OAR@UM Collection:

Ankle brachial pressure index in the early identification of cardiovascular disease risk in rheumatoid arthritis

2017-02-23T02:24:06Z

Title: Ankle brachial pressure index in the early identification of cardiovascular disease risk in rheumatoid arthritis Abstract: AIM Atherosclerosis in the Rheumatoid Arthritis population is under-diagnosed and the relation between Ankle Brachial Pressure Index (ABPI) measurement and cardiovascular disease is under reported. The aim of the study was to determine the relationship between ABPI and cardiovascular disease risk factors in the early identification of vascular disease in Rheumatoid Arthritis (RA) patients. METHODS A prospective observational non-experimental study was conducted on 100 subjects presenting with RA and no history of cardiovascular events. Demographic data and blood results including C-reactive protein, Erythrocyte sedimentation rate, RA factor, Anti-cyclic Citrullinated Peptide Antibodies and cholesterol levels were recorded. A vascular assessment including waveform spectral analysis and ABPI was conducted. ABPI was defined as abnormal if less than 0.9. RESULTS From all cardiovascular disease risk factors measured, this study has identified that high cholesterol levels were related to lower ABPI readings in this cohort (p=0.022). This study also identified gender, analgesics and biologics as other possible risk factors that showed a relationship to the ABPI although not statistically significant. CONCLUSIONS A relationship between ABPI and hypercholesterolaemia was found in RA patients who did not have diabetes, were not taking anti-platelet and anticoagulant treatments, had no history of ulcerations or cardiovascular events. The results showed that RA participants presenting with hypercholesterolaemia demonstrated lower values of ABPI when compared to subjects without hypercholesterolaemia, although almost all of them still fall within the normal range. Health professionals should closely monitor cholesterol levels to avoid possible atherosclerosis in this population. Description: M.SC.PODIATRY

Exploring managerial perception of the role of the podiatrist in new health care services

2017-07-27T09:00:31Z

Title: Exploring managerial perception of the role of the podiatrist in new health care services Abstract: Aim : The aim of the study was to explore managerial perception with regards to the inclusion or expansion of the role of the podiatrist in different health care sectors in Malta which deal with the prevention, diagnosis and management of lower limb pathologies. Methods : An exploratory qualitative design was adopted in this research study. Purposive sampling to recruit managers heading different departments dealing with lower limb pathologies was used. Unstructured interviews were employed amongst participants in order to gather their views with regards to Podiatric development in their respective department. Interviews were transcribed and thematic analysis was adopted for interview analysis. Results : The study showed that out of the six interviewed managers, mixed ideas exist with regards to introducing or expanding the role of the podiatrist, with some managers being fully in favour, some partially in favour, and some not in favour. The emergent themes were divided into two groups. The first group consists of the reasons against Podiatric development, and the second group deals with the reasons in favour of Podiatric development. Conclusion : This study concludes that there are different opinions with regards to the inclusion or expansion of the role of the podiatrists in different departments dealing with lower limb pathologies, with the majority of the opinions being in favour of this development. The study highlights the benefits which the podiatrists can bring to different departments and its patients, whilst also highlighting the barriers and challenges which the profession faces with this development. Further studies to evaluate the perceptions of other health care professionals within the multidisciplinary team, and patients’ perception are warranted. Description: B.SC.(HONS)PODIATRY

The effectiveness of calf muscle electro-stimulation on lower extremity arterial perfusion in patients living with diabetes mellitus and peripheral artery disease

2017-01-25T09:37:03Z

Title: The effectiveness of calf muscle electro-stimulation on lower extremity arterial perfusion in patients living with diabetes mellitus and peripheral artery disease Abstract: Aim: To investigate whether calf muscle electro-stimulation improves arterial inflow and walking capacity in claudicants with peripheral artery disease and diabetes mellitus. Methods: A prospective, one-group, pretest-posttest study design was employed on forty participants (n=40) with bilateral limb ischemia (ABPI <0.90), diabetes mellitus and calf muscle claudication. All participants received a program of calf muscle electrical stimulation with varying frequency (1-250Hz) on both limbs (N=80) for 1 hour per day for 12 weeks. Spectral Doppler waveforms of pedal arteries; ankle brachial pressure index (ABPI); absolute claudication distance (ACD); and thermographic temperature patterns across four specified regions of interest (hallux; medial forefoot; lateral forefoot; heel) at rest and after exercise, were recorded at baseline and following intervention to evaluate for therapeutic outcomes. Results: Significant increases were registered in mean ACD (137 meters; p=0.000) and mean ABPI (0.04; p=0.001) in response to the intervention. Resting foot temperatures across all regions of interest increased significantly (p= 0.000) while the post-exercise temperature drops were halved across all regions at follow-up, with two of four regions reaching statistical significance (hallux, p=0.005; lateral forefoot, p=0.038). Spectral Doppler waveforms did not change (p=0.304) between both serial assessments. Conclusion: Electrical stimulation of varying frequency for 1 hour per day for 12 consecutive weeks registered statistically significant improvement in outcome measures that assess arterial inflow and walking capacity in claudicants with diabetes mellitus. These results favor the use of ES as a therapeutic measure in this vulnerable population in order to reduce symptoms and potentially reverse derangements associated with the limb ischemia. Description: M.SC.PODIATRY

A comparison of athletes’ general endurance when wearing minimalist versus structured footwear

2018-05-04T06:18:23Z

Title: A comparison of athletes’ general endurance when wearing minimalist versus structured footwear Abstract: Background: Minimalist footwear have currently invaded the endurance running community due to their lightweight and less supportive characteristics, as opposed to structured footwear that possess heavily cushioned and protective characteristics. General endurance is the capacity to perform physical activity that includes large muscle groups, and the input of various body systems, over an extended period of time. A fundamental constituent when defining ‘general endurance’ is oxygen consumption, characterized by the amount of maximal oxygen consumption (VO2 max), which is the maximal amount of oxygen uptake achieved when an individual is working at maximal capacity. VO2 max assessment is commonly performed in endurance runners to predict aerobic fitness and endurance performance and this is measured on a treadmill or cycle ergometer when running. Studies have focused on structured and minimalist footwear and their effects on running economy and performance; however studies investigating the effect of structured and minimalist footwear on general endurance in terms of maximal oxygen consumption (VO2 max), are still lacking. Aim: To evaluate whether there is a difference in general endurance when comparing minimalist footwear to structured footwear, in long distance recreational runners. Objectives: To assess the athletes’ general endurance when running on a treadmill in minimalist versus structured footwear, for as long as possible and to measure if there is any difference in maximal oxygen uptake (VO2 max) between the two different types of footwear, when performing the Bruce Treadmill Protocol. Design & Methods: A quantitative, quasi-experimental, within subject design study was employed. A group of participants (n=30), of average age 24.80 (range 20-35), that were recreational long distance runners, who ran at least 12km per week, with no previous experience with minimalist running shoes and/or barefoot running took part. The VO2 max of each athlete was brought about by running on a treadmill when using the Bruce Treadmill Protocol were two different trials, ‘Trial 1’ wearing structured footwear and ‘Trial 2’ wearing minimalist footwear were performed by each participant. The time taken for each athlete to reach volitional exhaustion was recorded and interpreted via two equations depending on whether the participant was male or female. The results of the equation were the participants' estimate VO2 max and these were compared between the two types of footwear. Results: The results of this study found a significant difference in general endurance when wearing minimalist footwear versus structured footwear, since the p-value was that of 0.038, indicating a higher efficiency in minimalist footwear. Conclusion: Minimalist footwear was found to be more effective at improving general endurance over structured footwear, in long distance recreational runners. Further research should be conducted by using the direct method for measuring VO2 max, to investigate whether results are consistent with this study. Description: B.SC.(HONS)PODIATRY