CMAster: European Context Report (WP3)

Version History

Version
1.0 1.1 1.2

Date
11 May 2012 30 May 2012 12 Sept 2012

Change
Initialisation, Structure Draft Modify content Approved by Steering Group

Author(s)
Richard Baker Richard Baker Richard Baker

Abstract: Establishes the context in which Clinical Movement Analysis is delivered across Europe. It will include: survey of CMA services to include location and host institution, budgets, throughput and staffing levels. It will also map out training requirements and existing opportunities. survey of bodies regulating professions involved in CAM and specification of registration and CPD requirements. survey of academic societies relevant to CMA including policies on accreditation of services and educational and training acitivities survey of manufacturers and suppliers of CMA equipment and documentation of education and training requirements.

This has to be in sufficient detail to inform the Exploitation Plan and the Key Competencies list. Summaries of these reports will be submitted for publication in academic journals.

This project has been funded with support from the European Commission. This publication (communication) reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Overview of Europe

Europe comprises: 27 members of the European Union (EU) o Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, United Kingdom. 4 states of the European Free Trade Area (EFTA) o Iceland, Lichtenstein, Norway, Switzerland 16 other states o Albania, Andorra, Belarus, Bosnia and Herzegovina, Croatia, Republic of Macedonia, Malta, Moldova, Monaco, Montenegro, Russia, San Marino, Serbia, Turkey, Ukraine, Vatican City.

This report will focus on the 31 states in the EU and EFTA (but any Masters programme will be open to anyone).

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Clinical Movement Analysis Societies within Europe European Society for Movement Analysis in Adults and Children (ESMAC) The European Society for Movement Analysis in Adults and Children was founded in 1992 and exists to stimulate and advance scientific knowledge, professional interaction and the exchange of ideas among society members relating to movement analysis in adults and children in clinical and research settings. Its main activity focuses on an Annual Conference, generally held in September, and preceded by a programme of seminars and instructional courses. It is affiliated with Gait and Posture. It does not have a formal relationship with national or regional societies but these are listed on its web-site. Clinical Movement Analysis Society of United Kingdom and Ireland (CMAS) CMAS was formed in 2002 to encourage professional interaction, develop and monitor professional standards and training and to stimulate and advance scientific knowledge in the fields of clinical motion analysis. It holds an annual meeting in March or April. The society operates an Accreditation scheme for movement analysis laboratories which has accredited 14 laboratories and another has applied for accreditation. It also has an active Standards Working Group which meets at the Annual Meeting and at a mid-year meeting in October. Societa Italiana di Analisi del Movimento in Clinica (SIAMOC) SIAMOC was founded in 1999 with the mission to foster the study and the clinical application of movement analysis methods, in order to improve the functional evaluation of motor disorders, to enhance the efficacy of the treatments through a quantitative analysis of data and a more focussed treatment planning, to quantify the results of current therapies. It has an annual meeting in October and a number of other events throughout the year. A recent survey has covered 48 different laboratories across Italy. Society of Movement Analysis Labs in the Low Lands (SMALLL) SMALLL originated in 1999 and aims to act as an association for individuals working in or otherwise involved in the field of clinical motion analysis in the Dutch language. It has 21 affiliated institutions and holds an annual conference in November. Societe Francophone dAnalyse du Mouvement chez lEnfant et lAdulte (SOFAMEA) SOFAMEA originated in 2001 as GAMEA but was formally constituted in 2001. It aims to promote research into different aspects of the analysis of movement in adults and children clinical, sporting and others. 17 different laboratories are involved with SOFAMEA and an annual meeting is held in January. Die Gesellschaft fr die Analyse Menschlicher Motorik in ihrer klinischen Anwendung (GAMMA) GAMMA is committed to ensuring the establishment of instrumented gait and motion analysis in clinical practice. It holds irregular training events and covers 3 laboratories in Austria, 14 in Germany and 3 in Switzerland. 3|CMAster Provisional workplan

The Nordic Vicon Users Meeting (NVUG) NVUG is a group of users of a particular motion analysis system rather than a regional society for movement analysis but covers many similar functions including an annual meeting in January.

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Clinical Movement Analysis Services within Europe A survey is being conducted of gait analysis services across Europe. It was piloted across 14 services and so far a total of 35 centres have responded. (The survey was modified slightly after the pilot. Questions or options that were only included after the pilot are in red type).

Austria Estonia France Germany Italy Netherlands Poland Spain Sweden Switzerland United Kingdom Total

2 1 3 5 6 2 1 1 1 3 10 35

Services provided All of these offer 3-d kinematic analysis. Services offered in addition are:

Kinetics EMG Physical Examination Clinical video Foot Pressure Measurement Energy cost Total

34 32 34 34 20 4 35

97% 91% 97% 97% 57% 19%

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All offer lower limb kinetics and other kinematic measurements offered are:

Full body Trunk Multi-segment foot Upper limb Other Total

13 9 5 9 0 21

62% 43% 24% 43% 0%

Over half offer service other than basic gait analysis:

Balance and/or posture Upper limb Activities other than walking (non-sports e.g. Sit to stand) Activities other than walking (sporting e.g. Running or cutting) Total

11 8 8 6 21

52% 38% 38% 29%

The majority of services provide basic data, a biomechanical interpretation and clinical recommendations.

Gait graphs (and other data) Biomechanical interpretation Clinical recommendations All three1 Total

21 30 24 18 35

60% 86% 69% 51%

Answers suggest there may have been some ambiguity in wording of pilot study with regard to data only 6|CMAster Provisional workplan

Referrals are accepted from a wide range of medical and allied health professionals:

Orthopaedic surgeons Physiotherapists Neurologists Physical medicine and rehabilitation doctors Paediatricians Prosthetist/orthotist Other surgeons Family doctors Medico-legal Other doctors Patient/family Occupational therapists Neurosurgeons Other Total

Number of services 33 24 21 20 17 17 15 14 13 10 8 7 4 30 35

94% 69% 60% 57% 49% 49% 43% 40% 37% 29% 23% 20% 11% 86%

Throughput and cost Service surveyed conduct approximately 9,700 appointments each year.

Totals Cerebral Palsy Other neurological Amputee Other orthopaedic Other Totals Adults Children 567 1206 145 1315 359 3592 3532 903 66 1289 282 6072 Total 4099 2109 211 2604 641 9664
Only 2 centre were children only and 3 were adult only.

Percentages Adults 16% 34% 4% 37% 10% 100% Children 58% 15% 1% 21% 5% 100% Total 42% 22% 2% 27% 7% 100%

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Median throughput is 200 appointments a year (78 adults and 112 children).

12 number of services 10 8 6 4 2 0

Total throughput each year

There is a wide range of different charges for services coming from a wide variety of sources with the median cost being between 500 and 1,000.

Cost of gait analysis

16 14 Number of services 12 10 8 6 4 2 0

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Staffing Staff from a range of different professional backgrounds manage services and are work within them. Professional background of manager (note several services have more than one manager).

Lab manager Physiotherapist Physical Medicine and Rehabilitation Doctor Neurologist Orthopaedic Surgeon Professional engineer/physicist Kinesiolgist/human movement scientist Sports Scientist Clinical scientist Total

13 4 2 3 10 7 2 2 43

Staff spending 10% or more of their time working for gait analysis services:

Staff more than 10% (average) Medical doctors (inc surgeons) Allied health professional Biomechanist Technician Administrator Total Estimated total extrapolated to Europe

Average per centre Number % EFT 2.3 16% 1.8 52% 1.6 63% 0.4 27% 0.5 9% 6.6 168%

Total (35 centres) Number EFT 82 5.8 64 18.1 56 22.0 13 9.6 16 3.3 231 660 59 168

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Staff generally have a high level of education with nearly 70% already having a Masters degree or Doctorate.

Staff more than 10% (average) Medical doctors (inc surgeons) Allied health professional Biomechanist Technician Administrator Total Estimated total extrapolated to Europe

Highest degree In PhD/MD Masters Bachelors training Total 47 15 0 3 65 10 22 32 5 69 30 2 0 7 39 1 4 5 0 10 3 1 6 3 13 91 260 44 124 43 123 18 51 196 559

Similar trends are reflected in experience with nearly two thirds of staff having more than three years experience of clinical gait analysis.

Experience <1 year >1 and <3 >3 and <10 >10 Total

27 53 81 56 217

12% 24% 37% 26%

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82% of services are also involved in research. 333 papers in peer-reviewed journals and 107 ESMAC presentations listed one or more clinical service staff as co-authors over the last three years. Although this was quite heavily skewed by a few centres with high output rates. The median number of papers is 6.5 and of ESMAC presentations is 3.

Chart Title
9 8 7 Number of centres 6 5 4 3 2 1 0 0 >0 and <5 >5 and <10 >10 and <50 >50 and <100 >100 Publica^ons ESMAC presenta^ons

Accreditation Only 43% services named the organisation that accredits their institution and only 27% were accredited separately of that institution (and only one of these was outside the UK). Attitudes to a European Masters degree 100% of respondents thought that a Masters degree in Clinical Movement Analysis would be useful and 95% that work-based distance learning was a good approach (the one exception commented that it was a good idea but thought the numbers would be too low). Within the 21 services that responded a total of 30 staff might enrol on a CMAster programme over the next three years if it was in English and another 11 if it was in their own language.

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The price that a health professional would expect to pay to enrol on a Masters degree varied considerably. It is possible that some respondents used 0 for dont know. There was considerable variation in estimates from services within the same countries.

Expected cost of Masters

6 5 Number of centres 4 3 2 1 0

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Manufacturers and Distributors of Motion Analysis Systems within Europe

Vicon

Oxford, UK

Manufacturers of video and kinematic analysis systems and suppliers of video, kinetic and EMG equipment for use in association with these. Manufacturers of kinematic analysis systems. Wide range of kinematic, kinetic and EMG systems for clinical use. Inertial movement trackers Integrated systems for rehabilitation and gait analysis. Manufacturers of Myon EMG system. Distributors for VICON, AMTI, ZEBRIS, Contemplas. Ultrasound based movement analysis, pedobraography and EMG systems. Video based movement analysis systems. Goniometer, Acclerometer, dynamometer and force plates and measuring systems. Force plates and instrumented treadmills Wireless EMG system (used to be sold as ZeroWire) Active marker based kinematic systems and vector visualisation. Video based gait analysis systems Insole pressure systems and pedobarography. Pedobarogrpahy and insoles Biomechanical modelling software Kinematic analysis system (Saga-3RT), EMG, video based analysis and software solutions. EMG systems and other sensors Portable metabolic gas analysis systems (MetaMax) Distributors for VICON, GaitRite, Zebris, Motek, Anybody, Contemplas EMG systems

Qualisys BTS XSens Motek Prophysics Zebris Contemplas Biometrics ForceLink Cometa Codamotion Simi Novel RSscan AnyBody Biogesta Biovision Cortex

Gothenburg, Sweden Milan, Italy Enschede, Netherlands Amsterdam, Netherlands Zurich, Switzerland Isny, Germany Kempten, Germany Newport, UK Culemborg, Netherlands Milan, Italy Rothley, UK Unterschleissheim, Germany Munich Germany Olen, Belgium Aalborg, Denmark Valenciennes, France Wehrheim, Germany Leipzig, Germany Orsay, France Kuopio, Finland

Biometrics France Mega

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Masters Degrees across Europe

Country Austria

University and Programme UNIT (Hall) Human nutrition

Duration

Cost (EU)

Cost (non-EU

8,800

8,800

Belgium

Katholieke Universitieit Leuven Adapted physical acitivity Rehab sciences and physio 2 years 2 years (120) 8,000 1,200 16,000 1,200

Belgium

Universite de Liege Movement Science 2 years 1,670 5,670

Czech Republic Denmark

Charles University Physiotherapy 2 years 16,000 16,000

University of Life Sciences, Copenhagen Human Nutrition Gastronomy and health 2 years 0 28,000

Finland

University of Jyvaskyla Sport science and management 0 0

Germany

University of Applied Sciences Occupational therapy 2 year PT (60) 4,416 4,416

Ireland

Trinity College, Dublin Cardiovascular rehab 1 years 13,000 26,000

Italy

University of Rome Foro Italico European MSc in health and physical acitivity 2 years (120) 3,000 3,000

Italy

University of Milan Physiotehrapy and resp rehab 1 year 2,582

Italy

University of Pisa Sports physiotherapy 1 year (60) ?

Netherlands

Vrije Universiteit Amsterdam HMS (research) 2 years 3,400 24,000

Netherlands

University of Groningen HMS 2 years 3,400 19,200

Netherlands

Universiteit Leiden

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 Norway

Vitality and ageing (medical)

1 year

9,750

18,100

Norwegian University of Science and Tech Exercise physiology/sports sciences 2 years 0 0

Spain

Universitat Autonoma de Barcelona Structural Ostopathy 1.5 years 4,880 4,880

Switzerland

Bern and Zurich Universities of Applied Sciences Physiotherapy 6 semesters PT (90) 3,240 3,240

Switzerland

ETH Zurich Human Movement Sciences 2 years 1,800 1,800

UK

Coventry University Physiotherapy 1 year 6,100

UK

University of Salford Advancing physiotherapy 1 year 3,828 12,170

UK

Queen Margaret University Physiotherapy 1 year (90) 6,660 14,050

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