OAR@UM Collection:

A comparison of thermal camera technology in diabetic foot complications

Sun, 01 Jan 2023 00:00:00 GMT

Title: A comparison of thermal camera technology in diabetic foot complications Abstract: Aim: The aim of the study was to compare temperature readings from low-cost thermal cameras to a higher quality thermal camera in order to determine whether these cameras could be safely utilised when obtaining such temperatures in the diabetic foot in a clinical setting. Research Design and Method: This research project was a quantitative, postpositivist and quasi-experimental study which investigated the ability of low-cost thermal cameras to report temperature readings which are comparable to those of a high-cost thermal camera. The higher cost, ‘gold standard’ thermal camera was the FLIR T630, while the two low-cost thermal cameras used were one stand-alone thermal camera, the FLIR C3, and one smartphone-attached thermal camera, the FLIR One Gen 1. A thermal image of each participant was taken with each camera at three different ambient temperatures of 19℃, 23℃ and 28℃, in order to investigate whether the surrounding ambient temperature could affect the ability of those low-cost thermal cameras to report the appropriate temperature readings. From each thermal image, 8 different toe and forefoot regions of interest were manually demarcated using the FLIR ResearchIR programme, which then provided the mean temperature of each region. The mean temperature scores of the low-cost thermal cameras were then compared to the mean temperature scores of the FLIR T630 camera through the appropriate statistical analysis. Results: The findings of this study showed that the FLIR C3 camera did not report comparable results to the FLIR T630 (p=<0.05) at 19℃ and 23℃, however, the temperature readings were statistically similar at 28℃. The FLIR One camera on the other hand reported statistically similar readings (p>0.05) in all three room temperatures, which contrasts to what was observed in the FLIR C3. From the FLIR One temperature readings, only the 5th digit readings at 19℃ varied significantly from the FLIR T630. Conclusion These findings in the present study indicate that while the FLIR One smartphone thermal camera was able to report similar temperature readings to the FLIR T630, the FLIR C3 was not, even though the FLIR One is a cheaper option than the FLIR C3. A possible explanation for this observation is that although the FLIR C3 has a higher cost, its infrared resolution is lower than that of the FLIR One. This could be due to the fact that since the FLIR C3 is a stand-alone thermal camera, it requires a lot of computational features and specifications that the FLIR One camera does not need since it uses the features of the smartphone device to which it is attached. This helps keeps the cost of the FLIR One camera very low, and since the only major feature of the FLIR One is the infrared sensor, an improvement in the sensor still allows the cost of the FLIR One to remain low. This study has shown that certain low-cost thermal cameras may be used to report temperature readings correctly, however, it is important that the thermal camera is tested and validated before it is used for detailed temperature reading analysis of the diabetic foot. Description: M.Sc.(Melit.)

Biomechanical variations in gait of active and sedentary individuals upon perceived exertion

Sun, 01 Jan 2023 00:00:00 GMT

Title: Biomechanical variations in gait of active and sedentary individuals upon perceived exertion Abstract: Aim: The aim of this research was to investigate whether there are comparable differences in the gait kinematic, kinetic and spatio-temporal parameters which can be observed within the gait of both active and sedentary young adults upon exertion up to the point of maximal fatigue. Method: The current study is a quantitative, correlational, experimental study. The entire research protocol was performed in a clinical gait and motion analysis laboratory in the Podiatry Department, within the Faculty of Health Sciences (University of Malta, Mater Dei Hospital). An 18-camera Vicon Motion Capture System was utilised to collect all gait parameters. Retroreflective markers were placed upon various anatomical locations on the participants’ lower limbs as dictated by the Plugin-Gait model (Vicon). This system provided a digital map of the participants’ walking pattern in space whilst also providing quantifiable data which was then used to measure pattern differences. All participants were asked the same questions and the same readings were taken throughout the entire research process. After the initial motion capture, participants were asked to run/jog on a treadmill at a self-selected, comfortable pace whilst having their relevant recordings of Rate of Perceived Exertion (RPE), speed, distance, time, peripheral oxygen saturation (SPO2), and Heart Rate (HR) recorded. Once fatigue was achieved (when the participants stated that they scored their fatigue as 20 on the RPE scale), the participants were required to perform one final motion capture with the same instructions as the earlier gait analysis procedure. Subsequently, the six best pre- and post- trials (three for pre- and three for post-) with the most representative gait patterns were selected from each session and used for data processing. In data processing, the captures were tabulated and an average was calculated. This entire process was conducted for all participants and spanned over a period of 6 months. Results: A total of forty healthy participants successfully participated in this study, (Active participants: 31; Sedentary participants: 9; Male Participants: 20; Female Participants: 20; Age average: 26; SD ± 2.05). Significant (p <0.05) fatigue-induced changes in ankle dorsi/plantarflexion and GRFZ occurred in all the five phases of gait (Heel Strike, Mid-Stance, Weight-Transference, Toe-off, and Mid-Swing). This study found that these kinematic and kinetic variations altered various spatio-temporal parameters. These variations were evident in all the participants’ reduction in cadence (p = 0.002), step times (p <0.001) and stride times (p = 0.012). Furthermore, this study observed that fatigue alters gait significantly regardless of whether participants are active or sedentary. Conclusion: Considering the nature of the fatiguing task, subjects experienced maximal exhaustion, but they may not have progressed through to maximal fatigue. Nevertheless, the readings obtained within this study, which could be described as a “fatigued/exhaustive state”, still satisfy the requirements of the aim. Furthermore, this research observed significant effect of fatigue on ankle kinematic and kinetic mechanisms. Ankle dorsi/plantarflexion, GRFZ, along with other (less-significant) biomechanical alterations led to significant reduction in cadence, step times and stride times. It was also discussed how these kinematic and kinetic paradigms have substantial implications for the gait pattern of athletes, the elderly, and the general population. Addressing these may decrease the risk of falls and injuries. Description: M.Sc.(Melit.)

Evaluating medical thermography for the detection of joint synovitis of hands and feet in people living with rheumatoid arthritis

Sun, 01 Jan 2023 00:00:00 GMT

Title: Evaluating medical thermography for the detection of joint synovitis of hands and feet in people living with rheumatoid arthritis Abstract: Aim: To determine whether infrared thermography could detect the presence of joint synovitis in the hands and feet of people living with Rheumatoid Arthritis. Methods: A single-centre, quantitative, prospective, non-experimental, observational, comparative study was conducted at the Rheumatology Department in Mater Dei Hospital. The sample (n=26) included 5 participants who had joint synovitis (used as controls) and 21 participants whose status of whether joint synovitis was present or absent was unknown. The consultant rheumatologist conducted the disease activity score (DAS-28) assessment and an ultrasound assessment of the hand and feet whilst, a state registered podiatrist performed the Ritchie Articular Index (RAI) and thermographic imaging assessment of the hands and feet. Results: The study findings highlighted a significant difference between the temperature readings and ultrasound readings (p<0.05) of hands and feet. In all the joints of participants (n=26), the temperature readings taken with the FLIR thermographic camera were higher when joint synovitis was present on ultrasound then the temperature readings when joint synovitis was absent on ultrasound. Additionally, through the regression models the temperature cut-off points between participants living with RA in remission and participants with active synovitis was established for the finger, palm, forefoot and midfoot and heel. Finally, amongst the participants whose RA status was unknown (n=21) the results of the chi-square test (p>0.05) showed no significant difference between the results obtained from the FLIR thermographic camera images and the diagnostic ultrasound demonstrating a perfect agreement in results between both tools as to whether joint synovitis was either present or absent. Conclusion: The study findings conclude that in all the joints of the hands and feet, the temperature readings taken with the FLIR thermographic camera were higher when joint synovitis was present on ultrasound compared to no presence of synovitis. This study has identified the temperature cut-off points of the finger, palm, forefoot and midfoot and heel for individuals with RA in remission and individuals with RA with active synovitis, thus these results have added to the body of knowledge the baseline temperatures of an individual with RA with joint synovitis of the hands and feet. Since readings obtained from the FLIR thermographic camera correlated with the results obtained from diagnostic ultrasound in the detection of joint synovitis in the hands and feet, the authors recommend routine screening in RA patients utilizing infrared thermography as an alternative measure to diagnostic ultrasound for the early detection if any, of joint synovitis to enable early referral and management of this condition . Further studies are warranted to further confirm results of this study. Description: M.Sc.(Melit.)

A comparison of screening tools for the accurate diagnosis of peripheral neuropathy in type 2 diabetes

Sun, 01 Jan 2023 00:00:00 GMT

Title: A comparison of screening tools for the accurate diagnosis of peripheral neuropathy in type 2 diabetes Abstract: Aim: To investigate and compare different subjective screening modalities recommended in the diabetic foot screening guidelines for detecting peripheral neuropathy in a primary care setting, and compare their results with the objective tool, the NC-Stat® DPN Check®. Research Design and Methods: A prospective non-experimental quantitative comparative study was conducted in Primary Health Centres. Sixty- three participants (mean age 54.5 years ± 10.5) who met the inclusion criteria and were living with Type 2 diabetes mellitus for at least 10 years were recruited using a convenience sampling method. The subjective tools utilized were the Semmes-Weinstein 10-g monofilament, 128-Hz traditional tuning fork (TTF), neurothesiometer and the O‟Brien 128-Hz electronic tuning fork (ETF). These tools were compared with the objective measure NC-Stat® DPN Check® for the detection of peripheral neuropathy. The NC-Stat device was chosen since it has been deemed by research as a reliable tool to detect peripheral neuropathy in its early stages. Each test was carried out bilaterally, therefore a total of 126 limbs were statistically analysed. Results: A significant difference was reported between all the screening tools when compared in the same group of participants (P < 0.05). The descending order of limbs classified as having „absent‟ sensation, from highest to lowest percentage is as follows: NC-Stat® DPN Check® (32.5%), ETF constant mode (23.8%), ETF descending mode (23%), TTF (20.6%), neurothesiometer (11.1%) and lastly the 10-g monofilament (4%). Further analysis comparing each subjective tool with the NC-Stat device within their respective categories revealed significant differences between the percentages of limbs with peripheral neuropathy. Conclusion: The findings have shown that some screening modalities are more sensitive to the diagnosis of DPN than others. This highlights the importance of using multiple screening tools to assess diabetic peripheral neuropathy (DPN) to gain a better understanding of the patient‟s neurological status. The findings also suggest the inclusion of objective tools such as the NC-Stat tool in diabetic foot screening assessments, as it may enhance the early detection of peripheral neuropathy. Additionally, considering that the subjective measures utilized in this study were all recommended by diabetic foot screening guidelines, the observed variations among these tools suggest a compelling case for change. With the advancements in technology and our evolving understanding of disease progression, it is suggested that these emerging screening tools may be incorporated into revised guidelines to ensure optimal and evidence-based care. Standardizing diagnostic criteria and identifying early biomarkers for nerve degeneration in DPN are crucial for optimal patient care. Further rigorous studies comparing screening tests with a gold standard tool are necessary to determine the most valid non-invasive screening modality utilized in a primary care setting which would reduce the false negative/positive result. Description: M.Sc.(Melit.)