Publishable Final Report - cordis.europa.eu · Validation seminar held in Tunisia with relevant healthcare professionals ... Augmented and virtual technologies, CAD/CAM, Additive

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Publishable Final Report

Deliverable D5.3

Project co-funded by the European Commission within the Seventh Framework Programme

Grant agreement 609575 Project Acronym SOHEALTHY Project Title Mediterranean Research Network on Footcare Sector Type of funding scheme Coordination and support actions – FP7-INCO-2013-9 Project website http://www.sohealthyproject.eu Start Date of project September 01, 2013 Duration 24 months

Deliverable 5.3. Publishable Final Report

Final version, 2015 2

Table of Contents

Executive Summary......................................................................................................................... 4

1 Project objectives and achievements....................................................................................... 6

1.1 Project objectives ............................................................................................................ 6

1.2 Main achievements ......................................................................................................... 7

1.2.1 Networking .............................................................................................................. 7

1.2.2 Formulation of joint research strategies................................................................. 20

1.2.3 Knowledge Exchange ............................................................................................. 31

1.2.4 Dissemination and promotion................................................................................ 36

Conclusions................................................................................................................................... 48



Acronyms and abbreviations

Acronym/Abbreviation Description

DoW Description of work WP Work Package WG Working group GA Grant agreement EC European Commission SoA State of the Art SRA Strategic research agenda PMP Project Management Plan EU-Med European and Mediterranean EoI Expression of Interest



Executive Summary

The SOHEALTHY Project started in 2013 with the aim of enhancing the cooperation between Europe and the Mediterranean basin countries on high importance and impact areas for society related to the footcare sector. This is the case of the diabetic foot syndrome and other foot pathologies and conditions related to obesity and ageing.

Throughout the project, cooperation took place by means of different activities of diverse nature such us knowledge exchange actions, identification of technology transfer opportunities among the participating countries, identification of industrial needs in the EU-Med area and specific training actions, consisting in a series of training courses focused on the research priorities defined in the Strategic Research Agenda.

Furthermore, a community of experts was created within the project framework, with the aim of gathering professionals from different segments of the footcare value chain, interested in the project’s targets.

For the first time, a European project tackles the development of a joint Strategic Research Agenda in the footcare sector, with the participation of professionals from the clinical, industrial, academic and research sectors. In addition, the patients and their needs represent the essential core of the agenda in order to address the development of more specific and effective products.

The main activities carried out within the first year of the project were the creation of a project website and a EU-Med experts community, the SoA analysis of the most relevant technologies of the footcare sector, the organisation of a network event in Manchester, the creation of working groups for the development of a strategic research agenda (SRA), the identification of industrial needs, the organisation of exchange visits and the continuous dissemination of the SoHealthy project’s activities. More information about these activities can be found in the first periodic report.

During the second year of the project (Sept.2014 - Aug.2015), activities concentrated first on the management of the 5 working groups that worked together on the development of the SRA. In parallel, project partners worked on the mobility actions, according to the training plan developed and the technology transfer opportunities identified. As a result, 20 researchers were trained on different topics related to the SRA (WP3). Also, project partners continued working on maintaining the experts' community, trying to involve more members (WP1), and disseminating the SoHealthy project (WP4). In July, the final conference of the project was organised in Spain (WP1). Other tasks and activities were the identification of main financing lines that complemented the innovation supporting services (WP2). 2 training seminars on Horizon2020 (WP2) as well as 2 workshops on project results (WP3) were organised in Morocco and Tunisia and a worskshop on technology transfer was also organised together with CINEA project in Alicante,



Spain. Moreover, as part of the clustering activities (WP3), the SOHEALTHY project, together with other 6 INCO projects, organised “the Innovation week”, in Casablanca.



1 Project objectives and achievements

1.1 Project objectives

The SoHealthy project included the following Work Packages (WPs) and objectives:

WP1 – Networking:

Creation of a scientific and technological cooperation network of a high level centred on the footcare sector, specifically in the areas of obesity, diabetes and the older generation

Identification of thematic working groups (gathered around specific research areas).

Extending the scope of the network to new partners, linking with other organisations and promoting collaboration with new associated partners.

WP2 – Formulation of joint research strategies:

Generating a robust joint strategic research programme on the specific key research and technological areas identified in WP1 by providing a prioritised list of research topics.

Reinforcing the links between the partners through the performance of exchange visits.

Facilitating the participation in the Horizon 2020 framework programme and other national and regional programmes, identifying main funding opportunities and project ideas.

WP3 – Knowledge exchange

Increasing knowledge exchange among partners in the field of obesity, diabetes and ageing, within the footcare sector by hosting technicians and/or researchers in the partners’ organisations, devising specific training programmes and courses and organising workshops for showing results.

WP4 - Dissemination and promotion

Facilitating the dissemination of results showing their added value to the industry-academia-policy makers representatives who can be interested in them.

Assuring the successful implementation of results.

Supporting collaborative dialogues among the partners.

Providing a public area to allow the timely public dissemination of the publications supported by the project and to serve as a reference point.



1.2 Main achievements

1.2.1 Networking

At the beginning of the SoHealthy project, partners’ efforts focused on two main tasks: the definition of mutually interesting research areas amongst the research topics and the creation of an experts community. The first task started with the mapping exercise of the research and technology state of the art (SoA); to this end, a SoA form was designed in order to collect relevant and up-to-date bibliography from different sources (patents, research articles, doctoral theses…etc.) related to the footcare sector in order to identify current and future technology lines. In parallel to that task, The University of Salford prepared a document about the effect of ageing, obesity and diabetes on foot1 as it was crucial to understand the effect of each pathology / condition on the SoHealthy target group’s foot, the footwear requirements –according to such pathologies or conditions- and how each research field was linked with those needs.

In total, for the development of the document State of the art of the most relevant technology areas within the footcare sector SoA report, more than 300 bibliographic inputs- were analysed. As a result of such analysis, 90 technology and research trends were identified, which were divided into 11 major research fields. This document was the starting point for the following tasks of the project, mainly the mapping of partners’ expertise and competences, the identification of common interest technological and research areas and the creation of working groups on each topic.

Related to the State of the art analysis, 2 validation seminars were held in Spain and Tunisia, with the participation of 45 foot health-related professionals in total. The aim was to gather relevant footcare sector experts, ask them to prioritise the technology areas resulted from the analysis and identify new ones.

Figure1. Validation Seminar held in Spain

1 The SoHealthy target groups have been: the diabetics, the elderly and obese people.



Figure2. Validation seminar held in Tunisia with relevant healthcare professionals

The results of those seminars2 as well as those obtained from other sources, such as the SoA validation forms, which were sent to the experts community, or a Networking event held in Manchester, were collated and processed in order to obtain a more complete list of technology / research trends at that moment.

In parallel, the project partners also carried out a mapping of partners’ expertise and competences and the identification of common interest technological and research areas, where the project partners provided information about their expertise, resources, key staff and the technology areas of their interest.

After the SoA report, the project partners worked in the creation of working groups on each specific topic. The project partners decided to create 5 working groups around 5 major footcare sector’s challenges, which covered the 11 major research areas defined in the SoA report.

These working groups were as follows:

Towards more efficient provision: the aim of this working group was to reduce the delivery time of a pair of orthopaedic shoes/insoles. Patients or consumers usually have to wait too much time for a pair of orthopaedic shoes, consequently provision of footwear can be too slow, too iterative and is rarely “right first time” so it takes many hours of work until the final model is obtained. This fact finally raises the price and the patients/consumers perceive them as very expensive. This working group was indented to identify and prioritise the research lines that lead to a better provision of shoes.

Research fields covered by this working group: 3D surface digitisation technologies, Augmented and virtual technologies, CAD/CAM, Additive manufacturing, Rapid prototyping, Robotics, Sensor technology related to measurements.

Towards reduced foot infection: foot infections are common and problematic in skin and nails (above all in the diabetic foot syndrome). Footwear factors are strongly associated with favourable microbial growth and therefore can increase the risk of foot infections. This working group focused on this problem and tried to prioritise the most relevant technology lines related to this challenge.

2 A publishable version of the seminar held in Spain was published on the Sohealthy Website.



Research fields covered by this working group: Microbiology, trials, micro/nanoencapsulation, materials.

Towards materials innovation: footwear materials are mainly passive and can offer a limited range of functionality. Footwear technologies need to be more sustainable in the long term. To offer more effective solutions and therefore be competitive, the footwear sector should seek to adopt materials innovations from allied sectors.

Research fields covered by this working group: Advanced textile materials, Smart materials, nanomaterials, micro/nanoencapsulation, adhesives.

Up-skill providers: emerging technologies and new practices could both lead to improved efficiencies for the providers and solutions for end users. However, providers require constant updating in their fields and in the fields closely related to their work.

Research fields covered by this working group: Education and training (which impacts on the rest of research areas)

End user-driven journey: The foot health and foot needs of the three end user groups targeted by the SoHealthy project have not yet been fully characterised. A more end user driven journey would lead to more appropriate and effective product solutions and greater provider competitiveness.

Research fields covered by this working group: almost all research fields were represented within this working group: Biomechanics, Sensor technology related to measurements, CAD/CAM, Additive manufacturing, materials, etc.

It is worth mentioning that –since the beginning of the SoHealthy project- patients’ needs were at the centre of the working groups, as the project partners are convinced that patients are -and should be- the key drivers for the footcare industry. In addition, these working groups were interconnected and, in some cases, one research area was covered by more than one working group. The working groups were multidisciplinary, made of professionals from different segments of the footcare sector’s value chain. As it can be seen on the diagram below, the working groups were fed with the knowledge generated through the different activities carried out during the project, as the validation seminars held in Tunisia and Spain, the networking event held in Manchester, the SoA report, etc. The methodology followed to define the working groups can be seen below:



In parallel to the creation of the working groups, a process map was also defined for the working groups called “the patient/consumer journey”, that process map became the general framework for the working groups to align their aims to impact upon the patient/consumer journey. This journey starts since a person who is elderly, obese or has diabetes has a foot problem or pain or needs a new pair of shoes, depending on the situation, so that the consumer/patient takes the healthcare or the retail route (see image below). This way, the prevention of the health problem throughout the retail route is also taken into consideration.

Figure 4. Patient/Consumer journey

SoA validation forms

Network event and Spanish workshop

State of the art document & Partners expertise

Working groups

Ability to meet user need

Spread of technology areas

Validation

Expertise fulfil aims

Figure 3 Diagram of the methodology followed to define the working groups

SOH workshop in Tunisia

SOH

Partn

ers

SOH

Expe

rt Co

mmun

ity



As said before, for the creation of the working groups, a set of criteria were applied in the selection of the working groups’ members. These were:

1. Members have to be experts and/ or have experience in one or more areas covered by the working group.

2. The 11 major research fields had to be covered.

3. WGs had to be made up of 8-10 members, maximum.

4. All WGs had to have representatives from EU and MED countries, in order to define the geographical differences.

5. WGs had to be multidisciplinary.

6. WGs had to have representatives from different sectors in each WG.

7. WGs members had to be fluent in English.

The five working groups were made of 35 permanent members in total. As the working groups were interconnected, some members were involved in more than one working group, so that, as a result, there were 45 participations in total. To highlight that some external experts occasionally participated in the working groups. This is the case of some experts who participated in the WG seminar held in Barcelona, in February 2015.

In parallel with the creation of the working groups, the project partners developed the document: Database of industrial needs and definition of main actors on each research area, of public nature. Such document contains the main footcare industry’s needs in each research area defined in the SoA report, according to 8 categories of industrial needs and identify the main actors. This document, along with the analysis on patient’s needs, were crucial to better understand the footcare sector, from those two different perspectives.

The creation of an experts community was a continuous task since the beginning of the project. It was very important to create a critical mass of experts to involve them in the project’s events and activities and share the project’s results with them. To this end, more than 187,000 potential experts were contacted through different channels: press releases, publications, conferences, emails, project website, etc. As a result of such intensive work, 160 experts from 18 countries worldwide joined our experts community.

The following graph shows the percentage of experts per country:



% Experts per country

24%

9%

19%

20%

14%

1%

1%

Spain Morocco Tunisia England Italy Australia Belgium

Egypt France Greece Irak Japan Luxembourg Netherlands

Portugal Romania Turkey USA

Figure 5. Percentage of experts per country

If we analyse the experts per type of organisation, we find a wide range of organisations typology, what it meets the project’s criteria of involving experts of the whole footcare sector’s value chain.

% Type of organisations

23%

26%

18%15%

1%

1%

University Healthcare professionals Company

Research Centre Patients association Industrial association

Individual expert Policy makers Others

Figure 6. Type of organisations (%)

Among the SoHealthy experts there are European, national and regional platforms related to the topics of the project. To highlight the following ones:



PROsumerNet platform is The Design-based Consumer Goods Cross-ETP, a European Technology Platform, which has recently been officially recognised by the European

Commission, is a European consumer goods research initiative that started in 2009 as a European project. Most probably, in the near future, the European Footwear platform will be part of this platform too. Since then, the PROsumer.NET initiative has provided the consumer goods sector with valuable information, such as the development of a research Roadmap, among others.

Manu-Ket platform is the Spanish Technological Platform for Advanced Manufacturing. It is a technological platform that tries to identify the technological needs of future products and services, for which the incorporation of advanced materials, microelectronics, photonics and nanotechnologies require new processes, equipment and production systems.

The Enterprise Europe Network is a key instrument in the EU's strategy to boost growth and jobs. Bringing together close to 600 business support organisations from more than 50 countries, they help small companies seize the unparalleled business opportunities in the EU Single Market.

These platforms and organisations normally carry out their own sector’s analysis and roadmaps, so it was important to inform them about the SoHealthy project’s results, mainly the research priorities defined in the SRA, in order to not to duplicate the efforts and create synergies with them. Thus, as said before, we sent the SRA to these experts and some of them published it on their websites.

Finally, it is also worth mentioning the collaboration with the Institution for Preventive Foothealth (IPFH), which is an American non-profit private foundation committed to raising awareness about the importance of caring for the feet through education, research and the identification of methods demonstrated by clinical research to prevent, treat and manage painful conditions and diseases affecting the feet, mobility, functional status and quality of life. Thanks to the collaboration with IPFH, information about the SOHEALTHY Project was published in the Journal on Active Ageing, a publication of the International Council on Active Ageing, which is one of IPFH's educational partners. This way, IPFH helped the SOHEALTHY project to extend foot health awareness to other countries throughout the world, like USA.



Figure 8. The SoHealthy experts community comprises experts from diverse segments of the footcare sector’s value

chain: health care associations, training organisations, industrial associations, ETPs, research centres, universities etc.

To highlight that the SOHEALTHY project was one of the Sponsors of a public conference that took place in Brussels, the 15th-16th of October 2014. Such conference focused on the next steps in the PROsumer.NET initiative and the SOHEALTHY project’s results -at that moment- among other European project’s results.

Picture 1. Conference on PROsumer.NET initiative.

On February 26th a “Networking event”3 was organised at the University of Salford. Such event gathered 130 delegates, mainly from England, but also from Egypt, Tunisia, Morocco, Italy, Spain and France. There were in total 20 presentations, 33 posters and 6 demonstrations. During the planning phase of the event, the importance of involving speakers from different sectors (industry, health care, patients’ associations…etc.) and different countries from Europe and the

3 Reports of this event as well as the presentations given during the conference were published on the SoHealthy Website.

Training organisations

…other Primary and secondary schools in the Veneto area

Health care association

Industrial associations ETPs

The Moroccan association of podologists

Institut Mohamed al Kassab

…

…



Mediterranean area was emphasized. As a result, a high diversity of experts and speakers was achieved, which can be checked in the event programme. One of the main objectives of this event was to contact new stakeholders in the footcare and footwear industries and clinical services in the UK and across Europe and the Mediterranean-basin. This aimed to engage new organisations into European projects and to promote collaboration with, and between, new and associated partners. The networking event also enabled the presentation of current results of the project, expert clinical insights, industry challenges and the current nature of and limitations to foot health provision in wider-Europe. Therefore information and feedback gained at this event also contributed to the creation of the working groups.

Picture 2. Networking event in Manchester. On the right, project partners and some attendants during the event.

To highlight the participation of the SOHEALTHY project with other European projects in some of the topics of the SRA and the exploitation of some European research projects’ knowledge and results. Thus, the SRA were also promoted through these projects, which were the following ones:

NANOFOOT: Materials, Components and Footwear with enhanced comfort properties based on nanotechnologies (grant agreement n° FP7-SME-2013-2-606570)

INGA3D: Creative transfer of competences in 3D footwear CAD to footwear professionals (No. LLP-LdV-ToI/2013-RO-024)

EXPLORE: Extended exploitation of European research projects’ knowledge and results (No. 609226)

We would also like to highlight the collaboration between the SOHEALTHY and EXPLORE projects in finding and promoting some of the ideas generated during the WG seminar held in Barcelona. Both projects jointly organised a brokerage event in the framework of the SoHealthy final conference where those project ideas were presented, along with other ideas and R&D EU project’s results. Both, NANOFOOT and INGA3D projects organised 2 practical workshops, as part



of the second block of the final conference and both projects presented their results. The conference was a large-scale final public conference that was held in Elda, Spain, the 20th and 21st of July.

Figure 9. Agenda of the SOHEALTHY final conference

That two-day conference was titled “Innovation and advanced technologies at the service of the foot health: prevention, diagnosis, design, footwear, orthotics and materials”, and it was divided into the following blocks:

1. Block 1: Key aspects of the advances in footcare technologies: prevention, diagnosis and materials.

Within this block, up to 9 presentations were given by prestigious speakers from the footcare, nutrition, health care, biomechanics, etc. These presentations were related to the topics of the SOHEALTHY project, as for instance, diabetes, obesity and ageing. At the end of the first day, the round table “How to innovate more and better” was also held within this block. Such round table was focused on some of the research priorities identified in the SRA, as well as some of the recommendations arisen during the exchange visits carried out within the SOHEALTHY project.



Picture 3. The moderator introducing the participants of the round table to the audience

2. Block 2: Practical workshops on the use of new technologies and innovative solutions in the footwear sector.

This block consisted of 6 workshops: 3D footwear design, 3D sole design, orthopaedic footwear design, measuring devices, innovative training in footwear companies, examples of nanotechnology applied to footwear.

Picture 4. One of the groups during the practical workshop “measuring devices”



3. Block 3: Brokerage event.

As said before, a brokerage event was organised jointly with EXPLORE project. The aims were to present new project ideas to the audience and seek new partners to develop them and transform them into new project proposals. At the end of that session, the participants were asked to fill in an expression of interest form (EoI) about the project ideas presented in order to know their interest in participating/collaborating in any of those ideas.

Picture 5. Some speakers presenting their project ideas during the brokerage event.

Figure 10. Agenda of the Brokerage Event



SOHEALTHY FINAL CONFERENCE: RESULTS

It was estimated that 124,453 people were contacted through different dissemination channels. As a result of such intense effort, 167 people registered for the final conference (full seating capacity). Among the attendants’ countries of origin we find: Spain, England, Tunisia, Morocco, Portugal, Romania and Italy.

Within the following days after the conference was over, an online satisfaction survey was sent to the attendants in order to receive feedback from them and know their opinion. The results showed a high satisfaction with the conference. On average, it was obtained 4.67 points over 5, the foreign participants, and 4.39 over 5, the Spanish participants.



1.2.2 Formulation of joint research strategies

The Development of joint research strategies was one of the main tasks of the SoHealthy project. After the creation of the working groups, the following step was to decide how the working groups would be managed, defining the management structure and responsibilities, the communication management and a work plan for both, the working group and the task itself. With that aim, an action plan was developed to define the main steps to reach a Joint research programme. It contained the working group management strategy and the work plan to be followed by the members of the working groups, and it also defined the management structure and responsibilities of each one.

The activities with the working groups’ members started in September 2014 and finished in February 2015, with the organisation of a WG seminar in Barcelona. Each working group (WG) leader arranged a Skype conference with their WG members in September 2014 in order to give a brief presentation of the SoHealthy project and the working group’s objectives. The WG leaders introduced the members to each other and explained the working group’s objectives, tasks and rules, as well as the SoA template and the patient journey, which was the global framework for the working groups.

The work was divided into five steps or sections:

1. Mapping the patient journey Within this step, the members of the working groups indicated on what stages of the patient journey each working group impacted on. After receiving feedback from the members, each leader prepared a SRA template and circulated it among their members.

2. Challenges and opportunities The members of the working groups defined the footcare sector’s challenges and opportunities. Those challenges and opportunities had to determine the desired impact of the research and innovation priorities already mentioned. An integrated approach in addressing the challenges was of crucial importance.

3. Key research and innovation priorities Those priorities came from the research/technology research areas identified in the State of the art report and those arisen from other sources such as the validation seminars and the networking event.

4. Impact on new products Within this section, the members of the working groups identified how the prioritised research lines turned into industry innovations and these ones into new products and/or product modifications.

5. Key enablers Identification of key organisations in the field of research, academia, policy…etc.

The WG seminar was held in Barcelona, the 11th and 12th February. It was organised by The University of Salford and INESCOP and the meeting’s main objectives were as follows:



1. To finalise and sign-off their contribution to the task of defining the strategic research agenda

2. To develop EU project proposals for future funding calls.

Other specific objectives were:

To present the outcomes of the working groups to all meeting attendees

Lead discussions to complete the summary table and doubts

Present the working group findings so far

Present their EU project proposal(s)

Figure 14. Agenda of the SOHEALTHY working group seminar in Barcelona

The development of new EU project proposals for future funding calls had the aim of generating new competitive ideas for further development into beneficial project proposals. These new proposals came from the working groups – from the research priorities identified in each WG- and, as previously said, those ideas were also presented at the Brokerage event, during the SoHealthy final conference. For the development of the final version of the SRA, the WG leaders included a country overviews section to provide an insight into the situation of the SoHealthy project partners’ countries: Italy,



Morocco, Spain, Tunisia and United Kingdom, as regards as obesity, diabetes and ageing and the situation of the orthopaedic footwear sector in each of these countries. A section titled “Recommendations & needed initiatives” was also included in the SRA. Such section summarises the main conclusions extracted from the exchange visits carried out during the project and the discussion with the diverse professionals contacted in the different events of the project. This section sends a very important message to the Governments involved as it shows the most urgent measures to be undertaken within each country. Up to 50 professionals of the footcare sector from 9 Eu-Med countries (7 from Europe, 2 non-EU countries) contributed to the SoHealthy Strategic Research Agenda (see the Acknowledgements section of the SRA). To highlight the diverse nature of professionals who have worked in the SRA, including professionals from the clinical, industrial, academic and research sectors. Thus, the SRA contains the view of foot health-related professionals from the whole value chain. It is estimated that these professionals and experts of the footcare sector dedicated approx. 2,335 hours in total to the development of the SRA4.

The SRA was released in May 2015. It was –and it is- very important for the success of the project to reach a high number of stakeholders and policy makers in the EU-Med area.

4 This calculation does not include the dedication in hours of the WG leaders and project partners.



A series of exchange visits were planned since the beginning of the project. The aims of these exchange visits were to exchange information and experiences in the topics covered by the project, promote a better mutual knowledge and reinforce the links between partners. In addition, as mentioned before, the exchange visits provided information to the SRA, specifically to the section “Recommendations and needed initiatives”.

Next, it is provided a brief summary of the exchange visits carried throughout the project, in chronological order:

The first exchange visit was carried out in Spain. It took place at IVPIE (Unidad de Pie Diabético S.L.) clinic, where Mr Ángel Camp, podiatrist and Director of IVPIE, guided the delegation in a visit to the facilities, highlighting those topics of special relevance for the project, such as those summarised below:

CAD/CAM tools for designing customised footwear and insoles: IVPIE uses specific software for designing customised insoles and footwear from the patients’ foot measures obtained by means of different ways: foot measures taken manually, measures obtained with Microscribe, digitised feet, digitised moulding foam or digitised footbeds/lasts. Mr Camp pointed out that despite current big advances in Software tools, in his view, there still remains much to be done.

IVPIE also produces bespoke footwear, some of them made of chromium free leathers and other special materials for diabetics and other groups of patients. Mr Camp showed the partners some samples and explained that some compounds derived from the tanning process can be considered as potential allergens, which might have a negative effect on patients suffering from diabetic foot syndrome.

Mr Camp also showed all partners the Biomechanics lab, equipped with the most modern technologies, such as optoelectronic cameras (as part of a movement capture system), 3D force platforms, plantar pressure platforms, digitisers, surface electromyography system …etc. Mr Camp explained that the biomechanics lab was used for in-depth analysis of lower limbs in order to search possible pathologies, prevent problems in patients with diabetic foot, assess the functional, brain and neurological damage, analyse patients’ plantar pressure distribution…etc.

During the meeting, Mr Camp was asked about several issues related to most important patients’ needs and the industry concerns, in order to know his opinion and vision about the footcare sector.



Picture 4. Exchange visit at IVPIE, Valencia

The second exchange visit took place in Manchester, where the project partners and two experts from Morocco and Tunisia visited the Podiatry Clinic at Hope Hospital (Salford Royal NHS Foundation Trust) and got first-hand knowledge on the current situation of podiatry practice in UK.

The most important issues that Dr Jane McAdam (Principal Podiatrist - Biomechanics, Orthotics and Footwear) explained are summarised below:

- This is a footwear and orthotic clinic within the Hospital, working with several podiatrists and 1 orthotics technician, who see about 30 patients a day on average (both for treatment and prescription/follow-up of bespoke footwear and orthotics).

- Products are covered by the NHS: Patients should always have 2 pairs of shoes + orthotics useful/year, and they go to regular follow-up visits to assess the performance.

- Orthotics are prepared in the clinic and for shoes, they work with 2 national companies producing bespoke footwear. Products are prescribed & ordered after trying-on some sample models they have in stock.

- They work following the traditional procedures: foam, moulds, etc. and they do not use CAD systems.

- Specific requests they would make to the Industries of bespoke footwear would be related to: improved style aspects, more choice of models, improved product finish and enhanced performance (sometimes they found that products made with high-technologies did not show improved performance compared to manual produced products).

- Furthermore, they expressed their thoughts regarding the high cost of technologies. As an alternative to the high-investment, they proposed to create a regional centre equipped



with advanced technology and devices, providing services to clinics, hospitals or practitioners lacking these devices.

Following the visit to the Hospital, delegates visited the Podiatry clinic facilities in the University of Salford, where students are trained to use the latest technologies and techniques to provide a wide range of treatments under the supervision of academic staff.

The Podiatry clinic represents integrated clinical and research facilities that provide USAL students with practical experience and is open to everybody willing to be attended for essential care, foot conditions, gait disorders in children, etc. On average they provide 10,000 treatments a year.

In addition to primary care, the clinic provides also custom-made orthotics, and includes a gait analysis lab and the possibility for students to test the latest technologies/products resulting from participation in national and EU projects and cooperation with international well-known firms such as Scholl.

Picture 5. Exchange visit at Podiatry Clinic at Hope Hospital, Manchester

The third exchange visit was held in July 2014, in Padova, Italy. It was divided into two visits to two orthopaedic footwear companies, “Laboratorio Ortopedico Daniele Vittorio S.A.S.” and “Calzolaio Antonio Rigato”. The first one, Daniele Vittorio is also an orthopaedic clinic that unifies manufacturing and clinic services in only one company. This fact is very interesting because patients find all they need in only one company and at the same time the company receives first hand feedback from the patients/customers in all steps of the process so that they can have a global picture of the whole process. They offer their clients a wide range of models, colours and materials, so that patients can have different options and in the end, they are more satisfied. They can even produce models similar to others in the market in order to meet patients’ preferences (i.e. shoes similar to “Sneakers shoes”), actually they declared that design is their strongest point.

In order to get patients’ feet data, the company uses pressure plates, carbon sheets, foams etc, similar to those used by other orthopaedic companies. Regarding the manufacturing processes, they use the same machines used in others companies and, as usual, this process is very manual. Regarding the materials used for the manufacture of insoles and footwear, these are the same as



those used in other cases, they normally use leather without nickel, formaldehyde, chromium, etc in order to avoid possible allergies.

Picture 6. Visit to Daniele Vittorio, an orthopaedic footwear manufacturer and an orthopaedic lab

The second visit was to Calzolaio Antonio Rigato. The general manager, Wladi Rigato, welcomed the partners and explained the processes carried out in his company. This company is an orthopaedic footwear producer that works closely with orthopaedic clinics. The patient goes to the clinic and after choosing the model and the colour, the clinician sends a prescription form with all relevant data related to the patient’s feet, their pathology and the shoe model chosen by the client.

Picture 7. Visit to Calzolaio Antonio Rigato, an orthopaedic footwear manufacturer in Padova, Italy

The fourth exchange visit was carried out in Tunisia, the 23rd of September 2014. The project partners visited the Institut National d'Orthopédie Mohamed Kassab, a national public hospital located in Tunis, and the Centre National d’Appareillage Orthopédique, which is next to the M. Kassab hospital. Professor Catherine Dziri, Chief of service and professor in Physical and



Rehabilitation Medicine at the Faculty of Medicine of Tunis, showed the partners the different departments of both buildings. Next both visits are explained in detail:

The Institut National d'Orthopédie Mohamed Kassab is a specialized public institute of Muskuloskeletal Health located in the “Grand Tunis” (“Big Tunis”); it is a Public Health establishment dedicated to care, education (medical students/trainees, health professions as physiotherapy, occupational therapy, speech therapy, psychomotricity, ...) and research. This hospital belongs to the Ministry of Health and has 270 beds in total, with several departments (orthopaedic surgery for adults 70 beds /for children 70 beds, rheumatology 25 beds, intensive care unit 20 beds, physical and rehabilitation medicine 40 beds, septic 20 beds, hand surgery 25 beds). The department of Physical and Rehabilitation Medicine is the biggest public unit in Tunisia for rehabilitation, including outpatients and inpatients (40 beds); so that it takes care of patients with neurological problems (stroke, neuromuscular / neurodegenerative diseases, multiple sclerosis, cerebral palsy, ...), traumas (polytrauma, spinal cord injury, brain injury, fractures,...), amputations, elderly, rheumatologic diseases (arthritis,..), patients who have suffered accidents at work/ traffic accidents / domestic accidents/ and -since 4 years- war wounds….etc, generally, patients who have any kind of disability and need rehabilitation. Among the staff, there are 6 doctors, 5 training doctors, 12 physiotherapists, 2 occupational therapists, 1 speech therapist, nurses. Pr. Catherine Dziri explained the partners that 70% of population in Tunisia can not afford private health insurance. Unlike other North African countries, the CNAM, the Tunisian public social Security system, covers the total cost of a pair of orthopaedic shoes and insoles, but unfortunately the waiting list is of 6 months approx., which is definitely too long for a patient who has diabetic foot. In addition, the CNAM only covers 1 pair of orthopaedic shoes per 1 year for adults, what it is, in most cases, insufficient. Therefore it is necessary to get more funds and resources (human resources, more infrastructures, materials, etc) to supply the demand.

Picture 8. Visit to Institut National d'Orthopédie Mohamed Kassab, a hospital located in Tunis focused on Musculo skeletal Health (on the left) and the Centre National d’Appareillage Orthopédique, which is next to the hospital (on the right).

After visiting the hospital, project partners visited the Centre National d’Appareillage Orthopédique, which is next to the hospital M. Kassab. Both centres work closely, as the first one provides services to the second one. The Centre d’Appareillage Orthopédique started its orthopaedic services in 1966. Nowadays there are 120 workers in total, who take care of more than 7,000 patients per year. During the visit, the project partners had the opportunity to see at



first hand practical cases with real patients, as professor Catherine Dziri attended three patients with different feet problems and pathologies and discussed the cases with some students.

Picture 9. Visit to the Centre National d’Appareillage Orthopédique, which is located next to the hospital M. Kassab. On the left, prof. Catherine Dziri, attending one patient. On the right, one of the orthoprothesists showing lower leg orthotic device.

The last exchange visit was carried out in Morocco, the 3rd of March 2015, where the SOHEALTHY project partners visited the Centre Hospitalier Noor, a private hospital focused on re-education and functional rehabilitation located in Bouskoura, near Casablanca, which treats around 500 patients per year. The Centre Hospitalier Noor is the only hospital in Morocco that provides orthopaedic services and employs 2 orthopaedic technicians and 1 podiatrist. Ms. Hind Benziane, President of the Moroccan Association of Podiatrists (AMSP), and Ms. Fatima Lotfi, podiatrist at the Noor Hospital and general secretary of the AMSP, showed the different parts of the hospital. The visit ended with a meeting with Ms. Baha Rabi, Chief Doctor of the hospital, who kindly welcomed the project partners and positively assessed the work being carried out by the SOHEALTHY project.

Picture 10. Visit to the Centre Hospitalier Noor, which is located in Bouskoura, Tunisia.

To highlight that the partners also visited the other partners’ premises during the exchange visits.



To sum up, 13 organisations were visited in total, these are as follows:

• IVPie, a private podiatry clinic (October 2013, Spain)

• INESCOP premises. October, 2013.

• The Hope Hospital, Salford Royal NHS Foundation Trust. February 2014, Uk

• The Podiatry clinic facilities at the University of Salford (February 2014, Uk)

• Daniele Vittorio. Padova, July 2014

• Calzolaio Antonio Rigato. (July 2014, Padova, Italy)

• POLICALZ premises. (July 2014, Padova, Italy)

• The Institut National d’Orthopédie Mohamed Kassab (September 2014,Tunis)

• Centre National d’Appareillage Orthopédique (September 2014,Tunis)

• CNCC premises. September 2014, Tunis.

• Centre Hospitalier Noor. March 2015, Casablanca, Morocco

• A private podiatry clinic in Casablanca (March 2015, Morocco)

• CMTC premises. March 2015, Morocco

Within this work package, the project partners identified the main financing lines and funding programmes available in their respective countries (Spain, Italy, Morocco, Tunisia and United Kingdom). The final aim was to improve the information about financing programmes and the possible funding available on a National, European and International scale in order to promote new collaboration projects that were linked to the research areas contained within the joint research programme. This information about the financing programmes was related to the development of Innovation supporting services, where, among others, the project partners defined and designed a series of supporting services to support the phase of project preparation for participation in R&D projects.

The supporting services included the definition of the process of project development, partners search, presentation of Horizon 2020 Participant Portal, CORDIS and the Enterprise Europe Network as useful tools for the development of proposals, partners search, search of existing projects, etc., identification of the National Contact Points (NCPs) for project preparation, and useful tips for proposal writing, submission and communication.

Related to the innovation supporting services, in September 2014 and March 2015, 2 training seminars on Horizon 2020 were held in Tunisia and Morocco respectively. Both training seminars gathered in total 75 participants.



Picture 12. Training seminar held in Morocco. The coordinators of the SoHealthy and Menfri projects (the

organisers) welcomed the attendants.



1.2.3 Knowledge Exchange

Within this work package, the project partners first identified the Knowledge and technology transfer opportunities by completing a SWOT analysis that reflected the TT situation in each country/ area.

Picture 13. SWOT analysis

Project partners also identified the main training needs of both, the project partners’ organisations and their respective countries (England, Morocco, Italy, Tunisia and Spain) and geographical areas (Europe and the North Africa area) in order to develop specific training programs. The partners also identified the main training organisations in the EU-Med area and the courses or programmes they offer (related to footcare) in order to know the training offer available in each country.

As a result of the information collected, a training plan was developed to plan what it was called the “mobility actions”, or, in other words, the secondment of researchers / technicians. Such training plan contained the partners’ main training topics/needs, which were linked to those partners that could satisfy those needs, according to their expertise and competences and provided the basis for establishing the technicians/ secondment plan.

The mobility actions were held the weeks beginning 11th and 18th May 2015. They were hosted at INESCOP’s facilities. The training programme finally comprised the following research areas:



Computer Aided Design, Materials, Adhesives, Biomechanics and foot morphology related to footwear and footcare.. As a result, 20 researchers from Italy, Morocco, Spain, Tunisia and UK were trained on computer aided design, materials, adhesives, biomechanics and foot morphology. These researchers/technicians will act as multiplicators of the knowledge gained in their respective countries.

Picture 14. Example activities from week one of mobility

Picture 15. Example activities from week two of mobility

At the end of each week, all trainees received a certificate of attendance, as it can be seen next:



Picture 17. Example of a certificate of attendance given to the trainees

On the 23rd of September 2014 and the 2nd of March 2015, 2 workshops were held in Tunisia and Morocco, respectively. The aim was to present the project’s results achieved until that time and to create a dialogue framework on the topics related to the SRA. To this end, representatives from the Ministry of Industry and Health, of each country, attended the workshops.

The main objective of the workshop held in Tunisia was to present the first-year results of the SOHEALTHY project to the healthcare professionals’ community, researchers, policy makers and the industry.

The event was opened by the Minister of Industry, Energy and Mines of Tunisia, Mr. Kamel Bennaceur.

The specific objectives were as follows:

To make the topics of the project and the project itself closer to the footcare sector.



To raise awareness about the footcare sector’s needs and the importance of having effective communication between different sectors within the value chain.

To know different points of view around common problems and needs focusing the attention on patients.

To discuss about the needs of the industry and how other sectors can influence in addressing/improving those needs (the relationship between the industry and research).

To enhance the collaboration between different kinds of organisations around common issues in order to increase new opportunities for collaboration.

To involve more professionals in the SoHealthy experts’ community.

Picture 18. On the left it can be seen the Minister of Industry, Energy and Mines of Tunisia, Mr. Kamel Bennaceur, who opened the workshop. On the right, the project coordinator presenting the SOHEALTHY project’s results.

The second workshop on project results was organised in Casablanca, Morocco, the 2nd March 2015. That workshop, as well as the training seminar on Horizon 2020 (mentioned before) were organised in the framework of what it was called “The Innovation Week” in Morocco, where six R2I projects –including the SOHEALTHY project- decided to join forces together and with other Mediterranean initiatives in order to organize a powerful event on innovation. The event included a series of workshops, training sessions, roundtables and a brokerage event, with the aim of attracting the focus on the great innovation potential of the Region. Among the attendants there were representatives of the Moroccan Ministry of Health and Ministry of Industry.



Picture 20. Workshop on project results in Morocco

As part of the clustering activities for projects covering the same region, a technology transfer training workshop was held the 28th and 29th October 2014, at the University of Alicante(Spain). This workshop was co-organised with the CINEA project, a R2I project that covered similar geographical areas as the SoHealthy project. The participants came mainly from Morocco and Tunisia, but there were also participants from Spain, Algeria, Italy and Uk.

Picture 19. Technology transfer training workshop

It is worth mentioning that 98 people received training on H2020 and technology transfer and 87 people participated in the workshops.



1.2.4 Dissemination and promotion The activities related to this work package started with the Creation of a Website and a communication platform. In mid-November 2013 a first version of the Website containing basic information about the project and its partners was launched. This “basic” Website was extended with much more functionalities according to project’s needs, so that the final version of the Web was finished and published in February 2014. Since the beginning of this task, INESCOP, the task leader, wanted to design and create a useful and functional Website for both visitors and experts, so that it was a useful tool for attracting new experts to the Sohealthy community while keeping the interest of the experts that already joined the community. Thus, public and private areas were created, as described below:

Home (entry page: slide show + fast links) – PUBLIC o Useful links o A to Z o Latest news (Private)

The project - PUBLIC o Overview

Summary and objectives The challenge Expected results

o Consortium Centre Marocain des Techniques du Cuir Centre National du Cuir et de la Chaussure Cluster Calzado Innovación Politecnico Calzaturiero Instituto Tecnológico del Calzado y Conexas University Of Salford – School of Health Sciences

Networking - PUBLIC o Our footcare sector community o List of experts

Working groups o WP1- Towards more efficient provision o WP2- Towards reduced foot infection o WP3- Materials o WP4 – Up-skill providers o WP5- End user driven

Main results – PUBLIC AND PRIVATE o Main results library (Presentations, Publications, Others)

Our events - PUBLIC Can we help? - PUBLIC

o Media service o Contact us



Expert community login - PRIVATE Experts private area: - PUBLIC5

o Project documents o Profile management o Send a project document o Main results library o Latest news

Figure 16. SOHEALTHY home page

Project partners were able to access the project management platform through the “experts private area” on the Website, where they can download the most important project documents, such as guidelines, templates, internal documents, deliverables, working documents, etc. The website was continuously updated throughout the project, publishing news related to the project’s events, including the information of the new experts, uploading the public and private documents, presentations displayed at the different events of the project, etc. As a result, the SOHEALTHY website received 22,549 visits since the beginning of the project.

5 This section was initially private, in order to attract members to the SoHealthy experts community.



Figure 17. SOHEALTHY Website: statistics in 2015

Figure 18. SOHEALTHY Website: statistics in 2014

The SOHEALTHY Website also included social media links (LinkedIN and Twitter) and links to RSS feeds.



Figure 19. Some posts about the project published on LinkedIN

Apart from the Website, the project partners decided to create an innovative interactive platform called “Sohealthy platform”. This interactive platform is private, as opposed to other platforms such us LinkedIN, Twitter, etc. and it enables the members to publish news related to the footcare sector, share their ideas, publish information about courses, events, conferences, etc related to the sector, create groups according to the member’s specialization, comment the ideas and publications, etc. Therefore, this platform complements the functionality of the SOHEALTHY project website and transform its members from passive to active members.

Figure 20. Banner of the SoHealthy platform at the SOHEALTHY Homepage



Figure 21. Homepage of the SoHealthy platform, where the members can see the latest news,

ideas, courses,etc.

With the aim of disseminating the project results, the project partners carried out 167 dissemination actions towards their respective networks and communities at a European, national and regional level, and the number of people reached through the dissemination actions is estimated in more than 187,000 people6.

It is worth mentioning the publication “The perceived role of biomechanics in future footwear provision for European adults who are older, obese or who have diabetes”, published on Footwear Science7, a specialised journal on biomechanics and footwear. A copy of such publication can be found at the end of this deliverable (annex X). Within those dissemination actions, partners have used the dissemination materials designed for that purpose: posters, entry questionnaires, email signatures and leaflets in English, French, Italian and Spanish as well as the posters and leaflets about the SOHE ALTHY project’s final results produced at the end of the project. Those leaflets can be downloaded from the public area of the project website. As a result, more than 50,000 e-mails were sent with the Sohealthy signature and more than 2,500 leaflets (both electronic and printed) were sent -and distributed- at events.

6 This is an estimation, the real number is much more higher as we have not added the people reached in the majority of the dissemination actions because that data is unknown or very difficult to know.

7 Volume 7, Supplement 1, 2015. Pages S149-S151. Published online: 18 Jun 2015 DOI: 10.1080/19424280.2015.1039079.



The dissemination materials produced throughout the project are:

Project logo

Project banner

Adhesion questionnaires in English, French, Italian and Spanish



Project poster in English, French, Italian and Spanish. Two versions: extended and summarised

E-mail signature in English, French, Italian and Spanish. a special version of the e-mail signature was also created in December as season’s greetings and for Ramadan.



Electronic leaflets in English, French, Italian and Spanish about the project’s first year results:



• Poster about the project’s first year results in English, French, Italian and Spanish.

Poster about the final project’s results in English, French, Italian and Spanish.



Leaflets about the final project’s results in English, French, Italian and Spanish.



Other dissemination materials related to the project:

Figure 22: Newsletter prepared after the final conference



Figure 23. Standard e-mail signature and special Christmas greeting designed for Christmas eve.

We would like to highlight that, despite the project has already finished, the project partners will continue promoting and disseminating the SoHealthy project’s results in fairs, events related to foot health, publications, etc.



Conclusions

This report summarises the intensive work carried out throughout the SoHealthy project. As a result of such intense efforts, the SoHealthy project team has achieved the following results:

- Creation of a EUMed cooperation network with more than 160 experts from 18 countries, gathering all agents of the footcare sector value chain. These experts can interact in an innovative communication platform. - Development of the document: “The effect of ageing, obesity and diabetes on foot”, establishing links between patient’s needs and the research areas identified in the state of the art report. It contributes to a better understanding of the patient’s needs and how these needs affect the orthopaedic footwear production and design processes. - Analysis of the State of the art of the most relevant technology areas related to the footcare industry. As a result, 90 research trends were identified, for what more than 300 bibliographic inputs were analysed. - Development of the document: “Database of industrial opportunities and main actors for each research area”, which provides a better understanding about the necessities of the industry in the areas defined in the SRA, differentiating between countries. - Creation of 5 multidisciplinary working groups around 5 major footcare sector’s challenges, with the participation of 35 experts from 9 EU-Med countries. These WGs comprised professionals from different segments of the footcare sector: researchers, industrialists and health care professionals. - Development of a Strategic Research Agenda (SRA), identifying 25 research priorities in the short, medium and long term (2015-2020). Up to 12 European project proposals related to these priorities have been already submitted to Horizon 2020 calls. Moreover, 7 project ideas were generated and identified in a seminar and a brokerage event and will be further developed and submitted to the forthcoming calls. The SRA has been distributed to the experts community, as well as relevant organisations, stakeholders and policy makers from Europe and North Africa, in order to increase its impact. - Development of 2 reports on knowledge and technology transfer opportunities and on training programmes and courses. Both reports are strongly linked and helped partners to obtain a real picture about the situation in their countries. Thus, from these reports, specific training actions were designed and adapted to each case and a plan was developed for the secondment of researchers/technicians. As a result, 20 researchers from Italy, Morocco, Spain, Tunisia and UK were trained on computer aided design, materials, adhesives, biomechanics and foot morphology. These researchers/technicians will act as multiplicators in their respective countries. - Realisation of 5 exchange visits to 3 hospitals, 3 private clinics, 2 companies, 1 training centre, 4 research centres and 1 national public orthopaedic centre in Italy, Morocco, Spain, Tunisia and UK. Information collected contributed to a better understanding of the sector’s needs, reinforced the links between the partners and involved more experts.



- Development of innovation supporting services to support the phase of project preparation and facilitate the participation in Horizon 2020 programme and other programmes, identifying main funding opportunities and project ideas. - Organisation of different types of events: a network event, 2 workshops on project results, 2 training seminars on H2020, a seminar on technology transfer, 3 validation seminars, the innovation week in Casablanca and the final conference that have increased the cooperation network and the number of people informed about the project and trained on Horizon 2020 and technology transfer and have brought out specific opportunities for research collaborations. In total, 98 people received training on H2020 and technology transfer, 70 people participated in validation seminars and 350 people participated in the events and workshops. As a result, up to 532 people were directly involved in the project events. - Production of more than 160 publications about the project.

These figures shows that the SoHealthy project has had a high impact, getting all the objectives set at the beginning of the project.

Documents

Publishable Final Report - cordis.europa.eu · Validation seminar held in Tunisia with relevant healthcare professionals ... Augmented and virtual technologies, CAD/CAM, Additive