulcers healed, with a median time to healing of 8 weeks (range1-23). The median peak pressure on the ulcer was 116 kPa (range 62-192) when walkingwith the shoe. Five of seven participants respected the seal. Complications were secondaryulcer (n=1) and plantar hematoma (n=1). The most common complaint was difficulty todress (n=5).

    Sealed therapeutic shoes are an interesting avenue for future research; they include advantagesof non-removable knee-high devices as effective off-loading and high adherence,and overcome disadvantages as mobility restrictions and high costs.

    Conclusion: It seems feasible to seal a therapeutic shoe to off-load and heal forefoot ulcers.A randomized controlled trial is underway in which sealed shoes are to be comparedto total contact casting.

1 - 25 of 25
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