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Evidence for plantar pressure measurements

Discussion in 'Biomechanics, Sports and Foot orthoses' started by podpaul, Mar 19, 2009.

  1. podpaul

    podpaul Active Member

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    Hi everyone,

    I am looking for some advise from anyone who has audited the use of a pressure/force measurement system such as an RS or F scanner.

    I work for an NHS trust and we have recently purchased an RS scanner but I am coming up against a brick wall in terms of how I am going to audit it.

    We are mainly using the system for patients who have biomechanical complaints, patients with active ulcerations and high risk patients with peripheral neuropathy.

    As we have this new equipment, we are not able to with hold it from any patients in terms of treating some patients using the RS scanner as part of their assessment, and a control group of patients whoes assessment does not include use of the scanner.

    I have to try and show that having this piece of equipment is improving patient care, which I know it is from using it, but I just cannot come up with a way to showq this in an audit.

    Any thoughts would be appreciated!!!

  2. David Smith

    David Smith Well-Known Member

    Re: Audits for RS Scan

    Did you have a formal outcome measure protocol pre pressure mat system that you could compare with the same outcome measure post pressure mat system?

    I cannot say that using a pressure mat system absolutely improves my treatment or outcomes although sometimes it does give an added indication of pathological genisis that I may not have considered previously. Whether this indication is valid is another question. I cannot think of anything that a pressure mat can show that I cannot see from clinical and visual evaluations. However I can say that when the pressure mat output confirms my evaluation it adds value to my resulting diagnosis. Sometimes the system does not confirm my evaluation or even contradicts it. What then? I have to make a decision based on my experience and reasoning.

    On the question of diabetic evaluation in terms of predicting trauma in terms of plantar pressure parameters is a shaky one at best. The post hoc propter hoc statement is far from valid in this situation since no maximum pressure peaks or pressure / force integrals have been defined that would confirm this assumption.

    I think it would be unusual for a patient, with diabetic neuropathy causing anaesthesia, to have high pressure areas that are likely to become pathological due to the high pressure without any signs or symptoms that are obvious to the clinician without the use of a pressure mat or insole system. Even if this sign is only so much as the depressions in the patient's shoe insole.

    In the patient that already have pathological changes such as pressure lesions then it may be possible that a pressure insole system will indicate and confirm a reduction of localised peak pressure or some arbitrary pressure integral. However research will show that there is not always a correlation between vertical pressure parameters and ulceration may have more to do with shear forces, which are not detectable using vertical pressure systems. We can all recognise, without referring to a pressure system, that putting a balance pad or insole with cut out will reduce pressure in that area and very likely the shear forces too. But what about at the edge s of the cut out, how are the shear forces affected here?

    The advantages I have found using a pressure mat system are - Documentation is superior i.e. records and reports, Reviewability, Communication i.e. inter clinician, inter department, between establishments, with patient. Justifiability, validity, accountability. Perhaps none of these can directly correlate with improved outcome but can be argued that they are beneficial in the hierarchy of patient care.

    The possibility outlined in the first paragraph and these last criteria may be important determinants in an audit to show the value of a certain piece of equipment and the vertical pressure system in particular.

    Cheers Dave
  3. efuller

    efuller MVP

    Re: Audits for RS Scan

    That is a tough one. If you cannot withold pressure measurement from one population you are going to have trouble designing a study to assess the effect on outcomes. Can you go back into charts and get some data.

    The study that I wanted to do was with insensate feet and accomodative orthotics. I can recall one patient, who had an amputation and a chronic ulcer at the distal amputation site. I was attempting to modify the device to off weight the site, but could not be sure that I had. Using the FScan I was able to see that the area was not unloaded and a few modifications later it was recieving much less load. The old way is to put the accomodative device in the shoe and have the patient come back when they ulcerate with it. The vast majority don't ulcerate, but it still is best guess for the first try.

    You could look back through your records to see how many people developed problems from high pressure (or what you believe to be high pressure). Then you could do the same treatment with adding a pressure measurement and record whether or not you made a change in response to high pressure measurement and then look at number of people that problems related to high pressure.

    You could use fewer subjects if you had a population that was really fragile so that more of your subjects were likely to have problems. It would be hard to match subjects so that it would be a good study.

    Interesting question,

  4. Phil Wells

    Phil Wells Active Member

    Re: Audits for RS Scan


    Would it be possible to audit your interventions instead?
    If the pressure system is changing the type, cost, re-works needed of your orthoses, then you should be able to quantify it.
    My experience of using a pressure system in an at risk foot clinic was that I got the orthoses right first time more often and was able to use more durable materials as I was confident in the application of the ORF (Orthotis reaction forces).


  5. podpaul

    podpaul Active Member

    Re: Audits for RS Scan

    Thanks everyone for your comments, it gives me some ideas to work with!!
  6. Admin2

    Admin2 Administrator Staff Member


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