Harpreet Chhina

Normative data for the dynamic pedobarographic profiles of children

In order to establish the clinical utility of pedobarography in the treatment of childhood foot pathology, a reliable set of pedobarograph data describing non-pathologic feet is required. The purpose of this study was to describe the pedobarographic profiles of normal children across all ages, with specific focus on young children and explore age-related differences in foot pressure patterns. The Tekscan HR Mat pressure measurement system was used in a protocol involving a dynamic test at self-selected speed and walking pattern of 146 normal children (age range 1.6-14.9 years). Relative force and timing data were obtained across five foot segments (heel, lateral midfoot, medial midfoot, lateral forefoot, and medial forefoot). Analysis of variance (ANOVA) techniques were applied to determine if there were any age-related differences in foot pressure profiles in children across four a priori pedobarograph variables: % of stance at initiation at the heel, % of stance at initiation at the medial midfoot, maximum % force at the heel, maximum % force at the medial midfoot. Differences in foot pressure profiles were distinguished across three age groups: (1) Group 1: <2 years; (2) Group 2: 2-5 years; and (3) Group 3: >5 years. Age-related differences in initiation patterns, force transmission, and the amount of time spent on each foot segment provide evidence for maturation of childrens foot pressure profiles from a flatfoot pattern in the young child to a curvilinear pattern in the older child.

Health-related Quality of Life in People With Hereditary Multiple Exostoses

Background: Hereditary multiple exostoses (HME) is a rare genetic disorder, which can be associated with severe complications that may significantly affect the health-related quality of life (HRQL). Our primary objective was to describe the baseline HRQL in HME individuals at the British Columbia’s Children’s Hospital HME clinic and the Multiple Hereditary Exostoses Coalition compared with relevant Canadian and US population norms. This is the first study to explore the HRQL among adults and children with HME. Methods: Previously validated instruments Short Form-36 version 2, Short form-6D, and Child Health Questionnaire Parent Form 50 were used to assess the HRQL of individuals with HME. The scores from these instruments were compared with the relevant population norms. The British Columbia’s Children’s Hospital and Multiple Hereditary Exostoses coalition populations were also compared with each other. Results: The study sample consisted of 100 participants including 57 adults and 43 children. The mean age for Short Form 36 version 2 survey was 40.10±13.01 years and for Child Health Questionnaire Parent Form 50 was 9.93±3.48 years. Adult HME population had lower scores than both the US and Canadian general population in all domains except for emotional role limitations. Short Form -6D utility scores (0.65) indicates the quality of life for some individuals is near death and for others it is comparable or better than individuals with rheumatoid arthritis. Children with HME scored less than the US general population; particularly lower scores were seen in bodily pain (51.2 vs. 81.7) and emotional self-esteem (52.0 vs. 79.8). Conclusions: HME population has lower HRQL than the general population. These data provide a benchmark for individuals with HME. From such data, future research on HME disease progression and effectiveness of treatments/interventions can be tracked over time. Level of Evidence: Level II, This is a prognostic, prospective study with participants enrolled at different points in their disease.

The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up.

Background Continued monitoring and reporting of outcomes in clubfoot patients are important for providing an indicator of functional outcomes and surveillance and treatment for problems or recurrences. The purpose of this study is to report the 5-year outcomes of the updated cohort of 44 patients with 65 idiopathic clubfeet treated with manipulation, casting, and Botulinum toxin A (BTX-A). Methods As part of the original study, the patients underwent the corrective treatment phase of manipulation and casting followed with BTX-A injection and then the maintenance phase of bracing. The patients were seen at regular intervals and a detailed clinical history was maintained for each patient including ankle range of motion, recurrences, and interventions for recurrences. Results Mean values for range of motion at the 5-year visit were 22.3 and 17.1 degrees for dorsiflexion with the knee in flexion and extension, respectively. Overall, 48% (31 of 65 clubfeet) successfully responded to a single BTX-A injection and experienced no recurrence over the follow-up period. At least 1 repeat BTX-A injection was required in 34 clubfeet, for an overall recurrence rate of 52%. Surgery was required in 10 clubfeet, and the overall surgical rate was 15.4%. Conclusions Idiopathic clubfeet treated with BTX-A continued to show good outcomes at 2 to 5-year follow-up. The experience with this cohort provides support for the effectiveness of BTX-A in the initial correction and continued management of idiopathic clubfoot. Level of Evidence Levels III to IV. This is a prospective, nonexperimental clinical study investigating efficacy of an innovative treatment.

Onabotulinumtoxin A® injections: A safety review of children with clubfoot under 2 years of age at BC Children's Hospital

BACKGROUND Pediatric indications for Onabotulinumtoxin A extend beyond treatment of skeletal muscle conditions. Each of the indications for Onabotulinumtoxin A use have adverse events reported in the past. The aim of this study was to review dverse events in children less than 2 years of age who were treated with Onabotulinumtoxin A injections as part of equinus foot deformity, in the setting of clubfoot at British Columbias Children Hospital. METHODS A retrospective review of all clubfoot patients at British Columbias Children Hospital, less than 2 years of age, who received a Onabotulinumtoxin A injection for equinus correction, between September 2000 and December 2012 was conducted. Data collected included demographics, clinical diagnosis, treatment history, ankle range of motion and any adverse event noted by the clubfoot team or reported by the families. RESULTS A total of 239 eligible subjects (361 feet) had received 523 Onabotulinumtoxin A injections before the age of 2 years. There was only one adverse event reported out of the 523 Onabotulinumtoxin A injections (adverse events rate of 0.19%) given at British Columbias Children Hospital. However, this adverse event was not found related to the Onabotulinumtoxin A injection. CONCLUSIONS Onabotulinumtoxin A appears to be safe with respect to the adverse events, for use in children under 2 years of age with the diagnosis of clubfoot when dosed at 10 units per kilogram. However, the dose of Onabotulinumtoxin A and underlying diagnosis should always be kept in mind.

The contralateral foot in children with unilateral clubfoot, is the unaffected side normal?

The unilateral unaffected clubfoot has previously been used as a control in longitudinal studies of clubfoot outcomes. However, we have observed that the unaffected clubfoot does not necessarily exhibit the same pedobarographic measurements as seen in normal control subjects. The purpose of this study was to evaluate whether the unaffected foot is indeed normal or if there are differences in the pedobarographic measurements of the unaffected foot compared to healthy normal controls.The Tekscan HR Mat™ was used to dynamically test the walking pattern of 103 subjects with unilateral clubfeet and compare the results to our previously published series of normal controls. Patients were divided into three groups: Group 1 (< 2 years), Group 2 (2-5 years) and Group 3 (>5 years). An unpaired t-test (p < 0.05) was used to compare percentage of stance at initiation of force, the percentage of stance at maximum force, the percentage of stance at termination of force, the maximum percentage force and the average force/time integral between a group of normal age matched controls and the unaffected foot in patients with unilateral clubfoot. Significant differences were identified between the unaffected side and normal controls for the pressure distribution, order of initial contact and foot contact time. These differences evolved and changed with age. The pedobarographic measurements of patients with clubfoot are not normal for the unaffected foot. As such the unaffected foot should not be referred to as normal, nor should it be used as a control.

Practical strategies and perceptions from community pharmacists following their experiences with conducting pharmacy practice research: a qualitative content analysis

While prior research identified barriers to conducting research in community pharmacies, there remains a need to better understand facilitators to ensure successful collaborations between academic researchers and pharmacists. Our objective was to determine the experiences and perspectives of community pharmacists who have recently conducted a pharmacy practice‐based research study to gain in‐depth understanding of challenges as well as facilitators and identify strategies and solutions.