Browsing by Person "Coda, A."

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Beyond grades: integrating communication skills into the undergraduate curriculum for podiatry students
(Springer International Publishing, 2025-03-12) Coda, A.; Hawke, F.; Santos, Derek; Stevenson, E.; Girones, X.; Ruiz, X.; Escalona, C.; Sanson-Fisher, R.; Fellas, A.
This commentary paper emphasises the pivotal role of effective communication in the field of podiatry and advocates for its comprehensive integration into the educational curriculum. It argues that the combination of strong academic performance and well-developed communication skills equips podiatry students to improve diagnoses and successful future treatment outcomes. These skills should be comprehensively taught and carefully assessed as part of the patient-centered care approach for podiatry students. The paper explores the multifaceted role of communication in podiatry, highlighting its importance in various aspects of the profession. These include building rapport with patients, interpreting complex medical information, and fostering a therapeutic alliance that is conducive to successful treatment outcomes. It also underscores the significance of communication in collaborating with interdisciplinary teams and advocating for patient wellbeing. Proficiency in communicating with patients can contribute to the development of a wide range of career competencies in podiatric medicine, including clinical skills, research and innovation, cultural competence, and effective teamwork, both nationally and internationally. The paper also delves into various topics such as gathering patient history, explaining diagnoses and treatment options, providing patient education, and enhancing patient outcomes through interprofessional practice. This commentary paper explores the role of communication in research participation and the teaching and assessment of communication skills through innovative methods such as role-playing, simulations, and standardized patients. In conclusion, by reiterating that the essence of podiatry extends beyond technical proficiency to include meaningful interactions between the podiatrist and the patient, which are facilitated by strong communication skills. This paper may serve as a call to action for universities nationally and internationally to place greater emphasis in integrating and thoroughly assessing communication skills in their podiatric medicine programs.
OP0207-HPR EFFECT OF FOOT ORTHOSES IN REDUCING PAIN IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A 12-MONTH RANDOMISED CLINICAL TRIAL
(Elsevier, 2025-01-02) Fellas, A.; Chaitow, J.; Singh-Grewal, D.; Santos, Derek; Clapham, M.; Coda, A.
Background Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents [1]. The manifestation of JIA may include joint swelling, tenderness, and painful limitation with joint movement. Only few studies have explored the effect of foot orthoses (FOs) alone in children with JIA [2,3]. These studies showed FOs can reduce pain in children with JIA, however, further research with larger sample sizes and longer follow-ups are needed [4]. Prescribing FOs on the same day of the initial assessment may promote early clinical and targeted intervention, which is the gold standard approach in paediatric rheumatology. Objectives This single blinded multicentre randomised clinical trial (RCT) aims to investigate the effect of customised prefabricated FOs in reducing pain amongst children and adolescents with JIA. Methods Overall, 66 children and adolescents with JIA presenting with foot symptoms were recruited from the Sydney Children's Hospitals Network (Westmead and Randwick) and John Hunter Children's Hospital (Newcastle). The primary outcome measure was pain with a minimal clinical significance of 8mm on the visual analogue scale (VAS). Participants were randomly allocated to receive either customised prefabricated or sham FOs. The trial intervention was a low-density Slimflex Simple device that was customised at chair-side. The control (sham) device was made of 2mm flat leather board with no corrective modifications. Standardised tests such as the Foot Posture Index, navicular drift and drop were used to identify biomechanical abnormalities. The FOs were worn for a total of 12 months, with data collected at baseline, 4 weeks, 3, 6 months and 12 months. Results Reduction in self-reported pain was statistically and clinically significant at 4-weeks (p=0.018, -14.92 [-27.30, -2.55]) and 3 months (p=<0.001, -28.93 [-40.90, -16.96]) post intervention in favour of the trial group. The 6- and 12-month follow-ups were not statistically or clinically significant. Parent reported pain was statistically and clinically significant at the 3-month (p=<0.001, -21.92 [-33.16, -10.67]) in the reduction of pain in favour of the trial group. However, parent reported pain was not statistically significant at the 4-week, 6- and 12- month follow-ups. These results are similar to child reported pain with a p-value of less than 0.001 and average coefficients twice that of the clinical significance cut-off for VAS pain in paediatric rheumatology. The trial intervention was safe and tolerated well by participants with high compliance and adherence rates. Conclusion Results of this clinical trial indicate customised preformed FOs can be effective in reducing pain and in children with JIA experiencing foot and ankle symptoms. Significant clinical effects appear to be within the first 3-months of intervention prescription and reduce beyond 6 months. Overall, this podiatric intervention was safe, inexpensive, well tolerated and it can be easily implemented as part of the multidisciplinary paediatric rheumatology care. References [1]Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78. [2]Powell M, Seid M, Szer IS. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. J Rheumatol 2005;32:943–50. [3]Coda A, Fowlie PW, Davidson JE et al. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Arch Dis Child 2014;99:649–51. [4]Fellas A, Coda A, Hawke F. Physical and mechanical therapies for lower-limb problems in juvenile idiopathic arthritis: a systematic review with meta-analysis. Journal of the American Podiatric Medical Association. 2017 Sep;107(5):399-412. Acknowledgements We would like to acknowledge all parents and children for their precious time. Disclosure of Interests None declared
POS0283 EFFECT OF CUSTOMISED FOOT ORTHOSES ON PEAK PRESSURE AND PRESSURE TIME INTEGRALS IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS: A RANDOMISED CLINICAL TRIAL
(Elsevier, 2025-01-02) Fellas, A.; Singh-Grewal, D.; Chaitow, J.; Santos, Derek; Clapham, M.; Coda, A.
Background Children with juvenile idiopathic arthritis (JIA) often exhibit joint symptoms in the lower limb. Prolonged joint disease may cause further physical and functional impairment, which can lead to significant disturbances in gait such as abnormal pressure distributions and sub-optimal peak plantar pressures [1-3]. Recent studies have shown that children with JIA compared to an age and sex matched cohort displayed significantly higher peak pressures (PP) in most areas of the plantar foot [2]. Research also showed that children with JIA are displaying elevated pressure time integrals (PTI), meaning they are spending higher amounts of time in the stance phase of gait and less in the swing phase and thus a less propulsive gait [2]. To our knowledge only one previous clinical trial has explored the effect of a mechanical intervention such as foot orthoses (FOs) to improve the distribution of peak plantar pressures in children with JIA [4]. Objectives The aim of our randomised clinical trial is to further evaluate the effect of customised prefabricated FOs in improving PTI and PP in children with JIA. Methods A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the impact of customised preformed FOs on plantar pressures in children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. PP and PTI were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. PP were measured using kilo pascals (kPa) and PTI measured kPa per seconds (kPa/s). Differences at each follow-up were assessed using the Wilcoxon rank sum test. Results A total of 66 participants were recruited. Customised prefabricated FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of PP in the heel (baseline p=<0.001 (-104.33 kPa), 3-month p=0.004 (-126.16 kPa)), forefoot (baseline p=0.027 (-131.5 kPa)), 5th metatarsophalangeal joint (baseline p=0.007 (-37.17 kPa), 3-month p=0.001 (-69.5 kPa), 6-month p=0.016 (-50.91 kPa)) were statistically significant in favour of the trial group. These results were also positively correlated with PTI with the trial group spending less time and pressure on the heel, forefoot and rearfoot than the control. Finally, PP and PTI reductions were also associated with statistically significant increased midfoot contact with the trial device at baseline (29.84 kPa), 3 (24 kPa) and 6-month (43.75 kPa) data collections, showing that the trial intervention was successful in capturing the arch profile of participants and redistributing pressure. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%). Conclusion Clinicians may prescribe customised prefabricated FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot. References [1]Woolnough L, Pomputius A, Vincent HK. Juvenile idiopathic arthritis, gait characteristics and relation to function. Gait & Posture. 2021;85:38-54. [2]Merker J, Hartmann M, Haas J-P, Schwirtz A. Combined three-dimensional gait and plantar pressure analyses detecting significant functional deficits in children with juvenile idiopathic arthritis. Gait & Posture. 2018;66:247-54. [3]Hartmann M, Kreuzpointner F, Haefner R, Michels H, Schwirtz A, Haas J. Effects of juvenile idiopathic arthritis on kinematics and kinetics of the lower extremities call for consequences in physical activities recommendations. International journal of pediatrics. 2010;2010. [4]Coda A, Fowlie PW, Davidson JE, Walsh J, Carline T, Santos D. Foot orthoses in children with juvenile idiopathic arthritis: a randomised controlled trial. Archives of Disease in Childhood. 2014;99(7):649-51. Acknowledgements: NIL. Disclosure of Interests None declared.
The Influence of Walking Speed and Heel Height on Peak Plantar Pressure in the Forefoot of Healthy Adults: A Pilot Study
(OMICS International, 2017-07-18) Rangra, Prateek; Santos, Derek; Coda, A.; Jagadamma, Kavi
Background: The body of empirical research is suggestive of the fact that faster walking speed and increasing heel height can both give rise to elevated plantar pressures. However, there is little evidence of the interaction between walking speed and heel height on changes in plantar pressure. Therefore, the aim of this study was to investigate whether the effect of heel height on plantar pressure is the same for different walking speeds Methodology: Eighteen healthy adults, between the ages of 18 and 35 were assessed for changes in peak plantar pressure at walking speeds of 0.5 mph, 0.8 mph, 1.4 mph and 2.4 mph on a treadmill, wearing heels of 2 cm, 3 cm, 6 cm and 9 cm. Both the speed of walking and heels were randomly assigned to each participant. Peak plantar pressure values were determined in the forefoot region using the F-scan system which made use of in-shoe insoles. Data were analysed using two-way ANOVA. Results: Increasing heel height and walking speed resulted in significantly higher peak plantar pressure in the forefoot. Post-hoc analysis also confirmed the findings of two-way ANOVA of significant increase in peak plantar pressure with increments in heel height and walking speed. The two-way ANOVA illustrated significantly higher peak plantar pressures in both the forefeet due to interaction of walking speed and increasing heel heights. Conclusion: This study suggests that an interaction of walking speed and footwear design on distribution of plantar pressure exists. Therefore it is necessary to standardize walking speed and shoe design in future studies evaluating plantar pressures.