Analyse baropodométrique de la marche - Summary Baropodometric
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2007
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Documents
2007
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01 juin 2007
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Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
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English
Posted on Jun 13 2007 The purpose of this report is to assess the role in treatment strategy, indications and efficacy of baropodometric analysis of walking. Posted on Jun 13 2007
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Publié le
01 juin 2007
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BAROPODOMETRIC GAIT ANALYSIS
June 2007
Department of Medical and Surgical Procedures Assessment
2 avenue du Stade de France 93218 Saint-Denis La Plaine CEDEX Tél. : 01 55 93 70 00 Fax : 01 5593 74 00 rf-sastn.e:ptthah.www// N°SIRET : 180 092 041 00011 Code APE : 751 C
THE TEAM
Baropodometric analysis of walking
This report was compiled by Dr Françoise Saint-Pier re, project manager in the Department of Medical and Surgical Procedures Assessment. Documentary research and management were conducted by Ms. Christine Devaud, documentation officer, and Ms. Renée Cardoso, assistant documentation officer, under the guidance of Dr Frédérique Pagès, head of the documentation department. The meeting and secretarial services were organised by Félix Muller. -------------------------------------------------------------------------- Contact details regarding this dossier: Tel.: +33 (0)1 55 93 71 12 Fax : +33 (0)1 55 93 74 35 Email: contact.seap@has-sante.fr Department of Medical and Surgical Procedures Assessment Head of Department: Dr Sun Hae Lee-Robin Assistant Head of Department: Dr Denis-Jean David
Haute Autorité de santé/Department of Medical and S urgical Procedures Assessment/June 2007 2 - -
SUMMARY
Baropodometric analysis of walking
INTRODUCTION - The request for an assessment of the procedure "Baropodometric Gait Analysis " was made by UNCAM [French state health insurance body] and SOFMER (Société française de médecine physique et de réadaptation) [French society of physical medicine and rehabilitation] with a view to including it on the list of procedures covered by health insurance. - The Haute Autorité de Santé has assessed the expected benefits of this procedure in order to form an opinion as to whether it should be added to this list. CONTEXT - Any disturbance of the locomotor system caused by an external factor such as a trauma or pathology has consequences on the distribution of f orces acting on the plantar support surfaces. Observation of footprints is a popular method of analysis as it reveals certain malfunctions of the locomotor system as well as morphological abnormalities of the foot. A quantitative dynamic analysis of footprints, based on the distribution of plantar pressures during walking, is essential to have a better understanding of the functional strategies used by the locomotor system in order to keep the body in dynam ic equilibrium during walking. Plantar pressures and ground reaction forces can be analysed by baropodometric insoles (with sensors on the plantar interface) or by dynamometric platforms which are designed to measure ground support reactions in three dimensions. - The pathologies in question have many different aetiologies: neurological, orthopaedic, and metabolic as well as those due to malformation. Equine varus foot, or club foot, is one of the most common congenital disorders, though it can also be caused by cerebral vascular accident. A prospective cohort study conducted in France shows that 18% of individuals who have suffered a c erebral vascular accident have this condition one year later. The functional consequenc es can be minimised by specialist intervention starting at an early stage and continuing for an extended period. Podiatric complications are among the most serious consequences of diabetes. The prevalence of podological risk factors is high with 72.8% of a population of hospitalised diabetic patients regarded as being at low risk of ulceration opposed to 17.5% who were considered to be at high risk. This underlines the need for a policy of screening and prevention. - Nomenclatures: The procedure is not listed in the Common Classification of Medical Procedures tariff schedule. It has been identified in the American nomenclature. ASSESSMENT The method proposed by HAS for assessing the expected clinical benefit of medical or surgical procedures is based on the scientific data found in the literature and on the opinion of a working group of healthcare professionals. Critical analysis of literature data Publications examined The literature from January 1995 to February 2007 was surveyed through a search of the principal medical literature databaseslied(Mne,The Cochrane Library,National Guideline
Haute Autorité de santé/Department of Medical and S urgical Procedures Assessment/June 2007 - 3 -
Baropodometric analysis of walking
Clearinghouse andHTA Database). Two hundred and seventy-six documents were obtained, 24 quoted, of which 14 were analysed. The articles meeting the following criteria were selected and analysed: -six studies assessing the technical performance of various measurement devices: four reproducibility studies and two comparative studies (different systems of analysis); - eight studies assessing the expected benefits in terms of treatment efficacy and performance. Indications Analysis of a deficiency or disorder in the functio n of the foot (step orientation, support distribution, coordination) in two contexts: 1. help in deciding on therapy; 2. assessment of treatment efficacy (orthotic device, drugs, surgery). Efficacy The reproducibility studies (n = 152) show that: - Measurements taken on a walking platform are more reproducible with the "two-step" method (0.41 to 0.99) than with the traditional "mid-gait" method (0.18 to 0.99), so the former is therefore a reliable, reproducible and simple alternative. The reproducibility of the "one-step" and "three-step" methods is similar for peak pressure but different for the integral-pressure time and contact time parameters. - The various parameters can be reproducibly (> 0.90) measured in patients wearing shoes with in-soles taking up to 8 steps. However, in ord er to assess load parameters it is
necessary to control walking speed.
- A comparison of various systems, baropodometry versus pedobarography, shows a good correlation between the two systems except for peak pressure in the fore-foot. When comparing the shoes with in-soles system versus the force platform system, measurements of movement of the pressure centre show a higher degree of correlation for anteroposterior motion (> 0.90) than for mediolateral motion (> 0.70). Several clinical assessment studies (n = 416) show the expected benefits of the technique. Knowledge of the distribution of plantar pressures will guide the practitioner in his or her choice of therapy and/or apparatus, shoes or orthotic devices for patients suffering from several pathologies (diabetes, hemiplegia, rheumatoid polyarthritis, foot malformation). Safety No incidents or complications associated with the procedures were identified in the literature. Role within the diagnostic and therapeutic strategy Baropodometric analysis is a complement to clinical examination and other manual or instrumental methods of motor and/or morphostatic evaluation. Unlike static podobarometry, this is a dynamic analysis which shows the variation in the centre of pressure. Conditions of use A reference guide of physical medicine and rehabilitation describes how the procedure should be carried out. It requires a device for performing a baropodometric gait analysis, with baropodometric insoles inserted into the shoes (these should be replaced after fewer than 50 examinations). Impact on the general population, health care system and public health programmes No population study was identified.
Haute Autorité de santé/Department of Medical and S urgical Procedures Assessment/June 2007 - 4 -
Baropodometric analysis of walking
Position of the working group Indications and role in treatment strategy The groups of experts emphasises clearly that this examination is not a routine procedure. It is carried out only in difficult cases (with neurological, orthopaedic, malformation-related and metabolic features) where analysis of the distribution of plantar pressures and supports is vital to deciding the best treatment approach in order to improve walking. This dynamic analysis shows how the centre of pressure and the stabilising elements of the foot alter during walking and is different from the static analysis carried out by a podologist on a standing patient (podometry, plantar prints, etc.). It is not a first-line therapeutic approach for simple pathologies, but is a procedure performed only in the event of therapy failure. The analysis also enables the practitioner to monitor t reatment by assessing the efficacy of treatments. Pathologies/populations treated Many different aetiologies are implicated: neurological, orthopaedic, malformation-related and metabolic, with plantar pain, traumatic deformation of the foot, etc. The pathologies most frequently involved are diabetes, cerebrovascular accident (with lasting effects in 15% of cases, representing about 2% of a ll patients who have suffered a cerebrovascular accident) and rheumatoid polyarthritis. It is difficult to quantify the population. Many diabetics could benefit from this examination and thereby avoid amputation. It is difficult to determine how many of these procedures are carried out in France as no set tariff has been established for them. Experts believe there is a gap between the population currently benefiting from this procedure and the population that stands to benefit.. Efficacy The working group accepts the reproducibility and efficacy data described in the dossier. Safety There is some risk of falling; therefore patients must be examined in appropriate conditions. Training required Possibly in the context of basic training in physical medicine and rehabilitation as part of the third cycle of an undergraduate medicine course; this would also apply to rheumatologists and orthopaedists. Alternatively, in the form of additional training leading to a specific inter-university diploma for other specialists competent to treat foot pathologies. The group emphasises that interpreting the results requires at least as much skill as performing the procedure. Environment required The group agrees with the environment described in the reference guide of resources available in physical medicine and rehabilitation practices. It points out the need for high-quality work in the light of the assessment of professional practices (APP). Estimated target population The examination is necessary because of the severit y of the pathology. It is difficult to determine how many of these procedures are carried out in France as no set tariff has been
Haute Autorité de santé/Department of Medical and S urgical Procedures Assessment/June 2007 5 - -
Baropodometric analysis of walking
established for them. Experts believe there is a gap between the population currently benefiting from this procedure and the population that stands to benefit. It is difficult to calculate how many centres there are in France. Two centres per regional department would be a reasonable assumption. In a previous dossier on (metrological) gait analysis, the number of procedures was assessed at around 500 per centre per year, giving a total of 95,000. The group stresses that this figure covered all gait analyses and included the three types of analysis: metrological, baropodometric and kinematic, each of which produce different data depending on the information being sought. Conclusions of the working group The group agreed to approve listing of the procedure with a sufficient expected benefit (EB). Target population - Data from the literature: So many pathologies exist, at varying degrees of severity, that it is impossible to produce an accurate estimate of the number of patients who would be affected by the procedures. Data provided by professionals: -In a previous report on (metrological) gait analysis, the number of procedures was assessed at around 500 per centre per year, giving a total of 95,000. The group stresses that this figure covered all gait analyses and included the three types of analysis: metrological, baropodometric and kinematic, each of which produce different data depending on the information being sought. CONCLUSION Therapeutic benefit Baropodometric gait analysis is the only quantitative dynamic method that allows the distribution of plantar pressures and supports to be analysed in patients suffering from neurological, orthopaedic or metabolic pathologies or malformations. Performed only in difficult cases, this assessment is vital in order to help guide practitioners in their choice of therapy and/or aids, shoes or orthotic devices and to allow them to monitor patients. Public health benefit No study of the impact on public health was identified. The disabilities caused by the handicap take the form of pain, restricted activity, reduced mobility leading to difficulties at work, loss of autonomy and risk of falling. In the light of this data, the expected benefit (EB) is regarded as sufficient. The improvement in expected benefit (IEB) is regarded as minor (IV) in view of: - the usefulness of the procedure as a second-line option to quantify dysfunctionality to help in determining therapy and in order to objectively assess the efficacy of treatments; - the severity of the pathologies under examination.
Haute Autorité de santé/Department of Medical and S urgical Procedures Assessment/June 2007 6 - -
