The Experts below are selected from a list of 12201 Experts worldwide ranked by ideXlab platform
Orthopaedic Hospital - One of the best experts on this subject based on the ideXlab platform.
-
QUADRILATERAL SHAPED Brims MADE FROM HIGH-DENSITY POLYETHYLENE FOR LONG LEG CALIPERS
2016Co-Authors: G. E. Fulford, T. P. Cairns, From Princess, Margaret Rose, Orthopaedic HospitalAbstract:Quadrilateral shaped Brims made of ifigh-density polyethylene have been used with satisfactory results on more than 120 patients who needed ischial-bearing long leg calipers. At first the fitting technique was the same as that used for thigh amputees. Subsequently it has been possible to fit most patients from a range of pre-formed Brims. The properties of high-density polyethylene allow the caliper side irons to be riveted directly to the brim which, with the use of ready-made Brims, allows a patient to be fitted rapidly with a comfortable and effective caliper. The quadrilateral shaped brim has been used for many years by prosthetists in parts of Europe for fitting thigh amputees. In 1946 a team of Americans visited Europe to study European prosthetic techniques and were particularly impressed by the fittings of Strieda in Kufstein, Austria (Radcliffe 1973). After this visit a reproducible and teachable technique of socket fitting for thigh amputees using a quadrilateral shaped brim was developed at the University of California, Berkele
G. E. Fulford - One of the best experts on this subject based on the ideXlab platform.
-
QUADRILATERAL SHAPED Brims MADE FROM HIGH-DENSITY POLYETHYLENE FOR LONG LEG CALIPERS
2016Co-Authors: G. E. Fulford, T. P. Cairns, From Princess, Margaret Rose, Orthopaedic HospitalAbstract:Quadrilateral shaped Brims made of ifigh-density polyethylene have been used with satisfactory results on more than 120 patients who needed ischial-bearing long leg calipers. At first the fitting technique was the same as that used for thigh amputees. Subsequently it has been possible to fit most patients from a range of pre-formed Brims. The properties of high-density polyethylene allow the caliper side irons to be riveted directly to the brim which, with the use of ready-made Brims, allows a patient to be fitted rapidly with a comfortable and effective caliper. The quadrilateral shaped brim has been used for many years by prosthetists in parts of Europe for fitting thigh amputees. In 1946 a team of Americans visited Europe to study European prosthetic techniques and were particularly impressed by the fittings of Strieda in Kufstein, Austria (Radcliffe 1973). After this visit a reproducible and teachable technique of socket fitting for thigh amputees using a quadrilateral shaped brim was developed at the University of California, Berkele
H. Gunn - One of the best experts on this subject based on the ideXlab platform.
-
A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the Brims feasibility RCT.
Health Technology Assessment, 2019Co-Authors: H. Gunn, J. Andrade, L. Paul, L. Miller, S. Creanor, C. Green, P. Ewings, Kara Stevens, Andy Barton, M. BerrowAbstract:Background Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (Brims), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. Objective This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. Design Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. Setting Four sites across the UK. Participants Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. Interventions Intervention - manualised 13-week education and exercise programme (Brims) plus usual care. Comparator - usual care alone. Main outcome measures Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the Brims programme (via process evaluation) and economic data. Results A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0-6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 -7.7 [95% confidence interval (CI) -17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI -7.8 to 9) and MSIS-29vs2 psychological -0.4 (95% CI -9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0-93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking Brims. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of Brims were highlighted. Conclusions The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries. Future work Further development of Brims is required to address logistical issues and enhance user-satisfaction and adherence. Following this, a definitive trial to assess the clinical effectiveness and cost-effectiveness of the Brims intervention is warranted. Trial registration Current Controlled Trials ISRCTN13587999. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 27. See the NIHR Journals Library website for further project information.
-
Balance Right in Multiple Sclerosis (Brims): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised control
Pilot and Feasibility Studies, 2017Co-Authors: H. Gunn, J. Andrade, L. Paul, L. Miller, S. Creanor, C. Green, J. Marsden, P. Ewings, M. Berrow, J. VickeryAbstract:Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial. ISRCTN13587999 .
-
Balance Right in Multiple Sclerosis (Brims): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised control
BMC, 2017Co-Authors: H. Gunn, J. Andrade, L. Paul, L. Miller, S. Creanor, C. Green, J. Marsden, P. Ewings, M. Berrow, J. VickeryAbstract:Abstract Background Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. Methods/design This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: Feasibility outcomes, including trial recruitment, retention and completion Assessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level) Measures of adherence to the Brims programme Data to inform the economic evaluation in a future trial Process evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience) Discussion The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial. Trial registration ISRCTN13587999
Gunn H. - One of the best experts on this subject based on the ideXlab platform.
-
A self-management programme to reduce falls and improve safe mobility in people with secondary progressive MS: the Brims feasibility RCT.
'National Institute for Health Research', 2019Co-Authors: Gunn H., Andrade J., Paul L., Miller L., Creanor S., Green C., Ewings P., Stevens K, Barton A, Berrow M.Abstract:This is the final version, also available from NIHR journals library via the DOI in this record.Abstract Background Balance, mobility impairments and falls are common problems for people with multiple sclerosis (MS). Our ongoing research has led to the development of Balance Right in MS (Brims), a 13-week home- and group-based exercise and education programme intended to improve balance and encourage safer mobility. Objective This feasibility trial aimed to obtain the necessary data and operational experience to finalise the planning of a future definitive multicentre randomised controlled trial. Design Randomised controlled feasibility trial. Participants were block randomised 1 : 1. Researcher-blinded assessments were scheduled at baseline and at 15 and 27 weeks post randomisation. As is appropriate in a feasibility trial, statistical analyses were descriptive rather than involving formal/inferential comparisons. The qualitative elements utilised template analysis as the chosen analytical framework. Setting Four sites across the UK. Participants Eligibility criteria included having a diagnosis of secondary progressive MS, an Expanded Disability Status Scale (EDSS) score of between ≥ 4.0 and ≤ 7.0 points and a self-report of two or more falls in the preceding 6 months. Interventions Intervention – manualised 13-week education and exercise programme (Brims) plus usual care. Comparator – usual care alone. Main outcome measures Trial feasibility, proposed outcomes for the definitive trial (including impact of MS, mobility, quality of life and falls), feasibility of the Brims programme (via process evaluation) and economic data. Results A total of 56 participants (mean age 59.7 years, standard deviation 9.7 years; 66% female; median EDSS score of 6.0 points, interquartile range 6.0–6.5 points) were recruited in 5 months; 30 were block randomised to the intervention group. The demographic and clinical data were broadly comparable at baseline; however, the intervention group scored worse on the majority of baseline outcome measures. Eleven participants (19.6%) withdrew or were lost to follow-up. Worsening of MS-related symptoms unrelated to the trial was the most common reason (n = 5) for withdrawal. Potential primary and secondary outcomes and economic data had completion rates of > 98% for all those assessed. However, the overall return rate for the patient-reported falls diary was 62%. After adjusting for baseline score, the differences between the groups (intervention compared with usual care) at week 27 for the potential primary outcomes were MS Walking Scale (12-item) version 2 –7.7 [95% confidence interval (CI) –17.2 to 1.8], MS Impact Scale (29-item) version 2 (MSIS-29vs2) physical 0.6 (95% CI –7.8 to 9) and MSIS-29vs2 psychological –0.4 (95% CI –9.9 to 9) (negative score indicates improvement). After the removal of one outlier, a total of 715 falls were self-reported over the 27-week trial period, with substantial variation between individuals (range 0–93 falls). Of these 715 falls, 101 (14%) were reported as injurious. Qualitative feedback indicated that trial processes and participant burden were acceptable, and participants highlighted physical and behavioural changes that they perceived to result from undertaking Brims. Engagement varied, influenced by a range of condition- and context-related factors. Suggestions to improve the utility and accessibility of Brims were highlighted. Conclusions The results suggest that the trial procedures are feasible and acceptable, and retention, programme engagement and outcome completion rates were sufficient to satisfy the a priori progression criteria. Challenges were experienced in some areas of data collection, such as completion of daily diaries.National Institute for Health Research (NIHR
-
Balance Right in Multiple Sclerosis (Brims): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis : a protocol for a feasibility randomised contro
'Springer Science and Business Media LLC', 2017Co-Authors: Gunn H., Andrade J., Paul L., Miller L., Creanor S., Green C., Marsden J., Ewings P., Berrow M., Vickery J.Abstract:This study is funded by the NIHR Health Technology Assessment Programme (14/176/12), United Kingdom.Background: Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. Methods/design: This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: • Feasibility outcomes, including trial recruitment, retention and completion • Assessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level) • Measures of adherence to the Brims programme • Data to inform the economic evaluation in a future trial • Process evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience) Discussion: The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial.Publisher PDFPeer reviewe
-
Balance Right in Multiple Sclerosis (Brims): A guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised control
'Springer Science and Business Media LLC', 2017Co-Authors: Gunn H., Andrade J., Paul L., Miller L., Creanor S., Green C., Marsden J., Ewings P., Berrow M., Vickery J.Abstract:This is the final version of the article. Available from BioMed Central via the DOI in this record.Background Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. Methods/design This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: Feasibility outcomes, including trial recruitment, retention and completion Assessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level) Measures of adherence to the Brims programme Data to inform the economic evaluation in a future trial Process evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience) Discussion The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial.This study is funded by the NIHR Health Technology Assessment Programme (14/176/12), United Kingdom. This article presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The sponsor of this clinical study is the Plymouth Hospitals NHS Trust, Devon, England, UK
J. Vickery - One of the best experts on this subject based on the ideXlab platform.
-
Balance Right in Multiple Sclerosis (Brims): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised control
Pilot and Feasibility Studies, 2017Co-Authors: H. Gunn, J. Andrade, L. Paul, L. Miller, S. Creanor, C. Green, J. Marsden, P. Ewings, M. Berrow, J. VickeryAbstract:Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial. ISRCTN13587999 .
-
Balance Right in Multiple Sclerosis (Brims): a guided self-management programme to reduce falls and improve quality of life, balance and mobility in people with secondary progressive multiple sclerosis: a protocol for a feasibility randomised control
BMC, 2017Co-Authors: H. Gunn, J. Andrade, L. Paul, L. Miller, S. Creanor, C. Green, J. Marsden, P. Ewings, M. Berrow, J. VickeryAbstract:Abstract Background Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (Brims), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of Brims in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. Methods/design This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the Brims programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: Feasibility outcomes, including trial recruitment, retention and completion Assessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level) Measures of adherence to the Brims programme Data to inform the economic evaluation in a future trial Process evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience) Discussion The Brims intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the Brims intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial. Trial registration ISRCTN13587999