Examples of AHP good practice and innovation

The internship programme was conceived to address existing deficiencies in clinical research career paths for bright, new, podiatry graduates. The internship consists of an eight-week clinical research placement immediately after graduation and prior to commencement of their first clinical post. Once in their first clinical post, the internship continues via a two-year off-site mentorship programme, with an eventual return to the host centre to develop a fellowship/PhD studentship application.

Thirteen podiatrists have undertaken the internships since its inception in 2003. Two are currently working in their first NHS posts, while eleven have gone on to success in obtaining higher degrees, clinical academic posts and an externally funded clinical PhD studentship. Latterly, four have gone on to prestigious clinical research fellowships awarded by Arthritis Research UK and the National Institute of Health Research (NIHR).

The growing network of interns has rapidly become self-sustaining with the group meeting at the professional conferences, as well as in between, providing ongoing peer support to each year's intake.

The internships prevent the best clinicians from being lost to patients through choosing a research career. Via the internships, patient care is provided by the best and brightest, early career specialists, using the latest and highest quality evidence and in the best possible environment.

Image title: Five of the interns immediately after they had given presentations at the National Podiatry Conference in Bournemouth 2008. (Clockwise from the top: Michael Backhouse, Lindsey Hooper, Anita Gay, Lucy Edgson, Begonya Alcacer-Pitarch.)

Finger splints are often provided by occupational therapists to people with finger joint problems in musculoskeletal disorders to help control pain, improve functional ability and maintain joint positioning and muscle action. There is good evidence that these small finger splints can play an important part in reducing finger and hand pain and maintaining dexterity skills. Mostly these splints have been made in hard thermoplastic material that tends to be bulky and has limited strength and durability. Patients reported that they found the splints unattractive and embarrassing to wear. An innovative approach has been implemented in Winchester with occupational therapist Christian Macleod and local jeweller Jeremy France.

These small, effective, proximal interphalangeal splints are made to measure and can be adjusted and altered when required if the finger joint shape changes. The splints are made in silver to replicate jewellery and are made at a local jeweller under the guidance of a clinical occupational therapist (Figure 1). Some people have opted to have additional jewels inserted to make the splints even more attractive. Adherence rates to the splints is improved, people report feeling proud to wear these splints and feel pleased that they have individualised rings that are different from other people.

Not only are the splints seen as attractive alternatives to medicalised intervention by the people who wear them, they have also been reported as biomechanically effective in controlling the adverse joint positions that occur with swan necking of the rheumatoid proximal interphalangeal joint.

The North West Clinical Effectiveness Group (NWCEG) was established in 2003 with the aim of supporting podiatrists in the development of foot care services for people with rheumatic diseases. The group consists of podiatrists from services within the North West of England and academics from the University of Salford. In addition to service development support and providing some of the educational needs of the practitioner, the group has developed guidelines for the management of the foot affected with rheumatoid arthritis (RA).

These guidelines are based on the best available evidence and consensus opinion of the group. Their purpose is to ensure that appropriate foot health management is carried out regardless of the location of that care. Further to this they are considered essential in supporting newly qualified or non-specialist podiatrists who may be managing people with RA as part of their case load. These guidelines have been reviewed by representatives from the medical profession and the Podiatry Rheumatic Care Association.

Additionally, a representative from the NWCEG also contributed to the development of the PCRA/ARMA Standards of Care for People with Musculoskeletal Foot Health Problems http://www.prcassoc.org.uk/standards-project

Both the NWCEG guidelines and the above standards are useful for supporting and developing foot health services. For a copy of the NWCEG guidelines contact Dr Anita Williams.

Intervention for people with arthritic hand joints is often evaluated by the change in range of motion and hand function. Range of hand joint motion is usually recorded by clinicians in a static position with a goniometer. This has provided details of end range position only and to date the actual functional performance of the joint has been difficult to measure and evaluate.

Engineering researchers at the University of Southampton have developed a novel and innovative three-dimensional range of motion capture system. The new technique uses a system of very small markers to track hand and wrist movements during functional tasks. Joint movements are then measured for movements of the wrist, curvature of the palm, all the fingers and thumb movements. The technique has been tested for validity and reliability, and is capable of producing results that are accurate to less than 1 degree.

The technique has been applied by a multidisciplinary team consisting of engineers, occupational therapists and health researchers for specific analysis of arthritic hand joints. Research studies have been conducted to measure the effectiveness of small finger splints in rheumatoid arthritis and evaluating the movement of the thumb in basal thumb joint osteoarthritis. The method gives a more detailed account of the wrist and hand joint movements, alongside dynamic functional capacity.