A novel personalized approach to cardiovascular prevention: The VIVOPTIM programme.

BACKGROUND: Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable. AIMS: The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors. METHODS: Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring. RESULTS: Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619). CONCLUSION: As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.

Using effect size to quantify plantar pressure asymmetry of gait of nondisabled adults and patients with hemiparesis.

In the literature, numerous statistical analyses are used to quantify asymmetry in gait. This study tested the effect size (ES) statistic for quantifying asymmetry in nondisabled and pathological populations. The plantar pressure peaks on eight footprint locations of 27 nondisabled subjects and 18 patients with hemiparesis were bilaterally compared. Asymmetry quantifications were performed with ES and standard statistical tests (index of asymmetry, symmetry index, and ratio index). The results show an advantage in using ES to quantify asymmetry when confidence limits are also calculated. Conversely, traditional asymmetry indexes immediately implied asymmetry without statistical basis. These findings should be considered when one is attempting to diagnose pathological walking patterns or guide rehabilitation processes.

A real-time plantar pressure feedback device for foot unloading.

OBJECTIVE: To develop and test a plantar pressure control device that provides both visual and auditory feedback and is suitable for correcting plantar pressure distribution patterns in persons susceptible to neuropathic foot ulceration. DESIGN: Pilot test. SETTING: Sports medicine laboratory in a university in France. PARTICIPANT: One healthy man in his mid thirties. INTERVENTIONS: Not applicable. Main outcome measures A device was developed based on real-time feedback, incorporating an acoustic alarm and visual signals, adjusted to a specific pressure load. Plantar pressure measured during walking, at 6 sensor locations over 27 steps under 2 different conditions: (1) natural and (2) unloaded in response to device feedback. RESULTS: The subject was able to modify his gait in response to the auditory and visual signals. He did not compensate for the decrease of peak pressure under the first metarsal by increasing the duration of the load shift under this area. Gait pattern modification centered on a mediolateral load shift. CONCLUSIONS: The auditory signal provided a warning system alerting the user to potentially harmful plantar pressures. The visual signal warned of the degree of pressure. People who have lost nociceptive perception, as in cases of diabetic neuropathy, may be able to change their walking pattern in response to the feedback provided by this device. The visual may have diagnostic value in determining plantar pressures in such patients. This pilot test indicates that further studies are warranted.

Measurement of plantar pressure distribution in hemiplegic children: changes to adaptative gait patterns in accordance with deficiency.

OBJECTIVE: A comparison of plantar pressure distribution in hemiplegic children with a healthy control group was performed to illustrate the link between the changing dynamics during the stance phase and the degree of deficiency. DESIGN: Twenty three healthy control subjects and two groups of six hemiplegic children with minor and major spasticity were tested. BACKGROUND: In previous studies, it was shown that the musculoskeletal dysfunction due to spasticity disturbed the hemiplegic gait pattern, for example reduced walking speed and step length. However, plantar pressure measurements which would help to understand the pathological gait mechanisms have not been studied. METHODS: The stance phase parameters measured included spatio-temporal data and the relative impulse measurements during consecutive gait cycles. The relative impulses under eight plantar areas were determined with an in-shoe plantar pressure measurement device. RESULTS: Each group had a specific plantar pressure distribution profile that varied with the degree of deficiency. The most significant differences were found beneath the midfoot, the first metatarsal head and the hallux. CONCLUSION: The neuromuscular disorders and foot deformities due to the cerebral lesion modified the contact of the foot with the ground, and led to specific plantar pressure distribution profiles. The equinovarus, with clawed-toe deformity due to greater spasticity, seemed to be an important factor in disturbances of the terminal stance phase. However, the spastic hemiplegic subjects seemed to adopt a gait pattern required for optimal stability. RELEVANCE: From previous work, comparable data were available only for the hemiparetic adult patients. In-shoe pressure data from spastic hemiplegic children can provide detailed information specific to each region of contact for the support of diagnosis, a clinical decision or the prescription of appropriate footwear, braces or othoses. Both peak pressure and local impulse have proven to be valuable for the understanding of foot function, lower extremity dysfunctions and walking strategies.