The quality of life analysis of knee prosthesis with complete microprocessor control in trans-femoral amputees

Quality of life in young people with limb loss: a systematic review

PURPOSE

Life after any amputation can be significantly altered and can have a significant impact on quality of life (QoL). However, most of the evidence base involves older aged amputees, therefore there is a lack of understanding about the impact of amputation on QoL and the factors that predict QoL in younger amputees. The aim of this review is to identify the factors that predict QoL in young amputees.

METHODS

MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science were searched to identify articles that measured QoL in young amputees. Articles were independently assessed by two assessors. Data was extracted from the selected articles and a narrative synthesis performed.

RESULTS

18 articles were included in this review. QoL outcome measures varied between studies. The quality of evidence was generally low. This review identified, gender, age, cause of amputation, level of amputation, phantom pain, ability to use a prosthesis, physical function, depression, anxiety, body image, type of prosthesis as predictors of QoL.

CONCLUSION

This review identified modifiable and non-modifiable predictors of QoL in young amputees. Future research needs to focus on exploring the modifiable predictors of QoL as these are the aspects that can be improved to enhance QoL.

Gender differences in prosthesis-related outcomes among veterans: Results of a national survey of U.S. veterans

BACKGROUND

Women with lower extremity amputations (LEAs) tend to have poorer prosthesis-related outcomes than men, although the literature is sparse. To our knowledge, there are no prior studies examining prosthesis-related outcomes of women veterans with LEAs.

OBJECTIVE

To examine gender differences (overall and by type of amputation) among veterans who underwent LEAs between 2005 and 2018, received care at the Veterans Health Administration (VHA) prior to undergoing amputation, and were prescribed a prosthesis. It was hypothesized that compared to men, women would report lower satisfaction with prosthetic services, poorer prosthesis fit, lower prosthesis satisfaction, less prosthesis use, and worse self-reported mobility. Furthermore, it was hypothesized that gender differences in outcomes would be more pronounced among individuals with transfemoral than among those with transtibial amputations.

DESIGN

Cross-sectional survey. Linear regressions were used to assess overall gender differences in outcomes and gender differences based on type of amputation in a national sample of veterans.

SETTING

VHA medical centers.

PARTICIPANTS

The sample consisted of 449 veterans who self-identified their gender (women = 165, men = 284) with transtibial (n = 236), transfemoral (n = 135), and bilateral LEAs (n = 68) including all amputation etiologies.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The Orthotics and Prosthetics User's Survey, Trinity Amputation and Prosthesis Experiences Scale, and Prosthetic Limb Users Survey of Mobility-Short Form were used to assess satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, prosthesis use, and self-reported mobility.

RESULTS

Women had poorer self-reported mobility than men (d = -0.26, 95% confidence interval -0.49 to -0.02, p < .05); this difference was small. There were no statistically significant gender differences in satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, daily hours of prosthesis use, or by amputation type.

CONCLUSIONS

Contrary to the hypothesis, prosthesis-related outcomes were similar between men and women with LEAs. Minimal differences may in part be due to receiving care from the VHA's integrated Amputation System of Care.

Effects of microprocessor-controlled prosthetic knees on self-reported mobility, quality of life, and psychological states in patients with transfemoral amputations

OBJECTIVE

This study aimed to determine the effects of the microprocessor-controlled prosthetic knee (MPK) joint on self-mobility, body perceptions, depression, and quality of life in patients with unilateral transfemoral amputations (TFAs).

METHODS

Thirty consecutive patients (28 males, mean age=38.5 years, age range=22-57) who had previously used non-MPKs and who were approved to use swing and stance phase-control MPKs were included in this 12-week clinical study. Before the MPK use and after the three-month follow-up, prosthetic use and locomotor capabilities were evaluated using the Houghton Scale and the Locomotor Capabilities Index (LCI-5), respectively. Body perception was assessed using the Amputee Body Image Scale (ABIS). The depressive symptoms and quality of life were evaluated using the Beck Depression Inventory (BDI) score and the 36-Item Short- Form Health Survey (SF-36), respectively.

RESULTS

After MPK use, statistically significant ameliorations were observed in all outcome measures. The basic and advanced LCI-5 increased from 26.7±2.2 and 24.8±5.2 to 27.6±1.2 (p=0.007) and 27±2.1 (p=0.004), respectively. Houghton scores improved from 9±1 to 10.3±0.8 (p=0.000). The ABIS and BDI scores decreased from 43.2±10.9 and 5.7±6.6 to 37.1±8.9 (p=0.000) and 3.8±4.5 (p=0.015), respectively. Also, the SF-36 physical function and vitality subscales increased from 71.2±24.0 and 75.5±14.6 to 85.6±16.6 (p=0.001) and 81.7±14.1 (p=0.015), respectively.

CONCLUSION

MPK use provides significant improvements in the locomotor capabilities, quality of life, and activities of daily living to patients with TFAs as well as improves their body image perceptions and depressive symptoms.

LEVEL OF EVIDENCE

Level III, Self controlled study.

Establishing K-levels and prescribing transtibial prostheses using six-minute walk test and one-leg standing test on prosthesis: a retrospective audit

Rehabilitation programs after amputation often include fitting a prosthesis, but prescriptions vary under similar circumstances. The US Medicare Functional Classification Level (K-level) is a scale for describing functional abilities of persons after lower-limb amputation (from 0 = no ability or potential to ambulate, to 4 = prosthetic demands of a child/active adult/athlete). Different outcome measures are used to assess K-level, including six-minute walk test (6MWT). We attempted to predict the assigned K-level of unilateral transtibial prosthesis users from their results of 6MWT and one-leg standing test on prosthesis (OLSTP). Outpatients who had been rehabilitated and fitted with transtibial prosthesis at the University Rehabilitation Institute in Ljubljana in 2014 were included in a retrospective audit. The data were analysed using receiver-operating-characteristics curves, linear discriminant analysis, classification trees and ordinal logistic regression. Among the 120 patients (aged 39-90, mean 67 years; 79% men), eight belonged to K1 level, 94 to K2, and 18 to K3 or K4; 61 could not stand on the prosthesis, eight stood on it for 1 s, and 51 stood on it for 2 s or more. With a simple classification rule based only on 6MWT (130 m threshold for K2/K3/K4 vs. K1, 340 m for K3/K4 vs. K1/K2), we observed sensitivity and specificity close to 90%. The more sophisticated statistical approaches yielded substantially similar and comparably accurate results. 6MWT and OLST could therefore be used as predictors for transtibial prosthesis prescription in clinical practice.

Organic Optoelectronic Diodes as Tactile Sensors for Soft-Touch Applications

The distributed sense of touch forms an essential component that defines real-time perception and situational awareness in humans. Electronic skins are an emerging technology in conferring an artificial sense of touch for smart human-machine interfaces. However, assigning a conformably distributed sense of touch over a large area has been challenging to replicate in modern medical, social, and industrial robots. Herein, we present a new class of soft tactile sensors that exploit the mechanisms of triplet-triplet annihilation, exciton harvesting, and a small Stokes shift in conjugated organic semiconductors such as rubrene. By multiplexing the electroluminescence and photosensing modes, we show that a compact optoelectronic array of multifunctional rubrene/fullerene diodes can accurately measure pressure, position, and surface deformation applied to an overlying elastomeric layer. The dynamic range of sensing is defined by mechanical properties of the elastomer. Such optoelectronic approach paves the way for soft, conformal, and large-area compatible electronic skins for medicine and robotics.

Body image perception, compliance with a prosthesis and cognitive performance in transfemoral amputees

Objective

The aim of the study was to assess mutual associations of body image perception, compliance with the prosthesis and cognitive performance in transfemoral amputees.

Methods

Fourty transfemoral amputee (30 male and 10 female), who had a traumatic and unilateral amputation were included in this study. The mean age of the patients at the time of study was 37 ± 9.9 and the mean age at amputation was 12.6 ± 9.4 years. Patients's body image perception and compliance with the prosthesis paramaters were evaluated with Amputee Body Image Scale (ABIS) and Trinity Amputation and Prosthesis Experience Scales (TAPES). MoCA (The Montreal Cognitive Assessment) has been used to determine the cognitive ability of the participant. All tests has been administered by dual task method during ambulation. Patients who had neurologic or cognitive deficit were excluded from the study.

Results

There was a statistically significant relationship between an individual's body image perception and cognitive performance. Body image perception was significantly and negatively correlated with the MoCA score (r = −0.514, p < 0.001). There was a statistically significant positive correlation between psychosocial adjustment, prosthesis satisfaction and MoCA scores (r = 0.550, p < 0.001).

Conclusions

Body image satisfaction, psychosocial adjustment, lack of activity restriction, and satisfaction with prosthesis are positively associated with cognitive performance of transfemoral amputees. Before beginning the amputee rehabilitation programs, we recommend to include not only physical functions, but also consider body image and cognitive functions as assessment parameters.

Level of evidence

Level IV, Diagnostic Study.