Exoskeletons and orthotic devices are commonly used in physical rehabilitation. However, these devices, fitting intimately with the human body, often lead to skin-related issues amongst users. Misalignments between orthotic and anatomical joints cause relative sliding motion between the limb and orthosis and also cause pressure points on the limb, which may contribute to these skin problems. This research quantifies the effects of sagittal plane ankle-joint misalignments for an ankle-foot orthosis (AFO) user during walking. A 2D mathematical model that simulates the effects of sagittal plane ankle-joint misalignments in terms of relative motion between the limb and the orthosis was developed using MATLAB software. The orthotic ankle-joint was systematically misaligned against the anatomical ankle-joint to generate various misalignment conditions. Published gait data of 5 healthy subjects was used to generate walking kinematics which was then superimposed with an articulated AFO. The simulations showed that Anterior-Posterior misalignments resulted in greater pistoning motion than Proximal-Distal misalignments. Combined misalignments (Posterior-Distal, Anterior-Proximal, Posterior-Proximal, and Anterior-Distal) resulted in higher overall relative motions between the limb and AFO. The model also predicted pressure points on the shank and foot caused by misalignments. This study demonstrates that misaligned ankle-joints in AFOs lead to relative sliding motion and pressure points during walking.

UNASSIGNED: Poor walking aid compliance and accessibility can put the user at an increased risk of falls. We explored the acceptability and accessibility of magnetic walking aids (MWAs) compared to standard walking aids (SWAs) in inpatients following joint replacement.
UNASSIGNED: A non-blinded pilot randomised controlled trial was conducted. Inpatients following hip or knee replacement were randomly allocated to the MWA group (n = 20) or the SWA group (n = 20). Primary outcomes were the acceptability and accessibility of the MWA compared to the SWA during their inpatient stay, assessed through made-to-measure patient and staff questionnaires. The secondary outcome was the number of times the walking aid came to rest on the floor, measured using logbooks kept by participants.
UNASSIGNED: The participants in the MWA group reported their aid was more easily accessible, and that they were more likely to use their aid in their room than participants in the SWA group. Participants in the MWA group dropped their aid less often, with a median of 0.3 walking aid drops per day in the MWA group and 1.1 drops per day in the SWA group (p = 0.002).
UNASSIGNED: The results of this pilot randomised trial suggest MWAs may be an acceptable and inexpensive intervention for improving walking aid accessibility and adherence and reducing walking aid drops when compared to SWAs.
Magnetic walking aids may be a simple and cost effective way for improving walking aid compliance compared to standard walking aids.Walking aid adherence can be difficult to monitor within hospital and community settings.Magnetic walking aids may be safe to use in a controlled inpatient hospital environment with no adverse effects.Magnetic walking aids may reduce the number of instances a walking aid inadvertently comes to rest on the floor. This is of particular importance to patients post-operatively. For example, total hip replacements, where reaching to pick up an aid from the floor could lead to hip dislocation.

UNASSIGNED: Occupational therapists (OT) assess and prescribe assistive devices to older adults with limitations in performing daily living activities. Timely prescription of assistive devices to accommodate the rising demand has been affected by the COVID-19 pandemic. Tele-assessment allows for continuity of care, but its success depends on therapists\' acceptance.
UNASSIGNED: This study examined OTs\' perceptions of the feasibility of conducting tele-assessment and developing a clinical practice guideline for remote prescription of assistive devices for older adults in Singapore.
UNASSIGNED: Eligible OTs were recruited from purposive sampling. Semi-structured interviews were conducted via a virtual platform (Zoom). Audio recordings were transcribed verbatim. Inductive thematic analysis using a line-by-line coding method was used to identify common trends.
UNASSIGNED: Interviews with 10 participants revealed three main themes: (1) therapists\' perceptions of the feasibility of tele-assessment, (2) criteria for safe and appropriate prescription of assistive devices via tele-assessment, and (3) practical considerations for the implementation of tele-assessment. Participants felt that tele-assessment increases efficiency with more older adults being more receptive towards technology. They also raised suggestions to address OTs\' concerns regarding the safety and accuracy prescription of assistive devices following tele-assessment. This included establishing the client\'s suitability for assistive device prescription, characteristics of assistive devices, resources required, and considering the preferences of stakeholders involved.
UNASSIGNED: Tele-assessment for assistive device prescription by OTs appears feasible in Singapore. OTs should consider collaborating with other stakeholders to develop a tele-assessment clinical practice guideline for assistive device prescription. Further studies testing its clinical effectiveness during and/or post-pandemic are warranted.

UNASSIGNED: Rehabilitation professionals prescribe patients with suitable powered mobility aids (PMAs) based on patient characteristics, e.g., age and mobility. However, there is paucity of literature examining patient characteristics associated with PMA types in Asian contexts. This research aims to study (i) characteristics of Singapore PMA users and (ii) correlations between characteristics and two PMA types - motorised wheelchairs and powered scooters. It is hypothesised that patients\' age, mobility status and medical conditions have correlations with PMA types.
UNASSIGNED: A cross-sectional, retrospective study design was used to investigate characteristics of patients (age ≥ 21 years) at Tan Tock Seng Hospital Occupational Therapy Seating Clinic between 2017 and 2019. Comparisons of proportions of motorised wheelchair users versus powered scooter users based on characteristics were analysed using Chi-square test. Subsequently, statistically significant patient characteristics were selected for a multiple logistic regression.
UNASSIGNED: Among 352 patients, 21% and 79% were prescribed motorised wheelchairs and powered scooters, respectively. Patients aged 61-90 years were twice those aged 21-60 years. Males were double of females. Patients of (i) an older age, (ii) more ambulant, (iii) independent in transfers and (iv) in activities of daily living (ADLs), were more likely powered scooter users. Conversely, patients of (i) a younger age, (ii) less ambulant, (iii) require assistance in transfers and (iv) in ADLs were more likely motorised wheelchair users. Patients\' gender and caregiver status showed no statistically significant correlations with PMA types.
UNASSIGNED: Rehabilitation professionals could consider patients\' age, mobility status, transfer status and ADL status when prescribing PMA for Asian populations.
Guide rehabilitation professionals in making clinical decisions on the type of powered mobility aid (PMA) to prescribe based on patients’ characteristics.Aid in the development of future guidelines for rehabilitation professionals in prescription of PMAs.

BACKGROUND: Preventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person\'s needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes.
METHODS: In a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively.
CONCLUSIONS: This is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs.
BACKGROUND: ClinicalTrials.gov NCT05236660. Registered on 11 February 2022.

BACKGROUND: The treatment of axial spondylarthritis (axSpA) includes pharmacological treatment measures (PTM) and nonpharmacological treatment measures (NPTM) as well as supporting resources, such as rehabilitation services (RS) and membership in patient support groups (PSG). Nevertheless, there are significant participation restrictions in patients with axSpA in Germany.
OBJECTIVE: Investigation of functional deficits, participation restrictions and utilization of PTM, NPTM, RS and PSG membership in patients with axSpA.
METHODS: Multicentric, observational study of 770 axSpA patients in Germany (ATTENTUS-axSpA).
RESULTS: Substantial functional deficits and participation restrictions were observed in axSpA patients. Of the patients 39% did not receive treatment with biological disease-modifying antirheumatic drugs (bDMARD). In the NPTM 54% received physiotherapy less than once per week and 29% once per week. Physical activities were regularly performed by 86% of patients, mainly in the form of home exercises. Training in a gym (14%) or sports club (7%) was carried out much less frequently. Of the patients 54% received RS, one third had the last rehabilitation more than 5 years ago and 13% of the patients were members in a PSG. A significantly higher utilization of NPTM and rehabilitation was found in this group.
CONCLUSIONS: Treatment options and resources were often utilized to a small extent and/or in low intensity by axSpA patients, which could be a possible explanation for persisting restrictions of participation. Membership in a PSG was associated with an increased utilization of NPTM and RS.
UNASSIGNED: HINTERGRUND: Die Behandlung der axialen Spondyloarthritis (axSpA) umfasst neben medikamentösen Therapiemaßnahmen (MTM) auch nichtmedikamentöse Therapiemaßnahmen (NMTM) sowie unterstützende Ressourcen wie rehabilitationsmedizinische Therapieleistungen (RTL) und die Mitgliedschaft in Selbsthilfeorganisationen (SHO). Trotzdem bestehen deutliche Teilhabeeinschränkungen bei Patient*innen mit axSpA in Deutschland.
UNASSIGNED: Untersuchung der Funktions- und Teilhabeeinschränkungen und Nutzung von MTM, NMTM, RTL und SHO bei Patient*innen mit axSpA.
METHODS: Multizentrische, deutschlandweite Beobachtungsstudie von 770 axSpA-Patient*innen (ATTENTUS-axSpA).
UNASSIGNED: Es bestehen deutliche Funktions- und Teilhabeeinschränkungen bei den axSpA-Patient*innen; 39 % erhielten keine Therapie mit biologischen krankheitsmodifizierenden Medikamenten (bDMARDs). Bei den NMTM wurden bewegungstherapeutische Maßnahmen bei 54 % weniger als 1‑mal die Woche und bei 29 % 1‑mal pro Woche verordnet. Eine regelmäßige Bewegung führten 86 % der Patient*innen durch, hauptsächlich in Form häuslicher Übungen. Training im Fitnessstudio (14 %) oder Vereinssport (7 %) wurden seltener ausgeführt. Eine RTL erhielten 54 % der Patient*innen, und bei etwa einem Drittel lag die letzte RTL über 5 Jahre zurück. Es waren 13 % Mitglieder in einer SHO. In dieser Gruppe fand sich eine signifikant höhere Inanspruchnahme von NMTM und RTL.
CONCLUSIONS: Verfügbare Behandlungsoptionen und Ressourcen werden von axSpA-Patient*innen häufig in geringem Maß und/oder in niedriger Intensität genutzt, welches eine mögliche Erklärung für persistierende Teilhabeeinschränkungen sein könnte. Wir beobachteten eine verstärkte Inanspruchnahme von NMTM und RTL bei Mitgliedschaft in einer SHO.

UNASSIGNED: Assistive technology intervention has become an important strategy in enhancing function in young children with cerebral palsy. This study aimed to provide an in-depth knowledge of the use of assistive devices by describing their purposes, the environments in which they are used, frequency of use and perceived benefits from the caregiver\'s perspective.
UNASSIGNED: This is a cross-sectional population-based study using data from national cerebral palsy registers in Norway. Of a total of 202 children, 130 participated (mean age 49.9 months, SD 14.0 months).
UNASSIGNED: The 130 children and their families used a median of 2.5 assistive devices (range 0-12) to support positioning, mobility, self-care and training, stimulation and play. Devices most commonly had one or two main purposes and were used both at home and in kindergarten/school. The usage rate varied from less than twice a week to several times a day. The majority of parents reported significant benefits for caregiving and/or the child\'s functioning. Total use increased in accordance with the level of the child\'s gross motor limitations and was associated with restrictions imposed by housing concerns.
UNASSIGNED: The frequent use of a wide range of devices, and the intended and perceived benefits, demonstrates that early provision of assistive devices can be an effective function-enhancing strategy in young children with cerebral palsy. However, the findings also indicate that factors others than the child\'s motor abilities must be considered when integrating the use of devices into the child\'s daily routines and activities.
Early provision of assistive devices can be a powerful strategy to support everyday functioning and facilitate care in young children with cerebral palsy.Assistive devices seems to be most effective when they are well integrated into the child’s daily routines and activities across environments.The clinical classifications of motor abilities (Gross Motor Function Classification System and Manual Ability Classification System) can be used to estimate the need for assistive devices, however, factors others than the child’s motor function seem to be critical for optimum effectiveness, such as type of equipment, its physical and social environment and the intended benefits of use.

A 90-day intervention employed peer coaching, with and without home-based electronic devices connected to an app, to assess effectiveness in enhancing self-reported health outcomes of older adults.
Does peer coaching aid older adults to better manage their chronic health conditions, and is the coaching further enhanced by home-based electronic devices?
The study employed a pre-post intervention randomized controlled trial design with three groups: control (no coach, no devices), coach only, and coach + devices. Participants were 163 adults living in British Columbia, Canada, aged 65 to 98 years, with one or more chronic health conditions and access to a computer and Wi-Fi. Responses on five questionnaires assessed health outcomes pre- and post-intervention: Self-Efficacy Scale, PHQ-9, Medical Care, Patient Activation Measure and the RAND 36-Item Health Survey 1.0 Questionnaire.
Compared with the control group (no coach, no devices), participants with a coach reported decreased depression, higher activation levels and energy levels, and better handling of role limitations due to physical health, social functioning, and communication with their physician. Participants with coaches and devices showed similar improvements on these measures with further decreases in depression severity as well as improved self-efficacy, better handling of role limitations due to emotional problems, higher level of emotional well-being and general health ratings, and lower pain.
Peer coaches alone and in combination with assistive devices demonstrated several positive outcomes for older persons with chronic conditions that lasted at least 90 days. The program can enhance effectiveness of care provided by general practitioners.
RéSUMé: INTERVENTION: Une intervention de 90 jours a employé l’encadrement des pairs, avec et sans appareils électroniques à la maison connectés à une application, pour évaluer l’efficacité de l’amélioration des résultats cliniques autodéclarés d’adultes d’âge mûr. QUESTION DE RECHERCHE: L’encadrement des pairs aide-t-il les adultes d’âge mûr à mieux prendre en charge leurs affections chroniques, et cet encadrement est-il renforcé par l’utilisation d’appareils électroniques à la maison? MéTHODE: L’étude a employé un plan d’essai comparatif randomisé avant et après l’intervention avec trois groupes : un groupe témoin (sans pair aidant, sans appareils), un groupe avec pair aidant seulement et un groupe avec pair aidant et appareils. Les participants étaient 163 adultes de 65 à 98 ans vivant en Colombie-Britannique, au Canada, présentant une ou plusieurs affections chroniques et ayant accès à un ordinateur et au Wi-Fi. Les résultats cliniques avant et après l’intervention ont été analysés d’après les réponses à cinq questionnaires : échelle d’auto-efficacité, Patient Health Questionnaire (PHQ-9), questionnaire Medical Care, Patient Activation Measure et Questionnaire Rand de 36 questions sur l’état de santé (version 1.0). RéSULTATS: Comparativement au groupe témoin (sans pair aidant, sans appareils), les participants encadrés par un pair aidant ont déclaré une dépression réduite, des niveaux d’activation et d’énergie plus élevés et une meilleure gestion de leurs limites fonctionnelles dues à leur santé physique, à leur fonctionnement social et à leurs communications avec leurs médecins. Les participants ayant un pair aidant et des appareils ont présenté des améliorations semblables de ces indicateurs, avec des réductions plus poussées de la sévérité de la dépression, ainsi qu’une auto-efficacité améliorée, une meilleure gestion de leurs limites fonctionnelles dues aux troubles affectifs, de plus hauts niveaux de bien-être émotionnel et de santé générale, et moins de douleur. CONCLUSION: Les pairs aidants à eux seuls et en combinaison avec des accessoires fonctionnels sont à l’origine de plusieurs résultats positifs pour les personnes d’âge mûr atteintes d’affections chroniques ayant duré au moins 90 jours. Le programme peut améliorer l’efficacité des soins offerts par les omnipraticiens.

UNASSIGNED: To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting.
UNASSIGNED: This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied.
UNASSIGNED: Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device.
UNASSIGNED: These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings.IMPLICATIONS FOR REHABILITATIONThis research provides an understanding of lower-limb prosthesis users\' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting.The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation.Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations.Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation.When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome.

OBJECTIVE: The study aimed to gain an insight into the utilisation, self-perceived needs, and attitudes towards and influencing factors of assistive device (AD) usage among community-dwelling older adults in China.
METHODS: This is a cross-sectional study.
METHODS: A total of 5790 elderly people from eight communities within three provinces in China were recruited by convenience sampling. Utilisation, needs and attitudes towards ADs were assessed by a questionnaire designed by the authors. Barthel activities of daily living scale was used to determine disability, whereas cognitive function was assessed with the Mini-Mental State Examination. The impact of participant characteristics, enabling factors and demand factors on the utilisation of ADs were assessed by univariate and multifactor analyses.
RESULTS: The prevalence of AD ownership among participants was 10.9% (n = 634), whereas the self-perceived need for ADs was 46.1% (n = 2670). Most participants had negative attitudes towards ADs, with only 37.6% (n = 2175) of participants believing that ADs were of significant help. Factors influencing the usage of ADs included participant characteristics (age, occupation, living area, education), enabling factors (economic situation, number of children) and demand factors (activities of daily living score, attitudes, self-perceived needs).
CONCLUSIONS: Although ADs for the elderly in China have become more affordable and accessible after a series of reforms, there remains a gap in AD services resulting in low AD utilisation, high self-perceived needs and misconceptions of ADs. Certain factors influencing the use of ADs are more significant than others. The findings from this study will be informative for healthcare providers and decision-makers when designing strategies to achieve universal elderly AD usage.