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Journal articleNowinka Z, Alagha MA, Mahmoud K, et al., 2022,
Predicting Depression in Patients With Knee Osteoarthritis Using Machine Learning: Model Development and Validation Study
, JMIR FORMATIVE RESEARCH, Vol: 6- Cite
- Citations: 8
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Conference paperLu V, Zhang J, Logishetty K, et al., 2022,
109 The Impact of Extended Reality on Surgery: A Scoping Review
, ASiT Surgical Conference, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323 -
Conference paperEdwards T, Gupta S, Soussi D, et al., 2022,
1019 Collaborative Surgical Team Training in Virtual Reality Is Superior to Individual Learning: A Randomised Controlled Trial
, ASiT Surgical Conference, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323 -
Conference paperWoodbridge H, Alexander C, Jones M, et al., 2022,
Exploring the barriers to early physical rehabilitation and investigating its safety in critically ill patients receiving vasoactive drugs. Rising Star - ICS Gold Medal.
, Intensive Care Society State of the Art 2021 Congress, Publisher: SAGE Publications -
Journal articleSanz-Pena I, Arachchi S, Curtis-Woodcock N, et al., 2022,
Obtaining patient torso geometry for the design of scoliosis braces. A study of the accuracy and repeatability of handheld 3D scanners
, Prosthetics and Orthotics International, Vol: 46, Pages: e374-e382, ISSN: 0309-3646Objective: Obtaining patient geometry is crucial in scoliosis brace design for patients with adolescent idiopathic scoliosis. Advances in 3D scanning technologies provide the opportunity to obtain patient geometries quickly with fewer resources during the design process compared with the plaster-cast method. This study assesses the accuracy and repeatability of such technologies for this application.Methods: The accuracy and repeatability of three different handheld scanners and phone-photogrammetry was assessed using different mesh generation software. Twenty-four scans of a single subject's torso were analyzed for accuracy and repeatability based on anatomical landmark distances and surface deviation maps.Results: Mark II and Structure ST01 scanners showed maximum mean surface deviations of 1.74 ± 3.63 mm and 1.64 ± 3.06 mm, respectively. Deviations were lower for the Peel 1 scanner (maximum of −0.35 ± 2.8 mm) but higher with the use of phone-photogrammetry (maximum of −5.1 ± 4.8 mm). The mean absolute errors of anatomical landmark distance measurements from torso meshes obtained with the Peel 1, Mark II, and ST01 scanners were all within 9.3 mm (3.6%), whereas phone-photogrammetry errors were as high as 18 mm (7%).Conclusions: Low-cost Mark II and ST01 scanners are recommended for obtaining torso geometries because of their accuracy and repeatability. Subject’s breathing/movement affects the resultant geometry around the abdominal and anterolateral regions.
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Journal articleSaggu R, Barlow P, Butler J, et al., 2022,
Considerations for mulitmodal prehabilitation in women with gynaecological cancers: a scoping review using realist principles
, BMC Women's Health, Vol: 22, Pages: 1-35, ISSN: 1472-6874Background: There is increasing recognition that prehabilitation is important as a means of preparing patients physically and psychologically for cancer treatment. However, little is understood about the role and optimal nature of prehabilitation for gynaecological cancer patients, who usually face extensive and life-changing surgery in addition to other treatments that impact significantly on physiological and psychosexual wellbeing. Review question: This scoping review was conducted to collate the research evidence on multimodal prehabilitation in gynaecological cancers and the related barriers and facilitators to engagement and delivery that should be considered when designing a prehabilitation intervention for this group of women. Methods: Seven medical databases and four grey literature repositories were searched from database inception to September 2021. All articles, reporting on multimodal prehabilitation in gynaecological cancers were included in the final review, whether qualitative, quantitative or mixed-methods. Qualitative on unimodal interventions were also included, as these were thought to be more likely to include information about barriers and facilitators which could also be relevant to multimodal interventions. A realist framework of context, mechanism and outcome was used to assist interpretation of findings. Results: In total, 24 studies were included in the final review. The studies included the following tumour groups: ovarian only (n=12), endometrial only (n=1), mixed ovarian, endometrial, vulvar (n=5) and non-specific gynaecological tumours (n=6). There was considerable variation across studies in terms of screening for prehabilitation, delivery of prehabilitation and outcome measures. Key mechanisms and contexts influencing engagement with prehabilitation can be summarised as: 1) The role of healthcare professionals and organisations 2) Patients’ perceptions of acceptability 3) Factors influencing patient motivation 4) Prehabilita
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Journal articleLam K, Abramoff M, Balibrea J, et al., 2022,
A Delphi consensus statement for digital surgery
, npj Digital Medicine, Vol: 5, Pages: 1-9, ISSN: 2398-6352The use of digital technology is increasing rapidly across surgical specialities, yet there is noconsensus for the term ‘digital surgery’. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if >70% of the panel deemed the statement important and <30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law; litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. Future research into these issues must involve all digital surgery stakeholders including patients.
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Journal articleHohenschurz-Schmidt D, Draper-Rodi DJ, Vase PL, et al., 2022,
Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (Article I): a systematic review and description of methods
, Pain, Vol: Publish Ahead of Print, ISSN: 0304-3959Blinding is challenging in randomised controlled trials (RCTs) of physical, psychological, and self-management therapies (PPS) for pain, mainly due to their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently employed sham interventions and other blinding methods was required.Twelve databases were searched for placebo or sham controlled RCTs of PPS treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590).The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment, to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (e.g., duration and frequency of treatments) than others (e.g., physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions.A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
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Journal articleAllott N, McGregor A, Banger M, 2022,
Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: A systematic review
, BMC Musculoskeletal Disorders, Vol: 23, ISSN: 1471-2474Objective: This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear.Methods: MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies, PRISMA guidelines were followed. Studies were included if they used at least one assessment method to assess for ACL injury and participants were assessed at an acute trauma centre within 6-weeks of injury. Article quality was evaluated using the QUADAS-2 checklist. Results: A total of 353 studies were assessed for eligibility, 347 were excluded for the following reasons: injuries were not assessed in an acute trauma setting, injuries were not acute, participants had previous ACL injuries or chronic joint deformities affecting the knee, participants were under 18, or participants included animals or cadavers. A total of six studies were included in the review. Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a ‘pop’ and ‘giving way’ at the time of injury. Diagnostic accuracy varied greatly between the assessment method and the assessing clinician. Gold standard diagnostics were MRI and arthroscopy. A weighted meta-mean calculated the time to reach diagnosis to be 68.60 days [CI 23.94, 113.24]. The mean number of appointments to reach diagnosis varied from 2-5. Delay to surgery or surgical consultation ranged from 61 to 328 days. Conclusion: Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. Reliance on specialist assessments or radiological methods inevitably increases the time to reach a diagnosis, which has repercussions on management options. There is an ever-growing demand to improve diagnostic accuracy and efficiency; further exploration into , quantitative measures of instability would aid the assessment of peripheral joi
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Journal articleAlexander C, Strutton P, Kassam J, et al., 2022,
An investigation of the control of quadriceps in people who are hypermobile; a case control design. Do the results impact our choice of exercise for people with symptomatic hypermobility?
, BMC Musculoskeletal Disorders, Vol: 23, ISSN: 1471-2474Background: People with symptomatic hypermobility have altered proprioception however, the origin of this is unclear and needs further investigation to target rehabilitation appropriately. The objective of this investigation was to explore the corticospinal and reflex control of quadriceps and see if it differed between three groups of people: those who have symptomatic hypermobility, asymptomatic hypermobility and normal flexibility. Methods: Using Transcranial Magnetic Stimulation (TMS) and electrical stimulation of peripheral nerves, motor evoked potentials (MEPs) and Hoffman (H) reflexes of quadriceps were evoked in the three groups of people. The threshold and latency of MEPs and the slope of the input-output curves and the amplitude of MEPs and H reflexes were compared across the groups.Results: The slope of the input-output curve created from MEPs as a result of TMS was steeper in people with symptomatic hypermobility when compared to asymptomatic and normally flexible people (p = 0.04). There were no other differences between the groups.Conclusion: Corticospinal excitability and the excitability at the motoneurone pool are not likely candidates for the origin of proprioceptive loss in people with symptomatic hypermobility. This is discussed in the light of other work to suggest the receptor sitting in hypermobile connective tissue is a likely candidate. This suggests that treatment aimed at improving receptor responsiveness through increasing muscle tone, may be an effective rehabilitation strategy.
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Journal articleHopkins M, Turner S, McGregor A, 2022,
Mapping lower-limb prosthesis load distributions using a low-cost pressure measurement system
, Frontiers in Medical Technology, Vol: 4, Pages: 1-9, ISSN: 2673-3129Background: In the UK 55,000 people live with a major limb amputation. The prosthetic socket is problematic for users in relation to comfort and acceptance of the prosthesis; and is associated with the development of cysts and sores.Objectives: We have developed a prototype low-cost system combining low-profile pressure sensitive sensors with an inertial measurement unit to assess loading distribution within prosthetic sockets. The objective of this study was to determine the ability of this prototype to assess in-socket loading profiles of a person with an amputation during walking, with a view to understanding socket design and fit.Methods: The device was evaluated on four transtibial participants of various age and activity levels. The pressure sensors were embedded in the subject's sockets and an inertial measurement unit was attached to the posterior side of the socket. Measurements were taken during level walking in a gait lab.Results: The sensors were able to dynamically collect data, informing loading profiles within the socket which were in line with expected distributions for patellar-tendon-bearing and total-surface-bearing sockets. The patellar tendon bearing subject displayed loading predominately at the patellar tendon, tibial and lateral gastrocnemius regions. The total-surface bearing subjects indicated even load distribution throughout the socket except in one participant who presented with a large socket-foot misalignment.Conclusions: The sensors provided objective data showing the pressure distributions inside the prosthetic socket. The sensors were able to measure the pressure in the socket with sufficient accuracy to distinguish pressure regions that matched expected loading patterns. The information may be useful to aid fitting of complex residual limbs and for those with reduced sensation in their residual limb, alongside the subjective feedback from prosthesis users.
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Journal articleNg KCG, Bankes MJK, El Daou H, et al., 2022,
Capsular Mechanics After Periacetabular Osteotomy for Hip Dysplasia.
, J Bone Joint Surg Am, Vol: 104, Pages: 1015-1023BACKGROUND: Hip dysplasia is characterized by insufficient acetabular coverage around the femoral head, which leads to instability, pain, and injury. Periacetabular osteotomy (PAO) aims to restore acetabular coverage and function, but its effects on capsular mechanics and joint stability are still unclear. The purpose of this study was to examine the effects of PAO on capsular mechanics and joint range of motion in dysplastic hips. METHODS: Twelve cadaveric dysplastic hips (denuded to bone and capsule) were mounted onto a robotic tester and tested in multiple positions: (1) full extension, (2) neutral 0°, (3) flexion of 30°, (4) flexion of 60°, and (5) flexion of 90°. In each position, the hips underwent internal and external rotation, abduction, and adduction using 5 Nm of torque. Each hip then underwent PAO to reorient the acetabular fragment, preserving the capsular ligaments, and was retested. RESULTS: The PAO reduced internal rotation in flexion of 90° (∆IR = -5°; p = 0.003), and increased external rotation in flexion of 60° (∆ER = +7°; p = 0.001) and flexion of 90° (∆ER = +11°; p = 0.001). The PAO also reduced abduction in extension (∆ABD = -10°; p = 0.002), neutral 0° (∆ABD = -7°; p = 0.001), and flexion of 30° (∆ABD = -8°; p = 0.001), but increased adduction in neutral 0° (∆ADD = +9°; p = 0.001), flexion of 30° (∆ADD = +11°; p = 0.002), and flexion of 60° (∆ADD = +11°; p = 0.003). CONCLUSIONS: PAO caused reductions in hip abduction and internal rotation but greater increases in hip adduction and external rotation. The osseous acetabular structure and capsule both play a role in the balance between joint mobility and stability after PAO.
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Journal articleStoddart J, Garner A, Tuncer M, et al., 2022,
The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty - a finite element analysis
, Bone & Joint Research, Vol: 11, ISSN: 2046-3758Aims: To determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA) with consideration to the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial UKA (UKA-M) and bi-cruciate retaining total knee arthroplasty (BCR-TKA).Methods: Two experimentally validated finite element models of tibia were implanted. Intraoperative loads were applied through the condyles, ACL, MCL and LCL, and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone.Results: Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2mm had a much larger effect, resulting in a 6-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, though the smaller, less dense female model had a 1.5 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA.Conclusion: Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for a smaller and less dense tibiae. To minimise risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bony island anteriorly.
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Journal articleEdwards T, Guest B, Garner A, et al., 2022,
The metabolic equivalent of task score: a useful metric for comparing high functioning hip arthroplasty patients
, Bone & Joint Research, Vol: 11, Pages: 1-10, ISSN: 2046-3758Aims: This study investigates the use of the Metabolic Equivalent of Task (MET) score in a young hip arthroplasty population and its ability to capture additional benefit beyond the ceiling effect of conventional patient reported outcomes.Patients & Method: Oxford Hip Score (OHS), EuroQol-5D index (EQ-5D), and the MET were recorded in 221 primary hip arthroplasty procedures pre-operatively and at 1-year. The distribution was examined reporting the presence of ceiling & floor effects. Validity was assessed correlating the MET with the other scores using Spearman’s rank and determining responsiveness. A subgroup of 93 patients scoring 48/48 on the OHS were analysed by age, sex, BMI and pre-operative MET using the other metrics to determine if differences could be established despite scoring identically on the OHS.Results: From our electronic database of 751 hip arthroplasty procedures, 117 primary total hip and 104 hip resurfacing arthroplasty operations were included. Mean age was 59.4 ± 11.3. Post-operatively the OHS and EQ-5D demonstrate significant negatively skewed distributions with ceiling effects of 41% and 53%, respectively. The MET was normally distributed post-operatively with no ceiling effect. Weak-moderate significant correlations were found between the MET and the other two metrics. In the 48/48 subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher MET scores were demonstrated for patients aged <60 (12.7 vs 10.6, p=0.008), male patients (12.5 vs 10.8, p=0.024) and those with pre-operative MET scores >6 (12.6 vs 11.0, p=0.040). Conclusion: The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS.
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Journal articlevan der Straeten C, 2022,
Hip resurfacing arthroplasty in young patients: international high-volume centres' report on the outcome of 11,382 metal-on-metal hip resurfacing arthroplasties in patients ≤50 years at surgery
, HIP INTERNATIONAL, Vol: 32, Pages: 353-362, ISSN: 1120-7000- Cite
- Citations: 9
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Journal articleDavies A, Selmi H, Sabharwal S, et al., 2022,
Revision shoulder hemiarthroplasty and total shoulder arthroplasty a systematic review and meta-analysis.
, Journal of Shoulder and Elbow Arthroplasty, Vol: 6, Pages: 1-8, ISSN: 2471-5492The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.
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Journal articleGreenwood J, Hurley M, McGregor A, et al., 2022,
A qualitative evaluation of participants experiences of living with back pain, lumbar fusion surgery, and post-operative rehabilitation
, Pilot and Feasibility Studies, Vol: 8, ISSN: 2055-5784BackgroundThe use of lumbar fusion surgery is increasing in developed economies. High levels of patient dissatisfaction are reported post-operatively. To address this need, we developed a theoretically informed rehabilitation programme for use following lumbar fusion surgery (the REFS programme). We conducted a mixed methods randomised controlled feasibility study (REFS v ‘usual care’). The numerical and feasibility outcomes are reported separately. The current qualitative study was ‘nested’ within the main feasibility study to explore participants’ experiences before and after lumbar fusion surgery including the impact of rehabilitation content. This facilitated a deeper understanding of potential mechanisms of action, for theoretical and programme refinement.MethodsA purposive sample (n = 10 ‘usual care’, n = 10 REFS) was identified from the main feasibility study cohort. Individual semi-structured interviews were conducted post-operatively (median 8 months, range 5–11). Interview data were transcribed verbatim, coded, and analysed thematically.ResultsThree themes were constructed: the breadth and severity of impact associated with a chronic lumbar disorder was summarised in theme 1, ‘Ever-decreasing circles; living with a chronic lumbar disorder’. Theme 2, ‘What have I done? Reflections on recovery from lumbar fusion surgery’, illustrated participants post-operative helplessness, which was associated with worsening mental health, problematic use of opioids, fear related to the instillation of metalware, and the important mitigating effect of informal social support. Theme 3 ‘Rehabilitation experiences’ identified critical rehabilitation programme content including exercise, a shared rehabilitation experience, the opportunity for vicarious learning, and professional expertise.ConclusionsTo enhance patient benefit future REFS programme iterations s
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Journal articleDandridge O, Garner A, Amis A, et al., 2022,
Variation in the patellar tendon moment arm identified with an improved measurement framework
, Journal of Orthopaedic Research, Vol: 40, Pages: 799-807, ISSN: 0736-0266The mechanical advantage of the knee extensor mechanism depends heavily on the patellar tendon moment arm (PTMA). Understanding which factors contribute to its variation may help improve functional outcomes following arthroplasty. This study optimized PTMA measurement, allowing us to quantify the contribution of different variables. The PTMA was calculated about the instantaneous helical axis of tibiofemoral rotation from optical tracked kinematics. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of motion (root-mean-squared error 0.2 mm, max error 0.4 mm), whereas large errors were measured for raw, filtered-only and interpolated-only techniques at terminal flexion/extension. Before scaling, the mean PTMA was 46 mm; PTMA magnitude was consistently larger in males (mean differences: 5 to 10 mm, p < .05) and was strongly related to knee size: larger knees have a larger PTMA. However, while scaling eliminated sex differences in PTMA magnitude, the peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p = .01). Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle where peak PTMA occurred. This substantial variation in angle of peak PTMA has implications for the design of musculoskeletal models and morphotype-specific arthroplasty. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement.
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Journal articleMcGregor A, Clunie G, Hall H, et al., 2022,
Patient and practitioner perspectives on the design of a simulated affective touch device to reduce procedural anxiety associated with radiotherapy: a qualitative study
, BMJ Open, Vol: 12, ISSN: 2044-6055Objective The aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging. Design This qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke’s methods. Participants and setting Twenty patients and carers were recruited, as well as ten healthcare practitioners involved in either delivering radiotherapy or imaging procedures. Results Patients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device. Conclusions The desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group.
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Journal articleOlsen J, Turner S, Chadwell A, et al., 2022,
The Impact of Limited Prosthetic Socket Documentation: A Researcher Perspective
, FRONTIERS IN REHABILITATION SCIENCES, Vol: 3- Author Web Link
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- Citations: 1
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