OAR@UM Collection:

A comparison between the 12-lead electrocardiogram and hand-held spectral waveform doppler ultrasound in the detection of atrial fibrillation (Master's dissertation).

Thu, 01 Jan 2026 00:00:00 GMT

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.)

An investigation into remodelling, morphological and mechanical changes in the clinical management of mid-portion achilles tendinopathy

Thu, 01 Jan 2026 00:00:00 GMT

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.)

The development of a telemedicine service for core podiatry in the Maltese public service

Thu, 01 Jan 2026 00:00:00 GMT

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.)

The effectiveness of an innovative Hallux Valgus sock on dysfunction of the 1st Ray and Hallux Abducto-valgus progression

Thu, 01 Jan 2026 00:00:00 GMT

Title: The effectiveness of an innovative Hallux Valgus sock on dysfunction of the 1st Ray and Hallux Abducto-valgus progression Abstract: Hallux Abducto Valgus (HAV) is a progressive structural deformity of the first metatarsophalangeal joint which results in the lateral deviation of the hallux, and also can lead to changes in foot biomechanics, chronic pain, decreased mobility, difficulty in footwear fitting, and diminished quality of life. With a high global prevalence, especially in older adults and females, HAV lacks a consensus on an effective form of conservative treatment, and many acute and chronic situations of HAV involved surgery as the conventional treatment. Surgery in itself can create complications and risk for the patient, therefore the justification of an effective non-invasive treatment approach is both clinically and cost effective. The aim of this PhD study was to explore, assess, and test an innovative non-invasive therapeutic device; an ergonomically designed Hallux Valgus (HV) sock with a biomechanical corrective effect to relieve symptoms and restore function. The study was undertaken in four phases. Phase I entailed a full systematic review of non-surgical treatments for HAV. The systematic review involved determining clinical effectiveness, methodological quality, and biomechanical rationale of various interventions, including orthotic devices, physical therapy, footwear modifications, and bracing methods. It also aimed to assess the long-term outcomes and potential risks associated with each treatment modality, providing a comprehensive analysis of their effectiveness in halting or reversing the progression of hallux valgus.. The review found no close similarity across studies, substantial variability in outcomes, and limited high-quality evidence showing long term effectiveness for non-surgical approaches – signifying a clinical need to develop and conduct clinical trials. Phase II focused on preliminary biomechanical evaluation of the HV sock with a series of laboratory-based pilot studies. Particularly, surface electromyography (EMG) assessed muscle activation patterns, adductor hallucis, while plantar pressure mapping evaluated changes in forefoot pressure distribution and the first ray alignment while performing dynamic tasks. The studies provided evidence of a tangible mediation by reducing medial deviation of the first metatarsal, and increasing optimal loading patterns throughout the gait with the HV sock. Phase III involved a randomized controlled clinical trial with 100 participants diagnosed with mild to moderate HAV. Participants were randomly assigned to either conservative podiatric care (control group) or conservative podiatric care plus daily use of the HV sock (intervention group) during the trial of six months. Significant outcome measures included the change in HAV angle (clinically), foot function (Foot Function Index), pain intensity (Visual Analogue Scale), and patients’ quality of life (Manchester-Oxford Foot Questionnaire). Using mixed linear model and statistical tests, clinically and statistically significant improvement was demonstrated in all outcome measures in the intervention group by using eleven months with the HV sock, including a change in HAV angle that significantly exceeded established minimal clinically important difference thresholds than control group. [...] Description: Ph.D.(Melit.)