BACKGROUND: The design and manufacturing of effective foot orthoses is a complex multidisciplinary problem involving biomedical and gait pattern aspects, technical material and geometric design elements as well as psychological and social contexts. This complexity contributes to the current trial-and-error and experience-based orthopedic footwear practice in which a major part of the expertise is implicit. This hampers knowledge transfer, reproducibility and innovation. OBJECTIVE/METHODS: A systematic review of literature has been performed to find evidence of explicit knowledge, quantitative guidelines and design motivations of pedorthists. RESULTS: 17 studies have been included. No consensus is found on which measurable parameters ensure proper foot and ankle functioning. Parameters suggested are: neutral foot positioning and control of rearfoot motion, maximum arch, but also tibial internal/external rotation as well as a three point force system. Also studies evaluating foot orthoses centering on the diagnosis or orthosis type find no clear guidelines for treatment or for measuring the effectiveness. CONCLUSIONS: A gap in the translation from diagnosis to a specific, customized and quantified effective orthosis design is identified. Suggested solutions are both top-down, fitting of patient data in simulations, as well as bottom-up, quantifying current practices of pedorthists in order to develop new practical guidelines and evidence-based procedures.
While sustainability of transport projects is of increasing importance, the concept of sustainability can be understood in many different ways by the stakeholders that are involved in or affected by mobility projects. In this paper, we compare the outcomes of the assessment of sustainability of projects through a multi-criteria analysis (MCA) and the appraisal of stakeholder preferences through the multi-actor multi-criteria analysis (MAMCA). Evaluating projects with both tools and comparing the outcomes can provide insight into the stakeholder support of sustainable solutions and the sustainability of alternatives preferred by stakeholders. The sustainability of projects is assessed through 16 criteria grouped under the three pillars of sustainability. They were selected by in-depth review of 16 case studies of mobility projects, 18 transport evaluation schemes and the ranking of potential criteria by 214 stakeholders in North-West Europe. These criteria were weighted by 93 representatives of decision makers in the mobility domain. Stakeholder preferences were appraised through the criteria identified for each stakeholder group. We illustrate the framework by evaluating alternative solutions to improve cycling connections between the towns of Tilburg and Waalwijk in the Netherlands. The results of the comparison show that stakeholder preferences are biased towards one or two of the sustainability pillars (economy, environment, society) in three ways: through the selection of the criteria by the stakeholders, the weights of each criterion by each stakeholder group and differences in the final ranking of alternatives between the stakeholder groups and the MCA.
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AIMS: The Canadian Occupational Performance Measure (COPM) can be used to support children to clarify their needs themselves. However, for pediatric occupational therapists it is not sufficiently clear how to effectively use the COPM with children from 8 years of age.This study aimed to formulate specific instructions for using the COPM with children themselves, based on the experience of children, parents, and occupational therapists. In addition, professional consensus on the instructions was reached.METHODS: A multi-stage approach was used to develop the instructions. Triangulation of methods was used to gather knowledge of how the COPM with children themselves is performed in daily practice: interviews with 23 children, questionnaires completed by 30 parents, interviews with 13 therapists, and 10 video recordings of COPM administration. Specific instructions were derived from this knowledge and consensus for these instructions was reached by Delphi method.RESULTS: The data were analyzed and resulted in 40 specific instructions. Consensus of at least 80% amongst 10 occupational therapists, who regularly use the COPM with children, was achieved on each instruction.CONCLUSION: There is consensus on 40 specific instructions for administering the COPM with children. Following these instructions might help children to formulate their own goals for intervention.
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