Objective: The aim of this study was to obtain insight in specific elements influencing the use, non-use, satisfaction, and dissatisfaction of ankle foot orthoses (AFOs) and the presence of underexposed problems with respect to AFOs. Methods: A questionnaire was composed to obtain information from AFO users to investigate the variables associated with satisfaction and the relation between these variables. A specific feature of this study was the systematic analysis of the remarks made by the respondents about their AFO. Quantitative data analyses were used for analysing the satisfaction and qualitative analyses were used analysing the remarks of the respondents. A total of 211 users completed the questionnaire. Results: Our survey showed that 1 out of 15 AFOs were not used at all. About three quarters of the AFO users were satisfied and about one quarter was dissatisfied. Females and users living alone reported relatively high levels of dissatisfaction, especially in the field of dimensions, comfort, weight, safety and effectiveness. Dissatisfaction with respect to off-the-shelf AFOs for the item durability was higher than that for custom-made AFOs. In the delivery and maintenance process the items ‘maintenance’, ‘professionalism’ and ‘delivery follow-up’ were judged to be unsatisfactory. A large number of comments were made by the respondents to improve the device or process, mainly by the satisfied AFO users. These comments show that even satisfied users experience many problems and that a lot of problems of AFO users are ‘underexposed’. Conclusion: To improve user satisfaction, the user practice has to be identified as an important sub-process of the whole orthopaedic chain especially in the diagnosis and prescription, delivery tuning and maintenance, and evaluation phase.
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This article discusses the importance of fully integrating research activities into the Bachelor level programs (undergraduate programs) in orthopaedic engineering / prosthetics and orthotics. To work according to evidence based principles and acquire the competences to do so it is necessary for students to engage in research activities from within the educational programme as soon as possible. Involvement in research not only creates more insight in what research means and what the effects are, but also generates a number of cross links with the stakeholders involved in P&O education (see fig 1) which were not apparent before for the student. Also, the interaction with orthopaedic companies is stimulated in a broader context than is traditionally the case. A structure enhancing the interaction of educational institution, companies, research groups and institutions is presented which operates at the intersection of these stakeholders. A whole new world is therefore coming into range which will generate all kinds of new and unexplored opportunities.
Abstract 1 Im Laufe der Jahre haben die Orthopädieschuhmacher ihr Handwerk als eine Spezialisierung der traditionellen Schuhmacherei entwickelt. Im Gegensatz zu regulären Schuhmachern, die Schuhe für gesunde Füße machen, helfen Orthopädieschuhmacher Menschen mit Fußproblemen, welche ihre Mobilität behindern. Die Orthopädie-schuhmacher tun dies durch die Anpassung oder Änderung von Schuhen, je nach Schwere des Mangels des Fußes, in einem Bereich von einfachen Modifikationen der Standard-Schuhen bis zu vollständig maßgeschneiderten Schuhlösungen. In der Vergangenheit wurden die Orthopädieschuhmacher im Rahmen einer Lehre in der Berufspraxis ausgebildet. Auf diese Weise wurden berufliche Kenntnisse, Fähigkeiten und Fertigkeiten des Schuhmachermeisters an die Lehrlinge/Gesellen von Generation zu Generation übertragen. Diese Basiskenntnis wurde übertragen wie eine Katalog an Erfahrungswissen, zusammen gestellt aus: 1) Wissen über bekannte Probleme und 2) die dazu gehörige Lösungen. Weiterhin wurden 3) die Kenntnisse, Fähigkeiten und Erfahrungswissen formuliert und als prozedurales Wissen gelehrt, um effektive Lösungen zu entwickeln. Folge war, dass verschiedene Schuhmacher-Gruppen verschiedene Lösungen für die gleichen Probleme entwickelten, wofür jede "empirische Gültigkeit“ beanspruchte. Diese Kenntnisbasis von Orthopädieschuhmachern kann man charakterisieren als: Herstellung orientiert an impliziten, durch Tradition bestimmten Lösungsentwürfen. Da die empirischen Lösungen der Nachfrage entsprachen, waren die Begründung der Lösung und der methodische Entwurf der Orthopädieschuhe keine explizit geforderte Aktivität. Vor kurzem wurde in den Niederlanden diese traditionsbestimmte Kenntnisbasis der Orthopädieschuhmacher durch die Krankenkassen in Frage gestellt, da die Kassen wissen wollten, ob und warum ein Lösungsvorschlag wirksam wäre. Erfolgt diese Begründung nicht, wird nur die preiswerteste Lösung zurückerstattet. Die Kassen stellten die Begründungsfrage und forderten also eine akzeptable wissenschaftliche Erklärung für die Lösung des Mobilitätsproblems. Diese Erklärung ist im Prinzip erreichbar, als zum Beispiel innovative Imaging-und Messmethoden zur Verfügung stehen. Es gab großen Widerstand in den Reaktionen auf die Aufforderung, traditionelles Wissen wissenschaftlich zu begründen. Es gab abwehrende (in Zusammenhang mit den Kosten) aber auch pro-aktive / innovative Reaktionen. Fontys University of Applied Sciences nahm die innovative Perspektive und identifizierte Möglichkeiten um das Orthopädieschuhmacher-Handwerk qualitativ aufzuwerten zu einem modernen, mehr professionellen und mit wissenschaftlichen Einsichten unterstützten Beruf. Aus dieser Perspektive hat Fontys einen neuen Lehrplan gestaltet und die Schlüsselperspektiven: 1) Begründung und 2) methodischer Entwurf inkorporiert. Der Lehrplan wird die vorläufigen IVO Kriterien für eine Cat-II Akkreditierung erfüllen. Derzeit wird die Gestaltung von Lehrplänen in Vietnam als Teil der internationalen Kooperationsprojekte pilotiert. Keywords: Vom Handwerk zur Profession, Wissensarten, Methodischer Entwurf Abstract 2 Over the years, orthopaedic shoemakers developed their craft as specialisation of traditional shoemaking. In contrast of shoemakers who make shoes for the healthy feet, the orthopaedic shoemakers assist people with foot related problems causing mobility disabilities. They do this by adapting and modifying shoes in a range from simple modifications of standard shoes to complete bespoke shoe solutions depending on the severity of the deficiency of the foot. In the past, orthopaedic shoemakers were trained in a craft-apprenticeship model which was used to transfer the professional knowledge of the master shoemaker to the apprentice, from generation to generation. This transferred knowledgebase can be perceived as an catalogue of empirical knowledge consisting of 1) knowledge of known problems and 2) associate solutions (know –how). In addition, 3) the knowledge, skills, tricks and traps, formulated in procedural knowledge (do this-do that) was taught to produce the solutions. Consequently, different groups of shoemakers had different solutions for the same issues and each claimed empirical success. This orthopaedic shoemakers knowledgebase can be characterised as manufacture driven with implicit tradition based designs. As the traditional empirical solutions met the demand, explanatory knowledge and explicit methodological shoe design were no issues. In the Netherlands, recently the knowledgebase -know how- of the orthopaedic shoemakers was challenged as the insurance companies wanted to know whether and why a proposed solution is effective. If not, the cheapest solution was refunded. They requested an acceptable scientific explanation – know why- which in principle became achievable as innovative imaging- and measurement methods became available. As a result, the orthopaedic shoe branch was challenged when their mode 2 knowledge was questioned. The reactions were contrasting, from reactive(follow the money) to pro active/innovative. Fontys University of Applied Sciences took an innovative perspective and perceived possibilities to upgraded the craft of orthopaedic shoemakers into a modern, more academic, profession. Therefore, Fontys designed a new curriculum and added the key characteristic: 1) explanatory knowledge (mode 1 knowledge) and 2) methodical design. The curriculum is set up to meet the provisional IVO guidelines for a cat-II accreditation. At present, the curriculum design is piloted in Vietnam as part of international cooperation project. Keywords: from craft to profession, types of knowledge, methodical design
In Europe nearly 10% of the population suffers from diabetes and almost 1% from Rheumatoid Arthritis which can lead to serious problems with mobility and active participation, especially in the ageing population. Pedorthists deliver personalised designed and manufactured orthopaedic footwear or insoles for these patients. However, despite their often laborious efforts upfront, the industry has very little means to quantify how successful the fitting and function of a shoe is. They have to rely on subjective, qualitative measures such as client satisfaction and diminishing of complaints. Although valuable, the need for objective quantitative data in this field is growing. Foot plantar pressure and shear forces are considered major indicators of potential foot problems. Devices to measure plantar pressure slowly gain terrain as providers of objective quantitative data to guide orthotic design and manufacturing. For shear forces however, measuring devices are not yet commercial available. Although shear forces are considered as a major contributor to ulcer formation in diabetic feet, their exact role still requires elucidation and quantification. This project aims to develop a prototype of an in-shoe wearable device that measures both shear forces and pressure using state-of-the-art developments in sensor technologies, smart textiles and wireless data transfer. The collaboration of pedorthists’ small and medium-sized enterprises (SME)’s with medical device engineering companies, knowledge institutes,technical universities and universities of applied sciences in this project will bring together the different fields of expertise required to create an innovative device. It is expected that the tool will be beneficial to improve the quality of pedorthists’ services and potentially reduce health insurance costs. Furthermore, it can be used in new shear forces research and open new business potential. However, the eventual aim is to improve patient care and help maintain personal mobility and participation in society.
The clubfoot deformity is one of the most common congenital orthopaedic “conditions”. Worldwide approximately 100,000 children are born with unilateral or bilateral clubfoot every year. In the Netherlands the incidence is approximately 175 every year. This three dimensional deformity of the foot involves, equinus, varus, adductus, and cavus . Left untreated the clubfoot leads to deformity, functional disability and pain. Physical impairments of children with clubfoot might lead to limitations in activities and therefore impede a child’s participation. In clinical practice, the orthopaedic surgeon and physiotherapists are regularly consulted by (parents of) clubfoot patients for functional problems such as impaired walking and other daily activities. This does not only affect long-term and physical health of a child, it will also affect the development of social relationships and skills as well. Since walking is a main activity in children to be able to participate in daily life, our previous study (financially supported by SIA Raak Publiek) focussed on gait differences between children with clubfoot and controls. However, differences in gait characteristics do not necessarily lead to functional limitations and restricted participation. Therefore, providing insight in participation and a child’s performance in other activities than walking is necessary. Insight in a child’s participation will also indicate the functional outcome of the treatment, which on its turn could provide essential information concerning a possible relapse.. Early identification of a relapse is important since it could prevent the need for major surgical interventions. The occurrence of a relapse clubfoot will probably also lead to functional differences in the foot as well as problems during activity and participation. Therefore, the main focus of this study is the functional outcomes of physical activities and the characterisation of participation of children with clubfeet in daily activities of childhood.
