MSc in Podiatry
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7213
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Item THE EFFECTIVENESS OF SHAM INSOLES VERSUS PREFABRICATED BIOSOLE-GEL™ INSOLES, CUSTOM-MADE SOLE SUPPORTS™ ORTHOTICS OR CUSTOM-MADE CANADIAN ORTHOTICS LABORATORY LTD. ORTHOTICS FOR THE TREATMENT OF PLANTAR FASCIITIS IN CANADIAN MILITARY PERSONNEL.(2018)Currently the Canadian military does not provide a clinical treatment protocol manual for the treatment of its members for the treatment of plantar fasciitis. In March 2014 the physiotherapy staff at Canadian Forces Base Shilo (CFB Shilo) attended a civilian conference at which it was advised that prefabricated insoles were more effective at treating plantar fasciitis than custom-made orthotics. This then lead to an overnight change in the previous treatment protocol of providing military personnel at CFB Shilo who had been diagnosed with plantar fasciitis with two sets of custom-made Sole Supports™ orthotics to providing them with a set of prefabricated BioSole-Gel™ insoles instead. No research was conducted by the Canadian military to support this change. Personnel who had been transferred from other CFB regions were provided with whatever was available in their geographic region, mostly commonly either a prefabricated insole or a custom-made orthotic made from a subtalar neutral cast. As evidence-base practice is now the gold-standard in treatment measures this research is being proposed to determine whether the treatment for plantar fasciitis in Canadian military personnel should be a prefabricated BioSole-Gel™ insole, a custom-made Sole Supports™ orthotic, a subtalar neutral rigid custom-made orthotic from Canadian Orthotics Laboratory Ltd. or a sham insole. This 4-armed parallel study will be conducted by randomly allocating 324 Canadian military personnel deemed to be suffering from plantar fasciitis, into four evenly divided groups who will then receive one of the above mentioned devices, alongside a stretching protocol. At the commencement of this study participants will be asked to complete a Lower Extremity Functional Scale questionnaire (LEFS) as well as a Foot Status Health Questionnaire (FSHQ). This will be repeated at 4 weeks, 12 weeks, at the 26 week mid-point and at the conclusion of the study at one year. Once completed analysis of these questionnaires will be carried out to determine whether in fact there is a difference in outcomes for the four treatment options. Once analysed it is hoped that this information can be used to provide evidence based guidelines for the treatment protocol for plantar fasciitis for Canadian military personnel.Item THE CLINICAL EFFECTIVENESS OF FOOT ORTHOSES FOR THE ALLEVIATION OF LOW BACK PAIN(Queen Margaret University, 2017)Objective: To establish the effect of customised functional foot orthoses on patients' pre-existing, idiopathic low back pain (LBP). Design: A matched-subject randomised controlled trial designed to test the hypothesis that the use of functional foot orthoses is effective in alleviating chronic, idiopathic LBP. The experimental group will receive customised functional foot orthoses and the control will be a 'wait-list' group who will be monitored for 6 months prior to receiving the intervention. Setting: Podiatry clinic in Ilkley, West Yorkshire with recruitment from the Leeds and Bradford Metropolitan District Council areas. Participants: Initial recruitment of 60 participants with LBP who meet the inclusion criteria and have given their written informed consent to take part in the study. Allowing for withdrawals, a minimum final number of 40 participants is expected. Intervention: The treatment group will receive customised standard functional foot orthoses, vacuum-formed from polypropylene by LBG Medical. Measurements: Changes in levels of perceived LBP will be measured using the Low Back Pain Rating Scale (LBPRS), the Million Visual Analog Scale (VAS), and functional health status will be measured using the Oswestry Disability Index (ODI) over an initial six month period for both the experimental and control group participants. After six months, the control group will receive the intervention and both groups will continue to be monitored; the experimental group for a minimum of six more months and the control group for twelve months, using the same measurements. Participants will complete the Global Perceived Effect (GPE) scale at the end of the trial in order to determine whether they consider their LBP to have changed since the start of the trial. Data analysis: Homogeneity between the control and experimental groups will be verified for the variables of age, height, weight and LBP at the start and end of the trial using the Student's t-test. The p-values will then be calculated to determine whether there is a statistically significant difference between baseline and final scores. Statistical significance will be considered reached if p < 0.05. Homogeneity of Body Mass Index (BMI) and the Foot Postural Index (FPI-6) between the groups will be assessed using the Mann-Whitney U-test, and, for gender, the Pearson's chi-squared test. The data obtained during the trial from the pain scales will be assessed using the Wilcoxon signed-ranks test. The data will be analysed using the SPSS statistics software package (IBM 2016). Conclusion: The proposed trial aims to address the short-comings of previous research into the alleviation of LBP with the use of functional foot orthoses and aims to support the hypothesis that customised functional foot orthoses significantly help to alleviate LBP in people who have biomechanical abnormalities. Dissemination: The proposed trial will be registered with The International Committee of Medical Journal Editors (ICMJE 2017) and the editorial committees of relevant medical journals will be approached regarding publication.Item UNDERSTANDING THE LIVED EXPERIENCES OF MALTESE PATIENTS WITH CHRONIC DIABETIC FOOT ULCERS: A PHENOMENOLOGICAL STUDY(Queen Margaret University, 2017)Ulceration is a chronic and disabling condition affecting approximately 1-2% of the population of the developed world. The majority of such ulcers are often hard to heal and tend to recur, becoming a long-term chronic healthcare problem. Even though in majority of cases healing is attained, 12-month recurrence rates of 26-69% have been reported, thus making some patients suffer from symptoms of ulceration for most of their lifetime. Diabetic foot ulcers (DFUs) are the commonest complications of diabetes. Despite appropriate treatment, DFUs often fail to heal, becoming chronic in nature and 17% of such ulcers result in minor or major lower limb amputation. Chronic foot ulcers impose negative physical, physiological, social and psychological impact on patients and their families leading to a decreased quality of life. Given the prevalence and incidence of chronic DFUs, little research has been carried out about the individuals' experience pertaining to such wounds. Thus with this in mind, the researcher is proposing a research study that aims to explore further the lived experiences of patients with chronic, non-healing diabetic foot ulcers. Furthermore this study will also aim to understand better what it means for a person to live with chronic non-healing foot ulcers. The research objectives are to explore the lived experiences of Maltese patients living with chronic non-healing DFUs, to gain an insight how Maltese diabetic patients perceive their daily life while living with chronic DFUs and to describe what it means for a person to live with a chronic DFU. Gadamerian hermeneutic phenomenology will be chosen as method to guide this proposed research study. Semi-structured interviews will be used to collect the data, from ten patients with type 1 or type 2 diabetes and having a diabetic foot ulcer present for more than 4-8 weeks. The interview schedule was constructed for the purpose of this study after a careful literature search on the topic under study. The data that will be generated from the interviews will then be transcribed and analyzed using an Interpretative Phenomenological Approach (IPA).Item A study to investigate the impact of Low Level Laser Therapy (LLLT) on the improved healing and pain reduction in patients with Venous Leg Ulcers (VLUs).(Queen Margaret University, 2017)Venous leg ulcers (VLUs) are the most common ulcers of the lower limb accounting for 70% of all ulcerations of that kind. Reports suggest that with the current prevalence of chronic venous leg ulcers (CVLUs) of between 0.1% and 0.3% almost 1% of the population in the UK will suffer from VLUs at some stage in their lives (Agale, 2013). Currently the cost of VLU treatment by the NHS is estimated to range between £168 million and £198 million each year with 100,000 new cases of VLUs being reported annually (WELSH WOUND NETWORK.2017). VLUs are open wounds which can be reoccurring and can remain active for many weeks or even years. They have the potential to cause severe secondary complications such as squamous cell carcinoma, osteomyelitis or cellulites (Reich-Schupke et al. 2015). Many affected patients present with copious exudate, swelling and inflammation which lead to profound pain as well as psychological problems such as anxiety, depression, reduced sleep and a general sense of discomfort (Edwards et al. 2014). Recently, low level laser therapy (LLLT) has gained increased attention in treatment of VLUs, a phenomenon particularly evident from more than 400 double blinded randomised placebo control human trials supported by over 4,000 scientific research studies investigating the underlying mechanisms that present a local and systemic response to LLLT (Perlin, 2015). Low level laser therapy is thought to be beneficial in the healing of VLUs as it is believed to modulate Matrix Metalloproteinase levels (MMP) and reduce Reactive Oxygen Species (ROS), factors typically increased in CVLU patients. In addition, LLLT can lead to reduction of infection and pain associated with CVLUs. There are significant variations in the operational parameters of the lasers resulting in different outputs and these include the wavelength, power density, power output and fluence. If the incorrect parameters are chosen, which has been documented by a number of authors in the past, little or no effectiveness of the treatment or even tissue damage can be reported. Therefore it is imperative for positive results to choose the correct values of the critical factors. A thorough literature review on the effects of LLLT on wound healing and venous leg ulcers has been completed as part of this research proposal. Based on the literature review a number of parameters have been selected and are believed to be the most suitable for the application in the therapy of VLUs. The proposed 11 month long study is designed as a double blind randomised control trial with 44 participants recruited from wound clinics in cork. The participants will be appropriately randomised to receive LLLT or light emitting diode (LED) placebo; a conventional treatment of a hydrocolloid dressing and four layer compression bandaging will be applied after each treatment session regardless of the treatment group. The company supplying the laser machine for the study has assured that no difference in both the treatment and the placebo will be evident, making the distinction between the two treatment types effectively impossible even to a trained personnel. The obtained empirical data will be analysed by a qualified statistician and presented graphically to facilitate result interpretation.Item Hearing Impaired Podiatry Patients' Experiences of Receiving Healthcare(Queen Margaret University, 2016)Few Podiatrists are trained to assist in communication with hearing impaired patients. However, hearing impaired patients may constitute the bulk of patients seen when treating an elderly population. Keogh (2015) opines that over ten million adults in the UK have hearing loss, i.e. one in six of the population, and hearing loss will continue to be an even bigger challenge as the number of old people increases. It is vital that the hearing impaired have accurate communication in their healthcare because the conveyance of essential information could be potentially life-saving. Podiatrists have to be registered with the Health and Care Professions Council (HCPC) in the UK, and Van der Gaag (2015) postulates that the HCPC wants to place more emphasis on partnership with patients and service users, and foregrounded the importance of attributes such as empathy and compassion in patient care. Empathy and compassion is required to fully comprehend the experiences of the hearing impaired. This study has aimed to highlight and understand the experiences of the hearing impaired who use hearing aids and regularly access podiatric healthcare. Six patients over the age of eighteen who use hearing aids and the services of a private podiatrist have been invited to take part in semi-structured interviews with the principal researcher. Their responses have been entered on to a laptop computer. The typed interview has been returned to the participant for their views, and whether they would like to add or change anything thereby attempting to achieve triangulation. The responses have then been analysed as per the suggestions of Finlay (2011) as a phenomenological approach with a hermeneutic focus. This means the aim is to evoke lived experience through the explicit involvement of interpretation (appendix 1). The results of the interviews demonstrated that the hearing impaired participants did experience difficulties in communication during their podiatric and other healthcare. The conclusions include education of the podiatrist in understanding problems of the hearing impaired, and practical suggestions to help the hearing impaired in their interaction with the podiatrist and their team.Item Extended Literature Review on the Effectiveness of Urea on Increasing Skin Hydration Followed by a Research Proposal.(Queen Margaret University, 2016)Background: The skin is the largest organ, covering most of the human body and comprises of 15% of the body's weight. Dry skin occurs when there is reduction in water residing in the epidermis, causing the skin to flake and crack. Dry skin is also known as xerosis or xeroderma, affecting around 75% of individuals aged 64 and over. Urea based emollients are widely used for the treatment of dry skin conditions such as xerosis. Aim: The aim of this proposal is to determine whether there is a measurable difference in skin hydration levels of skin on the plantar aspect of the feet with the application of 5% and 10% concentrations of a urea based moisturiser. Method: Forty patients will be recruited from a private podiatry practice and all participants will receive the same treatment. The emollients used in this study are CCS ® footcare cream (10% urea) and Eucerin ® repair cream (5% urea). These emollients will be placed into 28 5g containers and one applied to each foot once daily. All participants will be asked not to use any topical skin preparations on their lower limb 14 days prior to the study. Data: The raw data from the hydration measurements taken from the right and left feet from day 0, day 14 and day 28 by a corneometer. The hypothesis is the emollient CCS foot care cream with a higher % concentration of urea has an increased effect on skin hydration levels. Comparisons will be made between both feet on the baseline (day 0), day 14 and day 28. Data will be analysed with parametric Student t-test using the statistical programme SPSS version 21. Keywords: skin, emollients, urea, xerosis, anhidrosis, skin hydration, corneometer,Item Determining the patient-perceived impact of foot health education for patients with diabetes mellitus(Queen Margaret University, 2015)The impact of foot problems in diabetes on the National Health Service (NHS) is extremely large, accounting for 10% of the entire NHS budget for England and Wales (Global Diabetes Community, 2015). The annual NHS spend on diabetes is predicted to rise from £9.8 billion currently to £16.9 billion by 2035 (Diabetes UK, 2012). The NHS (2011) commissioned a report which cited patient education as a key factor in the overall care package of optimum diabetic foot management. Indeed, patient education in diabetes mellitus is viewed as a vital part of a patient-centred care philosophy which is a pillar of the Diabetes National Service Framework (DoH and Diabetes UK, 2005). So much so, that National Institute of Clinical Excellence [NICE] (2009) list patient education as a key target for diabetes management with structured education programmes to be delivered at the point of diagnosis with annual reinforcement and review. However, what is not clear from many studies in this area is the patients perceptions of the education that they received and what impact they feel that this has had on their management of diabetes particularly in relation to their foot health. This study looked to determine the patient-perceived impact of foot health education for patients with diabetes mellitus via a qualitative methodology. 20 participants who have type 1 or type 2 diabetes mellitus who fit the inclusion criteria were randomly selected and invited for in-depth semi structured interviews relating to their experience of patient education in diabetes mellitus, with a focus on their foot health. The results of this study indicate that the individuals interviewed had a very inconsistent patient education experience, particularly in relation to their foot health with a large proportion of these individuals not receiving services in line with national commissioning reports and guidelines. This was most notably identified with almost half of all participants interviewed indicating that they received no patient education whatsoever, with those that did receive structured patient education not having this education reinforced annually. Furthermore, where patient education pertaining to foot health was received by individuals, the patient-perceived impacts of this education were varied and did not demonstrably lead to a sustained change in foot health perception or behaviours.