Clinical trials

Cavovarus feet are complex deformities in multiple planes. There is little consensus on the best way to address deformities. Furthermore there are various different phenotypes and we have previously described 4 distinct forefoot morphotypes that exist. It has been hypothesised that the various morphotypes could benefit from differing surgical strategies. However, identification of forefoot morphotypes has only been possible thus far using specialised semi-automated software and 3D animating software to manually identify morphotypes. It is therefore not straightforward to identify which patients may benefit from which surgery and this is not translatable to surgeons outside of a specialist centre. The utility of this classification has been thus far limited to research. There is a burning need to explore ways in which identification of forefoot morphotypes can be translated to other centres using techniques such as basic imaging or clinical examination to identify patients with different morphotypes. At Royal National Orthopaedic Hospital (RNOH) we have a large, complex cohort of patients with neuromuscular foot and ankle deformity and cavovarus feet. We also have access to advanced imaging techniques which we employ in routine care of our patients. We further have access to the software and previous research tools used to identify forefoot morphotypes. We have for many years been examining cavovarus feet and documenting the various clinical findings. We also run teaching clinics combined with registrars where patients are routinely examined as part of routine care and pre-operative work up. Therefore we are ideally and uniquely placed to carry out this research which is an extension of our previous work. Our primary aim is to identify a reproducible method of distinguishing between the various forefoot morphotypes in cavovarus feet in patients with Charcot Marie Tooth disease (CMT). This will include investigating the utility of clinical examination and manual measurements (without specialised software) on weightbearing CT (WBCT). We will also aim to examine the reproducibility of any techniques such as clinical examination.

Dynamic lycra garments are deployed in rehabilitation and exercise to support unstable areas of the body, enhance sensory feedback to improve movement patterns, reduce fatigue and pain and improve function. 2 case studies have respectively highlighted the effective use of postural correction to reduce hip pain in an adult with acetabular dysplasia while lycra orthoses have reduced pain and improved stability in the hip. Larger scale studies assessing the effect of lycra garments across a clinical population of those presenting with combined hypermobility and hip dysplasia are needed to investigate the extent of generalisable effects. The research question underpinning the project is as follows,"Can the use of dynamic compression shorts during daily activities improve short term treatment outcomes in hip dysplasia patients?". The intention of this single cohort, observational pilot is primarily to establish the feasibility of studying the effect of the garments and assess the justification for further quantitative study, rather than the adjunctive effect of the shorts themselves. The investigators are aiming to recruit 8-10 participants who will form a single cohort for observation, with the aim of gathering chiefly qualitative outcomes. This feasibility study is not intended to be blinded.

People with long-term (chronic) shoulder disorders caused by injuries, overuse or conditions (such as arthritis) often need physiotherapy. This usually includes exercise therapy to help reduce pain, rebuild strength and make every day activities easier. However, it can be hard to stick to an exercise programme. People may stop due to pain, fear of making the symptoms worse or simply loosing motivation. Virtual Reality (VR) is a technology that may help people say engaged with their exercise programmes by making exercises more enjoyable and interactive. When using a headset (similar to goggles), people can see and interact with a 3D virtual world. Their movement, especially their hands and arms, are shown as an 'avatar' (a virtual character) in this virtual world. Exercise can feel more like playing a game or engaging with tasks/challenges, rather than performing repetitive movements. This shift might help reduce focus on pain and increase motivation. VR also provides real-time feedback, helping people track their progress and adjust their movements instantly. This might lead to more accurate and consistent exercise performance and better recovery outcomes. Before we can test whether VR exercise programmes are effective for people with chronic shoulder disorders, we firstly need to understand whether it is practical and acceptable for patients to use. This 'feasibility' study will therefore involve 20 patients with chronic shoulder disorders referred for physiotherapy at the Royal National Orthopaedic Hospital (RNOH) in Stanmore, United Kingdom. Participants will take part in three VR exercise sessions at the RNOH over a three-week period. Levels of pain, quality of life and sleep quality etc. will be measured before and after three weeks. Interviews will also be held up to two weeks after the final session to explore people's experiences and thoughts towards the VR exercise programme. The results will help us decide if a larger study should go ahead.

Primary Objective: Score out of 44 on a validated test of anatomy and sono-anatomy Secondary Objective: Before training * Handedness (Edinburgh Handedness Inventory) * Subjective sleepiness (Karolinska scale) * Motor reaction time (Psychomotor Vigilance test) * Attention control (Anti-Saccade test) * Mental rotation (Mental Rotation Task) * Depression Anxiety, Stress (DASS score) * Visual Search Task (Divided Attention) * Knowledge pretraining After training and testing * Knowledge after training session * Acceptability: Client Satisfaction Questionnaire (CSQ-8) * Usability: CyberSickness in Virtual Reality Questionnaire (CSQ-VR) * Immersion: Witmer and Singer Presence Questionnaire * Subjective workload (NASA - TLX scale) * Cognitive Demand Battery (CBD) * Resource use: Calculation of cost differences between learning Modalities Study population: Resident anaesthetists Recruitment Target: 102 Methodology: This is a non-clinical randomised controlled trial of resident anaesthetists undergoing training in regional anaesthesia. Residents will be randomised to one of two groups for each training session day: * Standard anatomical training (Group A) * Virtual reality based anatomical training. (Group B) Then followed by another training day session and participants will enter either standard or VR teaching depending on the previous allocation: * Standard anatomical training (Group B) * Virtual reality based anatomical training. (Group A) Anatomical knowledge will be tested in both groups using an on-line questionnaire developed by the Chief Investigator. Eligibility criteria: Inclusion criteria: 1. Anaesthetists that are residents in a recognised Royal College of Anaesthetists (RCoA) training program 2. Anaesthetic training grades (Stage 1 - 3). Exclusion criteria: 1. Visual impairment (this does not include wearing glasses/contact lenses) 2. History of severe diseases affecting physical motion or balance 3. History of any drugs that may affect physical motion or balance within 12 hours of the intervention 4. Pregnancy 5. Individuals who had consumed alcohol within 24 h of the intervention. 6. Resident doctors not in a recognised RCOA training program e.g. Staff grade anaesthetists. Study treatment: Standard teaching - control Virtual reality teaching - intervention