https://www.um.edu.mt/library/oar/handle/123456789/143887 2026-10-12T00:42:42Z https://www.um.edu.mt/library/oar/handle/123456789/149531 Title: The effect of symptoms of depression on foot self-care practices and diabetes-related knowledge in housebound people with diabetes mellitus Abstract: Aim: To investigate the effect of symptoms of depression on both foot self- care practices and diabetes related knowledge in housebound people with diabetes. Methods: A prospective quasi-experimental design was employed, and participants were recruited from the Active Aging and Community Care database and conducted at their own homes. The sample population was divided into two groups following the SRQ-20: Group 1: 55 housebound participants with diabetes and without symptoms of depression and Group 2: 62 housebound participants with diabetes and with symptoms of depression. Participants were recruited through convenience sampling by the intermediaries. The intermediaries contacted the participants by telephone and upon verbal consent to the intermediaries, the researcher conducted the house visits and recruitment. Four questionnaires were utilised: The Self- Reporting Questionnaire (SRQ-20) (To assign into the respective group), the Diabetes Knowledge Questionnaire (DKQ-24) (To assess the knowledge), Nottingham Assessment of Functional Feet (NAFF) (To assess foot care behaviour) and EQ-5D-5L Questionnaire (To assess Quality of Life). Participants were assessed at three time points over six months, with changes in diabetes knowledge, foot care behaviours, and quality of life assessed and recorded. Results: Of the 124 participants who initially agreed, 117 were included in the analysis; 7 were excluded, due to admission to long-term care (n=3) and voluntary withdrawal (n=4). Both the Kolmogorov-Smirnov and Shapiro-Wilk tests were conducted to test for normality for both the DKQ-24 and NAFF Questionnaire separately and non-parametric test were used. The mean DKQ-24 scores increased significantly over time in both groups (p < 0.001), with no significant differences between participants with and without symptoms of depression at any time point (p > 0.05), indicating similar improvements in diabetes-related knowledge. The mean NAFF scores also increased significantly over time in both groups (p < 0.001), with participants without symptoms of depression consistently scoring higher than those with symptoms at all time points (p < 0.05), reflecting better foot self-care behaviours. These findings suggest that while symptoms of depression did not affect knowledge acquisition, it was associated with lower engagement in foot self-care practices. [...] Description: M.Sc.(Melit.) 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145691 Title: A comparison between the 12-lead electrocardiogram and hand-held spectral waveform doppler ultrasound in the detection of atrial fibrillation (Master's dissertation). Abstract: Background: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia and a leading cause of thromboembolic stroke. Early detection is essential to initiate timely intervention and reduce associated morbidity and mortality. While electrocardiography (ECG) remains the gold standard for AF diagnosis, its routine use in community settings is limited. Pedal Doppler ultrasound (US) is already widely utilised in podiatric practice for vascular assessments, offering a potential opportunity for opportunistic AF screening during routine foot care. However, evidence quantifying the accuracy of pedal Doppler US for arrhythmia detection is limited. Aim: This study aimed to evaluate the accuracy of pedal Doppler US in identifying atrial fibrillation when compared with ECG findings, to determine its potential role as an opportunistic screening tool within podiatric practice. Methods: A cross-sectional study was conducted involving 112 participants aged 65 years and older. Pedal Doppler US was used to classify peripheral pulse patterns as regular, partially regular, or irregular. ECG served as the reference standard to confirm the presence or absence of arrhythmias. Chi-square analysis was employed to assess the association between Doppler findings and ECG results, and Cramér’s V was calculated to estimate effect size. Results: A strong, statistically significant association was found between Doppler-detected irregular pulses and ECG-confirmed arrhythmias (χ²(1, N=112)=52.42, p<0.001, Cramér’s V=0.68). Doppler US reliably identified all cases of irregularly irregular rhythms indicative of AF but failed to detect regular arrhythmias such as first-degree atrioventricular block and sinus bradycardia. Conclusion: Pedal Doppler US shows considerable promise as a rapid, non-invasive, and accessible preliminary screening tool for irregular arrhythmias in podiatric settings. With appropriate training to standardize interpretation, podiatrists could play a pivotal role in opportunistic AF detection, facilitating timely ECG referral and potentially reducing stroke incidence in at-risk populations. Larger-scale, multi-center studies are recommended to validate these findings and inform future clinical guidelines. Description: M.Sc.(Melit.) 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144134 Title: An investigation into remodelling, morphological and mechanical changes in the clinical management of mid-portion achilles tendinopathy Abstract: Mid-portion Achilles tendinopathy is a chronic degenerative tendon condition characterised by pain, impaired function and structural alterations that compromise tendon integrity, affecting both sedentary and active individuals. Despite its widely reported high prevalence, the remodelling process during treatment remains poorly understood. This research investigates Achilles tendon remodelling during rehabilitation and High-Volume Image Guided Injection treatment, focusing on mechanical and morphological property changes to improve clinical management and patient outcomes. Carried out in three phases, the research first identified gaps in clinical practice and assessment modalities through various reviews and a sequential mixed methods scoping study. The findings highlighted the insufficiency of relying solely on morphological evaluation and underscored the local needs for optimised referral pathways, objective outcome measures and multidisciplinary care integration. This led to the establishment of a multidisciplinary Sports and Exercise Clinic. In phase two, the research validated both shear wave elastography and myotonometry as methods for measuring small tendon strains, the latter emerging as the more pragmatic tool. This led to the development of a standardised reliability protocol for consistent monitoring of tendon mechanical properties during treatment and rehabilitation. Phase three employed a pragmatic, assessor-blinded randomised controlled trial comparing exercise rehabilitation alone to High-Volume Image Guided Injection combined with exercise. The findings suggest that although both groups achieved comparable pain reduction, the intervention group showed an early unexpected reduction in stiffness (t=-3.09(16), p=0.007), raising questions about the injection’s immediate mechanical effect on the tendon. Furthermore, tendon bulge thickness decreased significantly in the intervention group, though this change fell short of clinical significance suggesting that morphological changes may require longer period to manifest. These findings should be interpreted in light of the small sample size, which was justified by a higher prevalence of insertional tendinopathy (67.9%) compared to mid-portion tendinopathy (20.3%) in the study population - an observation linked to shorter free tendon length, which may represent a potential anatomical risk factor for insertional tendinopathy. This research provides novel insights into tendon remodelling and is the first to objectively quantify short-term mechanical stiffness post High-Volume Image Guided Injection, highlighting a previously underexplored aspect of treatment efficacy and underscoring the need for further studies to evaluate the injection’s long term biomechanical impact. Description: Ph.D.(Melit.) 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144132 Title: The development of a telemedicine service for core podiatry in the Maltese public service Abstract: From a technological, cultural, and social perspective, telemedicine is considered one of the significant innovations in health services. Telemedicine benefits accessibility to health care services and promotes the quality of healthcare and organizational efficiency. Nonetheless, there are significant barriers to standardizing telemedicine as well as its complete consolidation and expansion. Although a growing number of pilot projects and viability studies have been carried out in various healthcare professions, only a few telemedicine applications have been rooted in clinical practice and consolidated into medical processes. Moreover, even these were frequently dropped once the initial phase was over due to heavy regulatory laws and resistance to change from stakeholders. This PhD research study aimed to investigate the feasibility of the development of a podiatric telemedicine framework for low-risk patients in a primary care setting. This research evaluated the possibility of implementing telemedicine in core podiatry; analyse interactions that arise throughout the process of implementation in podiatric care and changes that occur in organizations, management models, culture, and healthcare services. It also reflects on significant features associated to prioritization, design, deployment, integration, and assessment tailored for core podiatry services. The evaluation of the developed podiatric telemedicine guideline ultimately concentrates on significant aspects in the successful development of telemedicine and generates recommendations to overcome difficulties that could arise. This research comprised three main studies, an initial scoping study to investigate current foot and ankle telemedicine practice guidelines, the second study adopting a modified Delphi 3 study to develop the podiatric telemedicine guideline, followed by the last phase which included healthcare provider training and a pilot study testing the podiatric telemedicine guideline in a primary care setting. Lastly, this PhD research shed light on the challenges faced and opportunities for podiatric service expansion in a primary care setting. This study developed the first evidence-based guideline for podiatry services in a primary care setting for low-risk patients. Description: Ph.D.(Melit.) 2026-01-01T00:00:00Z