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Ferrell-Olson J, Hafner BJ, Sawers A. Evaluating fall event definitions relative to lower limb prosthesis users' lived experiences. Disabil Rehabil 2024:1-8. [PMID: 38967639 DOI: 10.1080/09638288.2024.2374501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/24/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Evaluate specific elements of previously proposed fall and near-fall definitions to determine whether they fully capture lower limb prosthesis (LLP) users' lived experiences. METHODS Semi-structured interviews were conducted with 24 LLP users. Interview transcripts were reviewed, coded, and analyzed using deductive thematic analysis to identify shared experiences and inform revisions to previously reported definitions. RESULTS Four major themes emerged: a fall can be initiated by more than just a loss of balance, loss of balance and losing balance are considered similar, falls are not limited to landing on the ground or floor, and catching yourself and recovering your balance are distinct responses to a loss of balance. CONCLUSIONS Two revisions were made to previous definitions to better align with LLP users' experiences and historically overlooked fall circumstances. A fall is defined as a loss of balance or sudden loss of support where your body lands on the ground, floor, or another object. A near-fall was defined as a loss of balance where you caught yourself or recovered your balance without landing on the ground, floor, or another object. Implementation of these new definitions will aid the collection of accurate, consistent, and meaningful fall data, enhancing aggregation and comparison across studies.
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Affiliation(s)
- Julie Ferrell-Olson
- Department of Kinesiology and Nutrition, University of IL Chicago, Chicago, IL, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of WA, Seattle, WA, USA
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of IL Chicago, Chicago, IL, USA
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Norvell DC, Henderson AW, Morgenroth DC, Halsne BG, Turner AP, Biggs W, Czerniecki JM. The Effect of Prosthetic Limb Sophistication and Amputation Level on Self-reported Mobility and Satisfaction With Mobility. Arch Phys Med Rehabil 2024; 105:1338-1345. [PMID: 38561145 DOI: 10.1016/j.apmr.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine if lower limb prosthesis (LLP) sophistication is associated with patient-reported mobility and/or mobility satisfaction, and if these associations differ by amputation level. DESIGN Cohort study that identified participants through a large national database and prospectively collected self-reported patient outcomes. SETTING The Veterans Administration (VA) Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings, and phone calls. PARTICIPANTS 347 Veterans who underwent an incident transtibial (TT) or transfemoral (TF) amputation due to diabetes and/or peripheral artery disease and received a qualifying LLP between March 1, 2018, and November 30, 2020. INTERVENTIONS Basic, intermediate, and advanced prosthesis sophistication was measured by the accurate and reliable PROClass system. MAIN OUTCOME MEASURE Patient-reported mobility using the advanced mobility subscale of the Locomotor Capabilities Index-5; mobility satisfaction using a 0-10-point Likert scale. RESULTS Lower limb amputees who received intermediate or advanced prostheses were more likely to achieve advanced mobility than those who received basic prostheses, with intermediate nearing statistical significance at nearly twice the odds (adjusted odds ratio (aOR)=1.8, 95% confidence interval (CI), .98-3.3; P=.06). The association was strongest in TF amputees with over 10 times the odds (aOR=10.2, 95% CI, 1.1-96.8; P=.04). The use of an intermediate sophistication prosthesis relative to a basic prosthesis was significantly associated with mobility satisfaction (adjusted β coefficient (aβ)=.77, 95% CI, .11-1.4; P=.02). A statistically significant association was only observed in those who underwent a TT amputation (aβ=.79, 95% CI, .09-1.5; P=.03). CONCLUSIONS Prosthesis sophistication was not associated with achieving advanced mobility in TT amputees but was associated with greater mobility satisfaction. In contrast, prosthesis sophistication was associated with achieving advanced mobility in TF amputees but was not associated with an increase in mobility satisfaction.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Alison W Henderson
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Beth G Halsne
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Wayne Biggs
- VA Puget Sound Health Care System, Seattle, WA
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Klenow TD, Lundstrom RL, Morris A, Patterson S, Simpson C, Trejo EG, Kannenberg A. An enhancement of the Genium™ microprocessor-controlled knee improves safety and different aspects of the perceived prosthetic experience for unilateral and bilateral users. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1342370. [PMID: 38798750 PMCID: PMC11122470 DOI: 10.3389/fresc.2024.1342370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024]
Abstract
Introduction Bilateral microprocessor-controlled prosthetic knee (MPK) users have unique needs in traversing environmental barriers compared to unilateral users. An enhancement to the Genium™/Genium X3™ MPK which included an updated ruleset, hydraulics, and new bilateral parameter presets was made to improve safety while stumbling and the smoothness of gait for all users while also improving the experience of bilateral users. The purpose of the study was to evaluate the effectiveness of the enhancements in a sample with unilateral and bilateral amputation. Methods A convenience sample of MPK users was recruited from two sites in the USA in two phases. Assessments included the L-Test of Functional Mobility, Activity-specific Balance Confidence Scale, Prosthetic Limb User Survey of Mobility, a study-specific questionnaire, and the Comparative Activities of Daily Living (ADL) Questionnaire. Statistical significance of extracted data was tested with the Wilcoxon Rank-Sum Test for independent data and Wilcoxon Signed-Rank for paired data with an a priori significance level of p < 0.05. Unilateral subjects were age-matched to the group of bilateral subjects for between-groups and within-groups analyses. Results Twenty-six subjects (n = 26) were enrolled. Stumble frequency reduced 85% from 16.0 ± 39.7 to 2.4 ± 2.3 (p = 0.008) between baseline and final assessment overall. The bilateral group reported 50% (p = 0.009) and 57% (p = 0.009) greater relative improvement in patient-reported ease and safety, respectively, of completing ADLs compared to the unilateral group. The unilateral group reported residual limb pain and low back pain reduced from 2.3 to 1.4 (p = 0.020) and 3.8 to 1.8 (p = 0.027), respectively, whereas the bilateral group did not. Discussion Substantial reductions in stumbles, residual limb pain, and back pain were shown overall. These reductions were driven by the unilateral group who also showed improvements in comfort, exertion, and concentration while walking. The enhancements to the knee likely reduced some gait asymmetry for unilateral users. Improvements in patient-reported ease and safety of completing ADLs were shown overall and were driven by the bilateral group. This study shows further improvement in patient experience is achievable through innovation in MPK technology even for patients who appear to be functioning well.
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Affiliation(s)
- Tyler D. Klenow
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Russell L. Lundstrom
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Arri Morris
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
| | - Stan Patterson
- Clinical Services Department, Prosthetic & Orthotic Associates, Orlando, FL, United States
| | - Chad Simpson
- Clinical Services Department, Dream Team Prosthetics, LLC, Duncan, OK, United States
| | - Ernesto G. Trejo
- Clinical Research & Services Department, Ottobock Healthcare Products GmbH, Vienna,Austria
| | - Andreas Kannenberg
- Clinical Research & Services Department, Otto Bock HealthCare LP, Austin, TX, United States
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Lee SP, Maluotoga M, Thind R, Lindsay L, Bhatta T, Miller CA. Utilization and Perception of Peer-Support After Lower Limb Loss in the United States: Potential Benefits on Mobility Outcomes. Arch Phys Med Rehabil 2024; 105:939-946.e3. [PMID: 38242299 PMCID: PMC11069449 DOI: 10.1016/j.apmr.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To examine participants' experiences with peer-support after lower limb loss (LLL) and the associations between the peer-support experience (perceived benefits and barriers) and mobility outcomes. DESIGN Quantitative and qualitative descriptive study with a cross-sectional design. SETTING National survey (distributed to 169 peer-support groups in 44 states in the US). PARTICIPANTS The survey was completed by 82 individuals with a major lower limb amputation (53% female, 54% over 55 years of age; N=82). MAIN OUTCOME MEASURES A 32-item survey to examine respondents' experiences in peer-support activities. Prosthetic mobility was measured using the Prosthetic Limb Users Survey of Mobility (PLUS-M). RESULTS Two out of 3 respondents received some forms of peer-support after amputation. Among them 75% reported peer-support having a positive effect on their outlook on life, and 78% reported that information gained from peer-support was helpful. Companionship, altruistic acts, and gaining information on how to cope with amputation were the top themes of why respondents enjoyed the peer-support experience. Nearly all (94%) respondents would recommend peer-support to other people with LLL. Individuals who received peer-support exhibited a trend of greater mobility (55th vs 36th percentile on PLUS-M; P=.055). CONCLUSION Individuals with LLL reported generally positive experiences regarding their engagement in peer-support activities. Peer-support groups are viewed as a helpful source for both information and emotional support, potentially benefiting functional and psychological recovery after amputation. Individuals who have received peer-support also exhibited greater mobility.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV.
| | - Moriah Maluotoga
- Department of Physical Therapy, University of Nevada, Las Vegas, NV
| | - Roopkiran Thind
- Department of Physical Therapy, University of Nevada, Las Vegas, NV
| | | | - Tirth Bhatta
- Department of Sociology, University of Nevada, Las Vegas, NV
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Fylstra BL, England DL, Stevens PM, Campbell JH, Wurdeman SR. Creating Adjusted Scores Targeting mobiLity Empowerment (CASTLE 1): determination of normative mobility scores after lower limb amputation for each year of adulthood. Disabil Rehabil 2024; 46:1904-1910. [PMID: 37203194 DOI: 10.1080/09638288.2023.2208376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. MATERIALS AND METHODS A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. RESULTS As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. CONCLUSIONS Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care.
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Affiliation(s)
- Bretta L Fylstra
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Dwiesha L England
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Phillip M Stevens
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
- Division of Physical Medicine and Rehabilitation, University of Utah Health Care, Salt Lake City, UT, USA
| | - James H Campbell
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
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Beausejour JP, Guinto G, Artrip C, Corvalan A, Furtado Mesa M, Lebron MA, Stock MS. Successful Powerlifting in a Unilateral, Transtibial Amputee: A Descriptive Case Series. J Strength Cond Res 2024; 38:e243-e252. [PMID: 38373088 DOI: 10.1519/jsc.0000000000004733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
ABSTRACT Beausejour, JP, Guinto, G, Artrip, C, Corvalan, A, Mesa, MF, Lebron, MA, and Stock, MS. Successful powerlifting in a unilateral, transtibial amputee: A descriptive case series. J Strength Cond Res 38(5): e243-e252, 2024-There are no reports in the literature of powerlifting success after amputation. We had the unique opportunity to characterize functional outcomes, strength, muscle contractility and size, and corticospinal excitability in an accomplished, competitive powerlifter (best competition squat = 205.0 kg, deadlift = 262.7 kg) with a unilateral, transtibial amputation relative to amputee controls. Four men (age range = 23-49 years) with unilateral, lower-limb amputation (3 transtibial, 1 transfemoral) participated in 1 laboratory visit. We assessed 10-m gait speed, the timed up and go (TUG) test, 5-time sit-to-stand performance (5TSTS), contractile properties of the vastus lateralis (VL) and medial gastrocnemius by tensiomyography, and VL cross-sectional area (CSA) by ultrasonography. Unilateral assessments for the intact limb included isokinetic knee extension and flexion torque and power and transcranial magnetic stimulation derived corticospinal excitability. An interview with the powerlifter provided contextual perspective. Compared with the control subjects, the powerlifter performed the 5TSTS faster (6.8%), exhibited faster VL contraction times (intact limb = 12.2%; residual limb = 23.9%), and showed larger VL CSA for the intact limb (46.7%). The powerlifter exhibited greater knee extension and flexion peak torque and mean power, particularly at 180°·s -1 , as well as greater corticospinal excitability for the intact VL (65.6%) and tibialis anterior (79.6%). By contrast, the control subjects were faster in the TUG (18.3%) and comfortable (13.0%) and fast (21.4%) in the 10-m walk test. The major themes of our interview included needing to modify lifting mechanics, persistence, and remarkable pain tolerance. Our findings highlight the impressive neuromuscular adaptations that are attainable after lower-limb amputation.
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Affiliation(s)
- Jonathan P Beausejour
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Goldshawn Guinto
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Chloe Artrip
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Alejandra Corvalan
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Maxine Furtado Mesa
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Modesto A Lebron
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
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Yerli S, Erbahçeci F, Kerem Günel M. Effect of pain on activity and participation in individuals with unilateral lower-extremity amputation based on the International Classification of Functioning, Disability, and Health. Prosthet Orthot Int 2024:00006479-990000000-00231. [PMID: 38517384 DOI: 10.1097/pxr.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and nonpainful sensory experiences. Pain after amputation has been shown to increase functional limitations caused by limb loss and lower quality of life. OBJECTIVE This study aimed to examine the effect of pain on activity and participation in individuals with unilateral below-knee amputations according to the International Classification of Functioning, Disability, and Health. STUDY DESIGN Cross-sectional study. METHODS In the study, 64 individuals were divided into 2 groups: those who experienced pain and those who did not. Group 1 included 33 below-knee amputees who experienced pain (27 males, mean age 43.9 ± 12.6 years) and Group 2 included 31 below-knee amputees who did not experience pain (25 males, mean age 47.4 ± 12.1 years). The McGill Pain Questionnaire and visual analog scale were used to assess pain, the Prosthetic Limb Users Survey of Mobility was used to assess activity, and the Reintegration to Normal Living Index was used to assess participation. RESULTS Demographic characteristics of the 2 groups were statistically insignificant (P > 0.05). The nonpainful group had significantly higher activity and participation scores than the painful group (P < 0.001). CONCLUSIONS It was found that phantom pain and stump pain in below-knee amputees limited activity and participation. It was also shown that phantom pain has a more negative effect on the activity level of individuals than stump pain.
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Affiliation(s)
- Sibel Yerli
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Tobaigy M, Hafner BJ, Hsieh K, Sawers A. Falls perceived as significant by lower limb prosthesis users are generally associated with fall consequences rather than circumstances. Disabil Rehabil 2024:1-7. [PMID: 38505985 DOI: 10.1080/09638288.2024.2328313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences. MATERIALS AND METHODS The circumstances and consequences of LLP users' most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into "low" and "high". Binary logistic regression was used to assess associations between fall significance and fall circumstances and consequences. RESULTS Ninety-eight participants were included in the analysis. Five fall consequences were associated with greater significance: major injury (OR = 26.7, 95% CI: 1.6-459.6, p = 0.024), need to seek medical treatment (OR = 19.0, 95% CI: 1.1-329.8, p = 0.043), or allied-health treatment (OR = 18.2, 95% CI: 2.3-142.4, p = 0.006), decreased balance confidence (OR = 10.9, 95% CI: 2.4-49.3, p = 0.002), and increased fear of falling (OR = 7.5, 95% CI: 2.4-23.8, p = 0.001), compared to two fall circumstances: impact to the arm (OR = 5.0, 95% CI: 2.0-12.1, p = 0.001), and impact to the face, head, or neck (OR = 9.7, 95% CI: 1.2-77.4, p = 0.032). CONCLUSIONS Significant falls were generally more associated with fall consequence than fall circumstances.
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Affiliation(s)
- Moaz Tobaigy
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
- Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, KSA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kelly Hsieh
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
- Department of Disability and Human Development, University of Illinois Chicago, Chicago, IL, USA
| | - Andrew Sawers
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
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Awad ME, Melton D, Shaw KG, Lev G, Gaffney BMM, Christiansen CL, Stoneback JW. How Comprehensive and Efficient Are Patient-Reported Outcome Measures for Individuals with Lower Extremity Amputation Undergoing Implantation of Osseointegrated Bone Anchored Limbs? JBJS Rev 2024; 12:01874474-202403000-00009. [PMID: 38489397 DOI: 10.2106/jbjs.rvw.23.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
» Patient-reported outcome measures (PROMs) are essential for measuring quality and functional outcomes after implantation of osseointegrated bone anchored limbs for patients with lower extremity amputation.» Using a novel assessment criterion with 8 domains, this study assessed all commonly used PROMs for their efficiency and comprehensiveness.» Comprehensiveness was scored according to the presence or absence of PROM questions related to these 8 domains (maximum score = 60): mobility (15 items), prosthesis (14 items), pain (10 items), psychosocial status (10 items), independence/self-care (4 items), quality of life/satisfaction (4 items), osseoperception (1 item), general information (1 item), and vitality (1 item).» The efficiency scores were calculated by dividing the comprehensiveness score by the total number of questions answered by the patients with higher scores being deemed more efficient.» The most comprehensive PROMs were Orthotics and Prosthetics User's Survey-Lower Extremity Functional Status (OPUS-LEFS) (score = 36), Prosthesis Evaluation Questionnaire (PEQ) (score = 31), and Questionnaire for Persons with a Transfemoral Amputation (score = 27).» The most efficient PROMs were the OPUS-LEFS (score = 1.8) and European Quality of Life (score = 1.4).
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Affiliation(s)
- Mohamed E Awad
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Melton
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kylie G Shaw
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Guy Lev
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado
- Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Cory L Christiansen
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Secco MZ, Balbi LL, Pereira MSDC, Santos Costa W, Barros ARDSB, Registro Fonseca MDC. Convergent construct validity of the Brazilian version of the Houghton scale. Prosthet Orthot Int 2024:00006479-990000000-00220. [PMID: 38377306 DOI: 10.1097/pxr.0000000000000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/30/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND After lower limb amputations, a decrease in gait capacity, even with prostheses, is common and persistent. Functional ability involves multiple constructs; therefore, several outcome measures, such as performance tests or self-report questionnaires, should be used to evaluate people with amputation who use prostheses. OBJECTIVE To analyze the convergent construct validity of the Brazilian version of the Houghton scale in a sample of lower limb prosthesis users. METHODS Volunteers selected were older than 18 years with any level of lower limb amputation and prosthesis use for at least 6 months. In this study, evidence of construct validity of the Houghton scale was established by the Spearman rho correlation with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility and with the Physical Function (PF) and Emotional Well-being subdomains of the Medical Outcomes Study 36-Short Form Health Survey. RESULTS Seventy-one volunteers were recruited for the study. The sample consisted mainly of men (70.4%) with a mean age of 50 ± 12 years. The primary cause of amputation was traumatic (53.5%), and most participants (54.9%) had a transtibial amputation. The Houghton questionnaire correlated strongly with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility questionnaire (rho: 0.74, p < 0.01) and weakly with the PF and Emotional Well-being of the 36-Short Form Health Survey (rho: 0.06 and rho: 0.22, respectively, p > 0.05). CONCLUSION This study showed evidence of convergent construct validity of the Houghton questionnaire to measure and classify functional use of lower limb prostheses, with great value to clinical practice. Additional work is needed to assess other measurement properties in different samples.
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Affiliation(s)
| | | | | | | | | | - Marisa de Cássia Registro Fonseca
- Department of Health Sciences, Rehabilitation and Performance Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Hjermundrud V, Hilding GF, Gjøvaag T. Four weeks of inpatient comprehensive prosthetic rehabilitation achieves contrasting results in different groups of prosthetic users. Prosthet Orthot Int 2024:00006479-990000000-00221. [PMID: 38377280 DOI: 10.1097/pxr.0000000000000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/17/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss. METHODS In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest). A step-monitoring device recorded ambulatory activity. RESULTS For the primary outcome measure, Prosthetic Limb Users Survey of Mobility, the between-group analysis revealed significant differences (χ2 = 10.91, df = 2, p < 0.01). Within-group Prosthetic Limb Users Survey of Mobility T-scores improved by 8.1% for the EXP-INT (p < 0.01) and 15.1% for NEW-INT (p < 0.01). Significant between-group differences were observed for the Amputee Mobility Predictor, L-test, 2-minute walk test, and 10-meter walk test. Within-group analysis demonstrated nonsignificant changes for the EXP-INT except for Prosthetic Limb Users Survey of Mobility, while the NEW-INT improved by 24.1% (p < 0.001), 34.0% (p < 0.01), 46.5% (p < 0.05), and 31.0% (p < 0.01), respectively. The number of steps during the last 7 d of rehabilitation showed significant differences between the groups (χ2 = 13.99, df = 2, p < 0.001). The NEW-INT improved by 138% (p < 0.05) compared with the first 7 d of rehabilitation, while the EXP-INT had nonsignificant changes. CONCLUSIONS A 4-week rehabilitation intervention substantially increased prosthetic mobility, function, and ambulation activity for new prosthetic users but less so for experienced users. The results of the NEW-INT at discharge signify a considerable functional improvement.
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Affiliation(s)
- Vegar Hjermundrud
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | | | - Terje Gjøvaag
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
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Clemens SM, Kershaw KN, Bursac Z, Lee SP. Association of Race, Ethnicity, and Gender to Disparities in Functional Recovery and Social Health After Major Lower Limb Amputation: A Cross-sectional Pilot Study. Arch Phys Med Rehabil 2024; 105:208-216. [PMID: 37866483 PMCID: PMC11190847 DOI: 10.1016/j.apmr.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/19/2023] [Accepted: 10/02/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To assess if evidence of disparities exists in functional recovery and social health post-lower limb amputation. DESIGN Race-ethnicity, gender, and income-based group comparisons of functioning and social health in a convenience sample of lower limb prosthetic users. SETTING Prosthetic clinics in 4 states. PARTICIPANTS A geographically diverse cohort of 56 English and Spanish speaking community-dwelling individuals with dysvascular lower limb amputation, between 18-80 years old. INTERVENTIONS None. MAIN OUTCOMES MEASURES Primary outcomes included 2 physical performance measures, the Timed Up and Go test and 2-minute walk test, and thirdly, the Prosthetic Limb Users Survey of Mobility. The PROMIS Ability to Participate in Social Roles and Activities survey measured social health. RESULTS Of the study participants, 45% identified as persons of color, and 39% were women (mean ± SD age, 61.6 (9.8) years). People identifying as non-Hispanic White men exhibited better physical performance than men of color, White women, and women of color by -7.86 (95% CI, -16.26 to 0.53, P=.07), -10.34 (95% CI, -19.23 to -1.45, P=.02), and -11.63 (95% CI, -21.61 to -1.66, P=.02) seconds, respectively, on the TUG, and by 22.6 (95% CI, -2.31 to 47.50, P=.09), 38.92 (95% CI, 12.53 to 65.30, P<.01), 47.53 (95% CI, 17.93 to 77.13, P<.01) meters, respectively, on the 2-minute walk test. Income level explained 14% and 11% of the variance in perceived mobility and social health measures, respectively. CONCLUSIONS Study results suggest that sociodemographic factors of race-ethnicity, gender, and income level are associated with functioning and social health post-lower limb amputation. The clinical effect of this new knowledge lies in what it offers to health care practitioners who treat this patient population, in recognizing potential barriers to optimal recovery and quality of life. More work is required to assess lived experiences after amputation and provide better understanding of amputation-related health disparities.
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Affiliation(s)
- Sheila M Clemens
- Department of Physical Therapy, Florida International University, Miami, FL.
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL
| | - Szu Ping Lee
- Department of Physical Therapy, Univeristy of Nevada, Las Vegas, NV
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13
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Lee SP, Chien LC, Shih HT, Ho S, Clemens S. Returning to work after dysvascular lower limb amputation-A novel multivariate approach to examine relative contributions of biopsychosocial predictors. Prosthet Orthot Int 2024:00006479-990000000-00214. [PMID: 38180145 PMCID: PMC11224136 DOI: 10.1097/pxr.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Returning to work is a key outcome of rehabilitation and social re-integration after lower limb amputation. It is important to understand what biopsychosocial factors contribute to returning to work after dysvascular amputation. OBJECTIVE Examining relative contributions of functional and contextual predictors of returning to work in participants with lower limb amputation due to diabetes and other dysvascular diseases. STUDY DESIGN Cross-sectional. METHODS Return-to-work outcome, biopsychosocial characteristics including physical functioning, self-efficacy & perceived ability, and socioeconomical support data were collected from a purposive sample (n = 57) in a multi-state collaborative research network. Grouped Weighted Quantile Sum model analysis was conducted to evaluate relative contributions of biopsychosocial predictors. RESULTS Less than 30% of the participants returned to work after their amputation. Physical functioning (odds ratio = 10.19; 95% CI 2.46-72.74) was the most important predictor group. Working before amputation, prosthetic mobility, and access to rehabilitation care were also identified as key factors associated with returning to work. CONCLUSIONS Fewer than 1 in 3 participants with dysvascular amputation returned to work, despite an average age of only 54 years at the time of amputation. Physical functioning was shown to be the most important predictor, while socioeconomic factors such as a lack of access to care also contribute to not returning to work after dysvascular amputation.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas; Las Vegas, Nevada, USA
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas; Las Vegas, Nevada, USA
| | - Hui-Ting Shih
- Interdisciplinary Health Science Program, University of Nevada, Las Vegas; Las Vegas, Nevada, USA
| | - Sabrina Ho
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas; Las Vegas, Nevada, USA
| | - Sheila Clemens
- Department of Physical Therapy, Florida International University; Miami, Florida, USA
- Department of Physical Therapy, University of Kentucky; Lexington, Kentucky, USA
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14
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Davie-Smith F, Powell L, Porteous N, Carse B. Changes in activities-specific balance confidence of active unilateral transtibial prosthesis users after provision of a self-aligning ankle foot. Prosthet Orthot Int 2024:00006479-990000000-00210. [PMID: 38170795 DOI: 10.1097/pxr.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Self-aligning ankle feet have an increased range of motion and are marketed to improve compliance over uneven terrain and increase function and balance; however, much of the existing literature focuses on the biomechanical aspect of these prostheses as opposed to patient-reported measures. OBJECTIVE To compare activities-specific balance confidence (ABC), health-related quality of life (HR-QoL), perceived mobility, gait speed, and step length before and after provision of a self-aligning ankle foot in the active unilateral transtibial prosthesis user. STUDY DESIGN Retrospective analysis of prospectively collected data. METHODS Patient-reported and functional measures were captured for 85 users who were provided with a self-aligning ankle foot. Measures were recorded immediately before self-aligning ankle foot provision and again at 6 months afterward. The primary outcome was the ABC Score, along with the following secondary measures; HR-QoL using EQ-5D-5L Health Index Prosthetic Limb User Survey of Mobility and 10-meter timed walk test. RESULTS The median age of the cohort was 55.2 years old and 71% were males, with the majority having their transtibial amputation due to trauma. There was a statistically significant improvement in ABC from 76 to 86% (p < 0.001) with a medium effect size. There was no statistically significant improvement in HR-QoL (p = 0.051), Prosthetic Limb User Survey of Mobility (p = 0.043), time taken to walk 10 m (p = 0.15) and step length (p = 0.003). CONCLUSIONS Self aligning ankle feet increased ABC and step length with no detrimental effect on HR-QoL, perceived mobility or walking speed in those with a unilateral trans-tibial amputation.
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Weerasinghe S, Aranceta-Garza A, Murray L. Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries: A quantitative assessment from Myanmar. Prosthet Orthot Int 2024; 48:5-12. [PMID: 37870366 PMCID: PMC10852039 DOI: 10.1097/pxr.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). OBJECTIVE The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. STUDY DESIGN The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. METHODS Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. RESULTS Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. CONCLUSION The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL.
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Affiliation(s)
- Stephney Weerasinghe
- Mandalay Orthopaedic Hospital, Prosthetics and Orthotics Department, Exceed Worldwide, Mandalay, Myanmar
| | | | - Laura Murray
- Biomedical Engineering Department, University of Strathclyde, Glasgow, United Kingdom
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16
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Hanlon SL, Swink LA, Akay RB, Fields TT, Cook PF, Gaffney BMM, Juarez-Colunga E, Christiansen CL. Walking Exercise Sustainability Through Telehealth for Veterans With Lower-Limb Amputation: A Study Protocol. Phys Ther 2024; 104:pzad112. [PMID: 37615982 PMCID: PMC10979409 DOI: 10.1093/ptj/pzad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This randomized controlled superiority trial will determine if an 18-month telehealth walking exercise self-management program produces clinically meaningful changes in walking exercise sustainability compared to attention-control education for veterans living with lower-limb amputation. METHODS Seventy-eight participants with lower-limb amputation (traumatic or nontraumatic) aged 50 to 89 years will be enrolled. Two groups will complete 6 one-on-one intervention sessions, and 6 group sessions over an 18-month intervention period. The experimental arm will receive a self-management program focusing on increasing walking exercise and the control group will receive attention-control education specific to healthy aging. Daily walking step count (primary outcome) will be continuously monitored using an accelerometer over the 18-month study period. Secondary outcomes are designed to assess potential translation of the walking exercise intervention into conventional amputation care across the Veteran Affairs Amputation System of Care. These secondary outcomes include measures of intervention reach, efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. IMPACT The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation through a telehealth home-based walking exercise self-management model. The approach includes 18 months of exercise support from clinicians and peers. Trial results will provide rehabilitation knowledge necessary for implementing clinical translation of self-management interventions to sustain walking exercise for veterans living with lower-limb amputation, resulting in a healthier lifestyle.
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Affiliation(s)
- Shawn L Hanlon
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Laura A Swink
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Rachael Brink Akay
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Thomas T Fields
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Paul F Cook
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brecca M M Gaffney
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado, Denver, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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Seth M, Horne JR, Pohlig RT, Sions JM. Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation. Arch Rehabil Res Clin Transl 2023; 5:100309. [PMID: 38163037 PMCID: PMC10757173 DOI: 10.1016/j.arrct.2023.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. Design Cross-sectional study. Setting Research laboratory. Participants Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83). Intervention Not applicable. Main Outcome Measures Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained. Results After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively. Conclusions Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.
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Affiliation(s)
- Mayank Seth
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
- Children's Specialized Hospital, Research Department, Union, NJ
| | | | - Ryan Todd Pohlig
- Biostatistics Core, University of Delaware, Newark, DE
- Epidemiology Program, University of Delaware, Newark, DE
| | - Jaclyn Megan Sions
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Development of a prosthetic fit and alignment assessment (ProFit) in persons with post-traumatic transtibial amputation. Prosthet Orthot Int 2023; 47:599-606. [PMID: 37052578 DOI: 10.1097/pxr.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/05/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND There are no standards for reliably measuring the quality of prosthetic fit and alignment which is important for evaluation and improvement of clinical care for patients with transtibial amputation. OBJECTIVES The purpose of this study was to develop an instrument to quantitatively assess prosthetic fit and alignment in patients with transtibial amputation. STUDY DESIGN Prospective cohort study. METHODS The fit and alignment assessment (ProFit) included 39 items for assessments of skin quality, stance and gait, and radiographic characteristics that could be feasibly captured in clinic using photographs, video, and radiographs. Data were collected on adults aged 18-60 years treated with transtibial amputation and followed up for 18 months at 1 of 27 US hospitals. One hundred thirteen assessments were conducted by 6 prosthetists using an online platform. Items demonstrating reliability and face validity were included in the ProFit score for subsequent validation testing. Validation measures included 18-month patient-reported function (Short Musculoskeletal Function Assessment ), tests of physical performance, patient-reported pain (Brief Pain Inventory ), satisfaction with prosthesis (Orthotics Prosthetics Users Survey), prosthesis use, and walking activity. RESULTS The ProFit score included 10 of 39 items that demonstrated high inter-rater reliability and face validity. A higher ProFit score correlated with worse function on all domains of the Short Musculoskeletal Function Assessment except arm and hand and with worse performance on the 4-Square Step Test, Shuttle Run, and Illinois Agility Test. ProFit scores did not correlate with the Brief Pain Inventory, Orthotics Prosthetics Users Survey, prosthesis use, or walking activity. CONCLUSIONS The ProFit score can be used by researchers and clinicians to measure the quality of socket fit and prosthetic alignment. Future prospective validation is necessary to verify the promising results observed in ProFit development and establish clinical utility.
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Johnston R, Sell D, Fiedler G, Singh A. Assessing Phase-Change Materials as Effective Long-Term Biosensors in Limb Prosthetics. BIOSENSORS 2023; 13:944. [PMID: 37887137 PMCID: PMC10605671 DOI: 10.3390/bios13100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
Monitoring and controlling the microclimate at the skin-socket interface of limb prostheses is an important, yet unresolved, clinical problem. Phase-change materials (PCMs) represent a promising biosensor technology that holds the potential to both detect and alter (i.e., stabilize) changes in the temperature of a hybrid biological/mechanical system, such as a prosthesis. The biologically inspired sensor capabilities of PCMs can enhance the internal socket conditions and offer improved comfort and suspension while minimizing skin injuries for prosthesis users. This study investigated how prosthetic liners equipped with PCM biosensors affected the long-term outcomes for prosthesis users. In this double-blinded longitudinal crossover study, a cohort of transtibial prosthesis users wore regular conventional liners for six months and PCM liners for another six months. Prosthesis utilization, physical performance, and gait symmetry were studied using Modus StepWatch, the 2-minute walk test, and the TekScan F-Scan gait test, respectively. Measured parameters from these various tests, acquired at multiple timepoints during the study, were compared pairwise between the two liners per individual. While the obtained quantitative data trends, such as the gait symmetry, favored the PCM liners, no statistically significant differences were found between the PCM and conventional gel liners in any of the study parameters.
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Affiliation(s)
- Robert Johnston
- Biomedical Engineering, Widener University, Chester, PA 19013, USA
| | - Danielle Sell
- Biomedical Engineering, Widener University, Chester, PA 19013, USA
| | - Goeran Fiedler
- Prosthetics and Orthotics, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Anita Singh
- Bioengineering Department, Temple University, Philadelphia, PA 19122, USA
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Slater C, Hafner BJ, Morgan SJ. Effects of high-profile crossover feet on gait biomechanics in 2 individuals with Syme amputation. Prosthet Orthot Int 2023:00006479-990000000-00188. [PMID: 37870369 DOI: 10.1097/pxr.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 08/23/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Prosthetic treatment options for people with ankle disarticulation (i.e., Syme amputation) are limited. Prosthetic feet designed for people with Syme amputation are often low profile to accommodate build-height restrictions, resulting in decreased energy return during gait. High-profile crossover feet that attach to the posterior proximal aspect of the prosthetic socket can bypass these restrictions and may promote a more physiologic gait pattern. OBJECTIVES To compare level-ground gait biomechanics and patient-reported outcomes between crossover and traditional energy-storing feet in people with Syme amputation. STUDY DESIGN Within-participant pilot study. METHODS Both participants were fit with energy-storing and crossover feet and were randomized to the order they used the feet. Participants used each foot for 2 weeks before assessment. Step length symmetry, prosthetic ankle range of motion, prosthetic-side energy return, and peak sound-side loading were determined from motion capture data obtained in a laboratory. Mobility and balance confidence were measured using standardized patient-reported outcome measures. Foot preference was assessed with an ad hoc survey. RESULTS Two participants with Syme amputations completed the study. Prosthetic ankle peak dorsiflexion and push-off power increased with the crossover foot compared with the energy-storing foot for both participants. Both participants reported an overall preference of the crossover foot. Changes in patient-reported outcomes did not exceed published minimum detectable change values. CONCLUSION Crossover feet increased prosthetic ankle range of motion and energy return compared with traditional energy-storing feet in this pilot investigation of 2 participants. Crossover feet seem to promote physiologic gait and may be a promising alternative to traditional low-profile feet for people with Syme amputation.
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Affiliation(s)
- Conrad Slater
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Present affiliation: Hanger Clinic, Olympia, WA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Sara J Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Present affiliation: Research Department, Gillette Children's Specialty Healthcare, Saint Paul, MN
- Present affiliation: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN
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Russell Esposito E, Hansen AH, Slater BS, Major MJ, Muschler K, Ikeda AJ, Erbes C. Footwear limitations in women prosthesis users relate to more than preference. Prosthet Orthot Int 2023; 47:511-518. [PMID: 36629586 DOI: 10.1097/pxr.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The option to wear desired footwear may be an important part of community reintegration after lower-limb amputation. OBJECTIVES This study explored outcomes related to footwear, health, and participation in women Veterans with lower-limb amputation. METHODS A cross-sectional questionnaire was mailed to all women Veterans age 18-82 years with major lower-limb amputation(s) who had received prosthetics services in the US Department of Veterans Affairs (N = 538). The questionnaire assessed Perceived Challenges (including clothing limitations, prosthetic foot limitations [width, height, and shape], and shoe avoidance for safety concerns), type of footwear used and preference, and included subscales from the Patient-Reported Outcome Measurement Information System, Amputee Body Image Scale Prosthetic Limb Users' Survey of Mobility, Community Participation Index, Activities-Specific Balance Confidence Scale, and Prosthesis Evaluation Questionnaire. Bivariate correlations examined relationships between a composite measure of Perceived Challenges and patient-reported outcomes. RESULTS One hundred questionnaires were returned (18.6% response rate; 3 excluded for limited prosthesis use). The Perceived Challenges score was significantly correlated with scores for the Amputee Body Image Scale-Revised (r = 0.24, p = 0.019), Patient-Reported Outcome Measurement Information System (ability to participate: r = -0.25, p = 0.014), Prosthesis Evaluation Questionnaire (utility: r = -0.32, p = 0.001, appearance: r = -0.48, p < 0.001), Activities-Specific Balance Confidence Scale (r = -0.20, p = 0.046), and Prosthetic Limb Users' Survey of Mobility (r = -0.21, p = 0.036), but not depression or anxiety. CONCLUSIONS Women who have greater issues with how their prosthesis affects the shoes and clothing they can wear also have poorer body image, reduced functional capabilities, and lower reported participation in activities. Improved prosthetic foot design may help to improve social participation and other important outcomes for women prosthesis users.
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Affiliation(s)
- Elizabeth Russell Esposito
- Extremity Trauma and Amputation Center of Excellence (EACE), Ft. Sam Houston, TX, USA
- Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, WA, USA
- Military Operational Medicine Research Program, Ft. Detrick, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | | | - Matthew J Major
- Northwestern University, Chicago, IL, USA
- Jesse Brown VA Medical Center, Chicago, IL, USA
| | | | | | - Christopher Erbes
- Minneapolis VA Health Care System, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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Bekrater-Bodmann R, Kehl I, Hafner BJ, Ranker A, Giordano A, Franchignoni F. Rasch validation of the German translation of the Prosthetic Limb Users Survey of Mobility short forms in people with lower limb amputation. Prosthet Orthot Int 2023; 47:552-557. [PMID: 36689667 DOI: 10.1097/pxr.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Prostheses are a primary rehabilitative intervention for people after lower limb amputation. To appropriately measure the effectiveness of prosthetic interventions, valid and reliable measures of prosthetic mobility are required. The Prosthetic Limb Users Survey of Mobility (PLUS-M) is a promising instrument for measuring prosthesis users' mobility. However, German translations of the PLUS-M short forms have not yet been validated. OBJECTIVES Rasch validation of the German translation of the PLUS-M short forms in people with lower limb amputation. STUDY DESIGN This study is based on a cross-sectional survey of prosthesis-using lower limb amputees from a nation-wide cohort. METHODS PLUS-M data (the 7-item and the 12-item shortforms; PLUS-M-7 and PLUS-M-12, respectively) from 194 lower limb prosthesis users were subjected to Rasch analysis, an advanced statistical method for assessing if the measurement properties of a questionnaire comply with a wide spectrum of psychometric requirements. RESULTS Analysis showed appropriate rating scale functioning, good internal construct validity (item fit), unidimensionality, and good targeting of the PLUS-M-7 and PLUS-M-12 short forms. Moreover, the greater conditional measurement precision of PLUS-M-12 (regarding higher test information and lower standard error of mobility estimates) was quantified. CONCLUSIONS Rasch analysis of the German translation of both PLUS-M short forms showed good psychometric qualities. In addition, our study showed that test scores from the PLUS-M-12 are more accurate. Therefore, the PLUS-M-12 is recommended for individual-level clinical applications (e.g., classification or change assessment).
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Affiliation(s)
- Robin Bekrater-Bodmann
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Isabelle Kehl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany
| | - Andrea Giordano
- Bioengineering Unit, Scientific Institute of Veruno, Istituti Clinici Scientifici Maugeri IRCCS, Veruno (NO), Italy
| | - Franco Franchignoni
- Physical and Rehabilitation Medicine Unit, Scientific Institute of Tradate, Istituti Clinici Scientifici Maugeri IRCCS, Tradate (VA), Italy
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Bajracharya AR, Seng-iad S, Sasaki K, Guerra G. Cross-Cultural Adaptation and Validation of The Nepali Version of The Prosthetic Limb Users Survey of Mobility Short-Form (Plus-M™/Nepali-12Sf) In Lower Limb Prosthesis Users. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2023; 6:41310. [PMID: 38873005 PMCID: PMC11168605 DOI: 10.33137/cpoj.v6i1.41310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/12/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Objective mobility measurement of Nepali prosthesis users is lacking. OBJECTIVE The objective of this study was to cross-culturally adapt, translate and evaluate construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M™/Nepali-12 Short Form (SF)) instrument in lower limb prosthesis users residing in Nepal. METHODOLOGY Two forward translations, review and reconciliation, back translation, expert review, developer review to create the PLUS-M™/Nepali-12SF. Psychometric testing for internal consistency, test-retest reliability and construct validity against the Two-Minute Walk Test (2MWT) and Amputee Mobility Predictor with Prosthesis (AMPPRO) were performed on sixty-six lower limb prosthesis users. FINDINGS The majority of populations were with transtibial amputation 45 (68%), with transfemoral amputation 15 (23%), with knee disarticulation 5 (7.5%) and with syme's amputation 1 (1.5%). The most common cause of amputation among the population was trauma and the least was tumor. Chronbach's alpha for the PLUS-M™/Nepali-12SF was 0.90, mean T-Score was 52.90, test-retest intraclass correlation coefficient (ICC) was 0.94 (95% confidence interval 0.90-0.96). Construct validity with the 2MWT was good (r = 0.62, p< 0.001) and moderately positive with the AMPPRO (r = 0.57, p< 0.001). CONCLUSION Our research evidenced that the PLUS-M™/Nepali-12SF had excellent reproducibility. The significance of this work is that it may allow for the measurement of mobility in austere locations of Nepal.
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Affiliation(s)
- AR Bajracharya
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - S Seng-iad
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - K Sasaki
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - G Guerra
- Department of Exercise and Sport Science, St. Mary's University, San Antonio, Texas, 78210, USA
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Heitzmann DWW, Block J, Trinler U, Wolf SI, Alimusaj M. [Motion analysis in lower limb exoprosthetics-possibilities and limitations]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04408-z. [PMID: 37458809 DOI: 10.1007/s00132-023-04408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Gait analysis is of high relevance in prosthetics as it is an essential part of the fitting process. The documentation of movement by means of videos and instrumented methods is becoming increasingly important in prosthetics as benefits of a complex prosthesis can best be shown by structured observation. PROCEDURE A movement analysis should always be preceded by an anamnesis and clinical examination in order to detect functional limitations of the examined person and thus to establish correlations to gait deviations. Additionally, the orthopaedic aid should be evaluated as well. In addition to walking on level ground, walking on everyday obstacles such as stairs and ramps is also of interest when observing people using prosthetic limbs. Functional tests can be used to determine the functional status more comprehensively. An instrumental-3D gait analysis is indicated for specific questions, especially regarding kinetic parameters.
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Affiliation(s)
- Daniel Walter Werner Heitzmann
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| | - Julia Block
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Sebastian I Wolf
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Merkur Alimusaj
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
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26
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Hunter SW, Motala A, Cronin AE, Bartha R, Viana R, Payne MW. Cortical activation during imagined walking for people with lower limb loss: a pilot study. Front Hum Neurosci 2023; 17:1163526. [PMID: 37476004 PMCID: PMC10354232 DOI: 10.3389/fnhum.2023.1163526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
Each year in Canada, a substantial number of adults undergo limb amputation, with lower limb amputation (LLA) the most prevalent. Enhancing walking ability is crucial for optimizing rehabilitation outcomes, promoting participation, and facilitating community reintegration. Overcoming challenges during the acute post-amputation phase and sub-acute rehabilitation necessitates alternative approaches, such as motor imagery and mental practice, to maximize rehabilitation success. However, the current evidence on activation patterns using motor imagery in individuals with LLA is limited. The primary objective was to assess the feasibility of observing brain activation during imagined walking in individuals with LLA utilizing 3T functional magnetic resonance imaging (fMRI). Eight individuals with LLA and 11 control subjects participated. Consistent with representations of the lower limbs, both control and amputee groups demonstrated bilateral activation in the medial surface of the primary motor and somatosensory cortices. However, individuals with lower limb amputations exhibited significantly greater activation during imagined walking, particularly in frontal regions and the medial surface of the primary motor and supplementary motor cortices. Furthermore, the volume of activation in the bilateral primary motor cortices was higher for participants with amputations compared to controls. The protocol developed in this study establishes a foundation for evaluating the effects of a gait training program that incorporates mental imagery alongside conventional rehabilitation practices, in contrast to standard care alone. This pilot investigation holds potential to enhance our understanding of brain plasticity in individuals with LLA and pave the way for more effective rehabilitation strategies to optimize functional recovery and community reintegration.
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Affiliation(s)
- Susan W. Hunter
- School of Physical Therapy, The University of Western Ontario, London, ON, Canada
| | - Aysha Motala
- School of Psychology, The University of Stirling, Stirling, Scotland
| | - Alicia E. Cronin
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Michael W. Payne
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. GGEM: Gender, Geography, and EMployment differences based on mobility levels among lower limb prosthesis users living in the United States. Prosthet Orthot Int 2023; 47:265-271. [PMID: 36787381 PMCID: PMC10249601 DOI: 10.1097/pxr.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND For individuals with a disability, an increase in functional mobility may improve their quality of life and well-being. Greater understanding is needed on how factors such as gender, geography, and employment may play a role in mobility levels among individuals with lower limb amputation. OBJECTIVES To assess the relationship between gender, geography, and employment status on mobility among lower limb prosthesis users. METHODS A cross-sectional analysis of 7,524 patient mobility outcomes completed across the United States was performed. The regression model included the independent variables, such as age, gender, region, employment status, and amputation level. Mobility was entered as the dependent variable. RESULTS Individuals who were employed had 3.6 times the odds of reaching increased mobility (Prosthetic Limb Users' Survey of Mobility ≥ 50) than those unemployed (odds ratio 3.56, 95% confidence interval 3.10-4.09). Gender and geography were significantly associated with mobility as well. CONCLUSIONS Being employed is associated with greater odds of reaching increased mobility. Addressing factors such as returning to employment may aid in improving mobility levels among prosthesis users.
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Affiliation(s)
- Dwiesha L. England
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
| | - Taavy A. Miller
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Phillip M. Stevens
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT
| | - James H. Campbell
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
| | - Shane R. Wurdeman
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE
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Sawers A, Fatone S. After scaling to body size hip strength of the residual limb exceeds that of the intact limb among unilateral lower limb prosthesis users. J Neuroeng Rehabil 2023; 20:50. [PMID: 37098570 PMCID: PMC10131313 DOI: 10.1186/s12984-023-01166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/30/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls. METHODS Twenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey's Honest-Difference. RESULTS A significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p < 0.001). A significant simple main effect of leg (p = 0.001) indicated peak torque differed between two or more legs per muscle group. Post-hoc comparisons revealed hip extensor, flexor, and abductor peak torque was not significantly different between the residual and control legs (p ≥ 0.067) but torques in both legs were significantly greater than in the intact leg (p < 0.001). Peak hip abductor torque was significantly greater in the control and residual legs than the intact leg (p < 0.001), and significantly greater in the residual than control leg (p < 0.001). CONCLUSIONS Our results suggest that it is the intact, rather than the residual limb, that is weaker. These findings may be due to methodological choices (e.g., normalization), or biomechanical demands placed on residual limb hip muscles. Further research is warranted to both confirm, expand upon, and elucidate possible mechanisms for the present findings; and clarify contributions of intact and residual limb hip muscles to walking and balance in LLP users. CLINICAL TRIAL REGISTRATION N/A.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology, University of Illinois at Chicago, 1919 West Taylor Street, Rm. 646, Chicago, IL, 60612, USA.
| | - Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA
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Yosmaoglu S, Yazicioglu G, Demir Y, Aydemir K, Yosmaoğlu HB. Validity and reliability of Turkish transcultural adaptation of the Prosthetic Limb Users Survey of Mobility. Prosthet Orthot Int 2023; 47:189-193. [PMID: 36037291 DOI: 10.1097/pxr.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Amputee-specific, self-assessment mobility scales are essential to evaluate mobility in lower-limb amputees. OBJECTIVES To evaluate the validity and reliability of a Turkish translation and adaptation of the Prosthetic Limb Users Survey of Mobility. STUDY DESIGN This is a validation study. METHODS Turkish translation of the Prosthetic Limb Users Survey of Mobility (PLUS-M-T) from its original was performed following the rules of intercultural adaptation and translation methods. The PLUS-M-T and its 12-item short form were applied to '100 induviduals with limb loss twice in 3-day intervals. The structural validity analysis was determined by calculating the correlation with the Amputee Mobility Scale, which is a valid, reliable scale for assessing the functional level in amputees. The Cronbach alpha coefficient was calculated to analyze the internal consistency. The interclass correlation coefficient (ICC) and Spearman correlation coefficient (r) were calculated, and the test-retest reliability was determined. RESULTS A positive, high correlation was found between the first application and its repetition of both PLUS-M-T (ICC = 0.85, r = 0.94, P < 0.001) and 12-item short form (ICC = 0.92, r = 0.93, P < 0.001). The internal consistency was high for both PLUS-M-T (Cronbach alpha = 0.94) and 12-item short form (Cronbach alpha = 0.91). A positive, high correlation was found between the scores obtained from the Amputee Mobility Scale and PLUS-M-T (r = 0.84, P < 0.001) and 12 question short form (r = 0.77, P < 0.001). CONCLUSION Turkish translation of the PLUS-M questionnaire is a valid and reliable scale for assessing the mobility of individuals who have undergone lower-extremity amputation using a prosthesis.
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Affiliation(s)
- Sevgin Yosmaoglu
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Gul Yazicioglu
- Faculty of Physiotherapy, Hacettepe University, Ankara, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Koray Aydemir
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane Faculty of Medicine, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Hayri Baran Yosmaoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey
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Gailey RS, Kristal A, Al Muderis M, Lučarević J, Clemens S, Applegate EB, Isaacson BM, Pasquina PF, Symsack A, Gaunaurd IA. Comparison of prosthetic mobility and balance in transfemoral amputees with bone-anchored prosthesis vs. socket prosthesis. Prosthet Orthot Int 2023; 47:130-136. [PMID: 36701197 DOI: 10.1097/pxr.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 08/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The literature comparing bone-anchored prosthesis (BAP) with socket prosthesis (SP) consistently reports improvement in physical health and quality of life using primarily patient-reported outcome measures (PROMs). OBJECTIVE To determine the differences in mobility and balance using performance-based outcome measures and PROMs in people with transfemoral amputations (TFAs) fitted with BAP vs. SP. STUDY DESIGN Causal comparative. METHODS Two groups of people with TFAs were recruited: one using a BAP (N = 11; mean age ± standard deviation, 44 ± 14.9 years; mean residual limb length as a percentage of the intact femur, 68% ± 15.9) and another group using a SP (N = 11; mean age ± standard deviation, 49.6 ± 16.0 years; mean residual limb length as a percentage of the intact femur, 81% ± 13.9), and completed the 10-meter walk test, component timed-up-and-go, Prosthetic Limb Users Survey of Mobility™ 12-item, and Activities-specific Balance Confidence Scale. RESULTS There were no statistically significant differences between the BAP and SP groups in temporal spatial gait parameters and prosthetic mobility as measured by the 10-meter walk test and component timed-up-and-go, yet large effect sizes were found for several variables. In addition, Activities-specific Balance Confidence Scale and Prosthetic Limb Users Survey of Mobility™ scores were not statistically different between the BAP and SP groups, yet a large effect sizes were found for both variables. CONCLUSIONS This study found that people with TFA who use a BAP can demonstrate similar temporal spatial gait parameters and prosthetic mobility, as well as self-perceived balance confidence and prosthetic mobility as SP users. Therefore, suggesting that the osseointegration reconstruction surgical procedure provides an alternative option for a specific population with TFA who cannot wear nor have limitations with a SP. Future research with a larger sample and other performance-based outcome measures and PROMs of prosthetic mobility and balance would further determine the differences between the prosthetic options.
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Affiliation(s)
- Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Anat Kristal
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
| | - Munjed Al Muderis
- The Australian School of Advanced Medicine, Macquarie University, North Ryde, Australia
| | - Jennifer Lučarević
- Division of Health Sciences Orthotics and Prosthetics, California State University, Dominquez Hills, Carson, CA, USA
| | - Sheila Clemens
- Department of Physical Therapy, Florida International University, Nicole Wertheim College of Nursing and Health Sciences, Miami, FL, USA
| | - E Brooks Applegate
- Department of Educational Leadership, Research & Technology, University of Western Michigan, Kalamazoo, MI, USA
| | - Brad M Isaacson
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD, USA
- The Geneva Foundation, Seattle, WA, USA
| | - Paul F Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Allison Symsack
- The Geneva Foundation, Seattle, WA, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ignacio A Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
- Bruce W. Carter Veterans Affairs Medical Center, Miami, FL, USA
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Balkman GS, Morgan SJ, Amtmann D, Baylor C, Hafner BJ. Development of a candidate item bank for measuring mobility of lower limb orthosis users. PM R 2023; 15:445-455. [PMID: 36270012 PMCID: PMC10119328 DOI: 10.1002/pmrj.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Orthoses are often prescribed to improve mobility of people with chronic health conditions that affect lower limb function. Patient-reported survey instruments can be used to measure aspects of mobility that cannot be easily assessed in clinical or research settings. A population-specific item bank could be designed to measure aspects of mobility that are most important to lower limb orthosis users and used to evaluate the effects of orthoses. OBJECTIVE To develop items for a new survey instrument to measure mobility of lower limb orthosis users. DESIGN Survey items were developed using a qualitative item review process. SETTING Focus groups were held by video conferencing. Cognitive interviews were conducted by telephone. PARTICIPANTS Focus group and cognitive interview participants were adults with at least 6 months of experience using a lower limb orthosis that extended from the foot to a level above the ankle. METHODS Research methods included focus groups with lower limb orthosis users, an item generation and reduction process that involved a stakeholder advisory panel, and cognitive interviews with target respondents. RESULTS A total of 1180 extant items were identified in a literature review. Focus group participants (n = 29) provided feedback that informed the suitability of a construct definition and conceptual model. An advisory panel contributed to the selection of 118 candidate items for measuring orthotic mobility. Feedback from cognitive interview participants (n = 30) informed removal or revision of problematic items, resulting in a candidate bank of 100 mobility items. CONCLUSIONS The rigorous qualitative methods applied here resulted in a large set of candidate items that spanned a range of situations relevant to moving with a lower limb orthosis. Next steps include administration of the candidate items to a large sample of lower limb orthosis users and calibration of the item bank.
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Affiliation(s)
- Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Sara J. Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Gillette Children’s Specialty Healthcare, St. Paul, MN
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Hafner BJ, Amtmann D, Morgan SJ, Abrahamson DC, Askew RL, Bamer AM, Salem R, Gaunaurd IA, Gailey RS, Czerniecki JM, Fatone S, Fergason JR, Fothergill I, Kelly VE, Weber EL, Whiteneck GG. Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS-M). PM R 2023; 15:456-473. [PMID: 36787171 PMCID: PMC10121932 DOI: 10.1002/pmrj.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Achieving mobility with a prosthesis is a common post-amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient-reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research. OBJECTIVE To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility. DESIGN A cross-sectional study was conducted to administer previously developed candidate items to a national sample of lower limb prosthesis users. Items were calibrated to an item response theory model and two fixed-length short forms were created. Instruments were assessed for readability, effective range of measurement, agreement with the full item bank, ceiling and floor effects, convergent validity, and known groups validity. SETTING Participants were recruited using flyers posted in hospitals and prosthetics clinics across the United States, magazine advertisements, notices posted to consumer websites, and direct mailings. PARTICIPANTS Adult prosthesis users (N = 1091) with unilateral lower limb amputation due to traumatic or dysvascular causes. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Candidate items (N = 105) were administered along with the Patient Reported Outcome Measurement Information System Brief Profile, Prosthesis Evaluation Questionnaire - Mobility Subscale, and Activities-Specific Balance Confidence Scale, and questions created to characterize respondents. RESULTS A bank of 44 calibrated self-report items, termed the Prosthetic Limb Users Survey of Mobility (PLUS-M), was produced. Clinical and statistical criteria were used to select items for 7- and 12-item short forms. PLUS-M instruments had an 8th grade reading level, measured with precision across a wide range of respondents, exhibited little-to-no ceiling or floor effects, correlated expectedly with scores from existing PROMs, and differentiated between groups of respondents expected to have different levels of mobility. CONCLUSION The PLUS-M appears to be well suited to measuring prosthetic mobility in people with lower limb amputation. PLUS-M instruments are recommended for use in clinical and research settings.
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Affiliation(s)
- Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sara J Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Research Department, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel C Abrahamson
- Mobile Prosthetic and Orthotic Care, Veterans Integrated Service Network 20 VA NW Health Network, Seattle, WA, USA
| | - Robert L Askew
- Department of Psychology, Stetson University, Deland, FL, USA
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Ignacio A Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Center for Limb Loss and MoBility, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Stefania Fatone
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - John R Fergason
- Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ian Fothergill
- Medical Center Orthotics & Prosthetics, Silver Spring, MD, USA
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Eric L Weber
- Hanger Institute for Clinical Research and Education, Austin, TX, USA
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McDonald CL, Kahn A, Hafner BJ, Morgan SJ. Prevalence of secondary prosthesis use in lower limb prosthesis users. Disabil Rehabil 2023; 46:1-7. [PMID: 36843538 PMCID: PMC11182650 DOI: 10.1080/09638288.2023.2182919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Prostheses designed for daily use are often inappropriate for high-level activities and/or are susceptible to water damage and mechanical failure. Secondary prostheses, such as activity-specific or back-up prostheses, are typically required to facilitate uninterrupted participation in desired life pursuits. This study estimated the prevalence of secondary prosthesis use in a large, national sample of lower limb prosthesis users (LLPUs). METHODS We conducted a secondary analysis of survey data from three cross-sectional studies that assessed mobility in LLPUs. Descriptive statistics were used to determine the percentage of secondary prosthesis users and percentages of LLPUs that used different type(s) of secondary prosthesis(es). Secondary prosthesis users and non-users were compared to identify differences in participant characteristics between groups. RESULTS Of participants in the analysis (n = 1566), most (65.8%) did not use a secondary prosthesis. The most common secondary prosthesis types were back-up (19.2%) and activity-specific prostheses (13.5%). Secondary prosthesis users differed significantly from non-users with respect to gender, race, and other characteristics. CONCLUSIONS Results suggest that secondary prosthesis use for most LLPUs is limited and may differ based on users' demographic and clinical characteristics. Future research should determine how LLPUs' health-related quality-of-life outcomes are affected by access to and use of secondary prostheses.Implications for RehabilitationSecondary prostheses, including activity-specific, back-up, and shower prostheses, have the potential to improve function, mobility, and participation for people who use lower limb prostheses.Most lower limb prosthesis users do not use secondary prostheses, and access to these devices may be related to users' demographic and clinical characteristics.Rehabilitation professionals play a key role in facilitating prosthesis users' access to secondary prostheses and should advocate for those who need them.
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Affiliation(s)
| | | | | | - Sara J. Morgan
- University of Washington, Seattle, WA
- Gillette Children’s, St. Paul, MN
- University of Minnesota, Minneapolis, MN
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Gaunaurd IA, Morgan SJ, Balkman GS, Kristal A, Rosen RE, Haynes JS, Gailey RS, Hafner BJ. Modifying the five-time sit-to-stand test to allow use of the upper limbs: Assessing initial evidence of construct validity among lower limb prosthesis users. PLoS One 2023; 18:e0279543. [PMID: 36763586 PMCID: PMC9916626 DOI: 10.1371/journal.pone.0279543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/08/2022] [Indexed: 02/11/2023] Open
Abstract
The Five-time Sit-to-Stand (5xSTS) Test is a performance-based measure used by clinicians and researchers to assess the body functions needed to accomplish sit-to-stand transitions (e.g., lower limb strength, balance, and trunk control). The current requirements for performance of the 5xSTS Test (i.e., crossing arms over the chest) may not be appropriate for many, if not most lower limb prosthesis (LLP) users. The study aims were to (1) develop a modified five-time sit-to-stand (m5xSTS) Test protocol; (2) to examine initial evidence of known-groups construct validity among LLP users by comparing differences in performance by amputation level, amputation etiology, and functional level; and (3) to assess initial evidence of convergent construct validity by examining the correlations between m5xSTS performance with self-reported mobility (Prosthetic Limb Users Survey of Mobility (PLUS-M)), self-reported balance confidence (Activities-balance Confidence Scale (ABC)) and functional capability (comfortable walking speed). Three-hundred sixty-one LLP users participated in this cross-sectional study. The investigators developed a m5xSTS Test protocol that allows tested individuals to use different assistance strategies (i.e., use of upper limbs to push off thighs, push up from the armrests, or use a walker) when needed to perform the test. The investigators recorded m5xSTS Test times and assistance strategies. Significant differences in m5xSTS Test times were found between those who did and did not use an assistance strategy, as well as between participants grouped by different amputation level, etiology, and functional level. Significant moderate negative correlations were found between m5xSTS Test times and PLUS-M T-score (ρ = -0.42, p<0.001), ABC score (ρ = -0.42, p<0.001), and comfortable walking speed (ρ = -0.64, p<0.001), respectively. The m5xSTS Test allows LLP users to perform sit-to-stand transitions in a manner that accounts for their functional impairments, is consistent with post-amputation training, and is safe for the tested individual. Results from this study provide preliminary evidence of known groups and convergent construct validity for the m5xSTS Test with a large national sample of LLP users.
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Affiliation(s)
- Ignacio A. Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Sara J. Morgan
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
- Spine Research Program, Gillette Children’s Specialty Healthcare, Saint Paul, MN, United States of America
| | - Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Anat Kristal
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Rachael E. Rosen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Jessica S. Haynes
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Research Division, The Geneva Foundation, Tacoma, WA, United States of America
| | - Robert S. Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
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Tan JM, Halford GRJ, Lukin M, Kohler F. Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures. Prosthet Orthot Int 2023; 47:13-25. [PMID: 36629556 PMCID: PMC9945573 DOI: 10.1097/pxr.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care. METHODS Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made. RESULTS The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire-Residual Limb Health, Prosthetic Evaluation Questionnaire-Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS ; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+ ; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct ; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System-29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs. CONCLUSION The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.
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Affiliation(s)
- Jade M. Tan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Gregory R. J. Halford
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
| | - Martina Lukin
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Friedbert Kohler
- School of Clinical Medicine, Medicine & Health, University of New South Wales, Sydney, Australia
- Clinical Directorate Aged Care and Rehabilitation, South Western Sydney Local Health District, Liverpool, Australia
- Rehabilitation Medicine, Braeside Hospital, Braeside Hospital, HammondCare Health, Sydney, Australia
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Stability and Falls Evaluations in AMPutees (SAFE-AMP 2): Reduced functional mobility is associated with a history of injurious falls in lower limb prosthesis users. Ann Phys Rehabil Med 2022; 66:101679. [PMID: 35667624 DOI: 10.1016/j.rehab.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. METHODS Retrospective (2016-2018) observational study. Logistic regression applied. RESULTS A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). CONCLUSION(S) Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes.
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Affiliation(s)
- Taavy A Miller
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA; Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA
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Clemens S, Gaunaurd I, Raya M, Kirk-Sanchez N, Klute G, Gailey R. Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation. Prosthet Orthot Int 2022; 46:484-490. [PMID: 35511444 DOI: 10.1097/pxr.0000000000000140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. METHODS Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. RESULTS Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation ( P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers ( P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. CONCLUSIONS Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.
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Affiliation(s)
- Sheila Clemens
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
- Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA
- Research Department, Miami Veterans Administration Healthcare System, Miami, FL, USA
| | - Ignacio Gaunaurd
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
- Research Department, Miami Veterans Administration Healthcare System, Miami, FL, USA
| | - Michele Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Glenn Klute
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Center for Limb Loss and Mobility VA Puget Sound Health Care System, Seattle, WA, USA
| | - Robert Gailey
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. Mobility Analysis of AmpuTees (MAAT 7): Normative Mobility Values for Lower Limb Prosthesis Users of Varying Age, Etiology, and Amputation Level. Am J Phys Med Rehabil 2022; 101:850-858. [PMID: 34864771 PMCID: PMC9377488 DOI: 10.1097/phm.0000000000001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to establish normative values of lower limb amputation mobility across primary etiologies based on age and amputation level. DESIGN This study is a cross-sectional observational analysis of outcomes. A total of 11,995 lower limb prosthesis users were included in the analysis. Participants were grouped by etiology into four categories: cancer, congenital, trauma, and diabetes/dysvascular. Mobility was assessed by using the Prosthetic Limb Users Survey of Mobility. RESULTS Mobility across seven age groups for the four etiologies was established for both above-the-knee amputation and below-the-knee amputation. Differences were found between age groups for individuals: above-the-knee amputation: cancer (χ 2 (6) = 40.97, P < 0.001), congenital (χ 2 (3) = 9.41, P = 0.024), trauma (χ 2 (6) = 18.89, P = 0.004), and dysvascular (χ 2 (5) = 39.73, P < 0.001; below-the-knee amputation: cancer (χ 2 (6) = 29.77, P < 0.001), trauma (χ 2 (6) = 28.22, P < 0.001), and dysvascular (χ 2 (6) = 144.66, P < 0.001). CONCLUSIONS The awareness of differences across amputation etiologies extending across the lifespan of ages can assist the goal-setting process as part of prosthetic rehabilitation. In addition, refined normative values provide the ability to benchmark new and innovative changes in clinical practice.
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Morgan SJ, Rowe K, Fitting CC, Gaunaurd IA, Kristal A, Balkman GS, Salem R, Bamer AM, Hafner BJ. Use of Standardized Outcome Measures for People With Lower Limb Amputation: A Survey of Prosthetic Practitioners in the United States. Arch Phys Med Rehabil 2022; 103:1786-1797. [PMID: 35398048 PMCID: PMC9452451 DOI: 10.1016/j.apmr.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the clinical resources available for the assessment of health outcomes in people with lower limb amputation and to understand barriers and facilitators associated with use of standardized outcome measures in clinical practice. DESIGN Cross-sectional survey. SETTING General community (online). PARTICIPANTS A volunteer sample of prosthetic practitioners was recruited through national professional organizations. Eligible participants were practitioners certified by a professional prosthetics organization and currently practicing as a prosthetist, prosthetist-orthotist, or prosthetic assistant. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A custom-designed online survey on clinical use of patient-reported and performance-based standardized outcome measures to assess patients with lower limb amputation. RESULTS A total of 375 participants completed the survey. Most participants (79%) reported that they are encouraged or required to administer standardized outcome measures in their clinic or facility. Most participants reported that use of patient-reported and performance-based outcome measures are within their scope of practice (88%) and that they have the knowledge required for outcomes measurement (84%). Few participants agreed that outcomes measurement is standardized across the profession (30%). Most participants had access to small spaces and equipment for outcomes measurement, such as short hallways (65%-94%), stairs (69%), and tablets with wireless internet connection (83%). Most participants reported that they would be willing to spend between 5 (36% of participants) and 10 (43% of participants) minutes on self-reported surveys, and between 10 (41% of participants) and 20 (28% of participants) minutes on performance-based tests. CONCLUSIONS Outcomes measurement is encouraged or expected in contemporary prosthetic practice. Strategies to improve standardization and efficiency of administration are needed to facilitate routine use of outcome measures in clinical care.
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Affiliation(s)
- Sara J Morgan
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Research Department, Gillette Children's Specialty Healthcare, St Paul, Minnesota; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Kimberly Rowe
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Chantelle C Fitting
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Ignacio A Gaunaurd
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, United States
| | - Anat Kristal
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, United States
| | - Geoffrey S Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Rana Salem
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Alyssa M Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
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From outcome measurement to improving health outcomes after lower limb amputation-A narrative review exploring outcome measurement from a clinical practice perspective. Prosthet Orthot Int 2022; 46:e341-e350. [PMID: 35357360 DOI: 10.1097/pxr.0000000000000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional body encouragement, and successful examples of system level outcome measurement within some health care settings, many barriers still exist preventing outcome measurement from becoming embedded in clinical practice. This paper presents a narrative review which aims to describe the state of the outcome measurement evidence base in prosthetic rehabilitation, as applied in clinical practice, with a view to identifying areas for future work aimed at making outcome measurement in prosthetic rehabilitation a meaningful reality. A literature search of four databases was undertaken, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis principals appropriate to narrative reviews, and using the search terms outcome, measur*, tool, scale, instrument, prosthe*, amput* and limb loss. A total of 1116 papers were identified. Following screening 35 papers, focusing on four main themes, were included in the review. Themes were: 1) What outcome domains should be measured? 2) How can these outcome domains be measured? 3) What are the barriers to outcome measurement? and 4) What can be learnt from examples of ROM in prosthetic rehabilitation? Findings suggest that successful outcome measurement is multifaceted. Understanding and embedding value at every step appears to be key to success. Addressing the questions of 'what' outcome domains to measure and 'how' to measure them, may help establish consensus. Routine outcome measurement practice at the clinical level should ensure data collection is valuable to clinical practice, makes use of information technology solutions and has organisational engagement.
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Sawers A, McDonald CL, Hafner BJ. A survey for characterizing details of fall events experienced by lower limb prosthesis users. PLoS One 2022; 17:e0272082. [PMID: 35901056 PMCID: PMC9333270 DOI: 10.1371/journal.pone.0272082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Despite their importance to fall prevention research, little is known about the details of real-world fall events experienced by lower limb prosthesis users. This gap can be attributed to the lack of a structured, population-specific fall survey to document these adverse health events. The objective of this project was to develop a survey capable of characterizing the circumstances and consequences of fall events in lower limb prosthesis users. Best practices in survey development, including focus groups and cognitive interviews with diverse samples of lower limb prosthesis users, were used to solicit input and feedback from target respondents, so survey content would be meaningful, clear, and applicable to lower limb prosthesis users. Focus group data were used to develop fall event definitions and construct a conceptual fall framework that guided the creation of potential survey questions and response options. Survey questions focused on the activity, surroundings, situation, mechanics, and consequences of fall events. Cognitive interviews revealed that with minor revisions, survey definitions, questions, and response options were clear, comprehensive, and applicable to the experiences of lower limb prosthesis users. Administration of the fall survey to a national sample of 235 lower limb prosthesis users in a cross-sectional preliminary validation study, found survey questions to function as intended. Revisions to the survey were made at each stage of development based on analysis of participant feedback and data. The structured, 37-question lower limb prosthesis user fall event survey developed in this study offers clinicians and researchers the means to document, monitor, and compare fall details that are meaningful and relevant to lower limb prosthesis users in a standardized and consistent manner. Data that can be collected with the developed survey are essential to establishing specific goals for fall prevention initiatives in lower limb prosthesis users.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Cody L. McDonald
- Division of Prosthetics and Orthotics, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Brian J. Hafner
- Division of Prosthetics and Orthotics, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
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Erbes CR, Ferguson J, Yang K, Koehler-McNicholas S, Polusny MA, Hafner BJ, Heinemann AW, Hill J, Rich T, Walker N, Weber M, Hansen A. Amputation-specific and generic correlates of participation among Veterans with lower limb amputation. PLoS One 2022; 17:e0270753. [PMID: 35797375 PMCID: PMC9262244 DOI: 10.1371/journal.pone.0270753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Participation in valued interpersonal and community activities is a key component of rehabilitation for Veterans with amputation. The purpose of this study was to identify specific factors that promote or inhibit participation to inform development of interventions that may facilitate participation in desired life activities. A convenience sample of 408 Veterans with at least one lower limb amputation and who had received outpatient care from the Regional Amputation Center (RAC) completed a mailed survey. Participation was measured using the Community Participation Indicators (CPI) Importance, Control, and Frequency scales and the Patient Reported Outcome Measurement Information System (PROMIS) Ability to Participate in Social Roles and Satisfaction with Social Participation scales. Multiple imputation procedures were used to address missing data. Correlates of participation were examined through multiple linear regression. A total of 235 participants completed the survey, a response rate of 58%. Levels of participation, measured with the PROMIS instruments, were 43.2 (SD = 8.1) for Ability and 46.4 (SD = 8.6) for Satisfaction. Regression analyses found robust amputation-specific correlates for participation, including body image and balance confidence. Generic (non-amputation specific) correlates for participation included depression and pain interference. Development of treatment approaches and devices that can address body image, balance confidence, pain, and mental health concerns such as depression have the potential to enhance the participation and rehabilitation of Veterans with lower limb amputation.
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Affiliation(s)
- Christopher R. Erbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - John Ferguson
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kalia Yang
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Sara Koehler-McNicholas
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Melissa A. Polusny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Brian J. Hafner
- Departments of Rehabilitation Medicine and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Allen W. Heinemann
- Departments of Physical Medicine and Rehabilitation, Emergency Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University and Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Jessica Hill
- Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Tonya Rich
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Nicole Walker
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Marilyn Weber
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
| | - Andrew Hansen
- Minneapolis Adaptive Design and Engineering Program, Minneapolis VA Healthcare System, Minneapolis, Minnesota, United States of America
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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43
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Lee SP, Bonczyk A, Dimapilis MK, Partridge S, Ruiz S, Chien LC, Sawers A. Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. PLoS One 2022; 17:e0262977. [PMID: 35797362 PMCID: PMC9262185 DOI: 10.1371/journal.pone.0262977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting. Methods Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 years, range = 4–21 years) during prosthetic training were recorded. Recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. We also explored whether LLP users’ age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received. Results We recorded a total of 20 training sessions, yielding 904 statements of instruction from 338 minutes of training. Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 64% were internal, 9% external, 3% mixed, and 25% unfocused. Regression analysis revealed that female, older, and higher functioning LLP users were significantly more likely to receive internally-focused instructions (p = 0.006, 0.035, and 0.024, respectively). Conclusions Our results demonstrated that verbal instructions and feedback are frequently provided to LLP users during prosthetic training. Most verbal interactions are focused internally on the LLP users’ body movements and not externally on the movement effects. Impact statement While more research is needed to explore how motor learning principles may be applied to improve LLP user outcomes, clinicians should consider adopting the best available scientific evidence during treatment. Overreliance on internally-focused instructions as observed in the current study may hinder prosthetic skill learning.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
- * E-mail:
| | - Alexander Bonczyk
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Maria Katrina Dimapilis
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Sarah Partridge
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Samantha Ruiz
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, United States of America
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, Nevada, United States of America
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Rich TL, Voss G, Fairhurst S, Matsumoto M, Brielmaier S, Koester K, Netoff TI, Hansen AH, Ferguson JE. Feasibility testing of a novel prosthetic socket sensor system. Disabil Rehabil 2022:1-8. [PMID: 35797711 DOI: 10.1080/09638288.2022.2093997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Poorly fitting prosthetic sockets contribute to decreased quality of life, health, and well-being for persons with amputations. Therefore, improved socket fit is a high clinical priority. METHODS In this study, we describe the design and testing of a novel sensor system that can be incorporated into a prosthetic socket to measure distal end weight bearing in the socket and can alert a prosthesis user if poor socket fit is suspected. We present the results of testing this device with three Veterans who were new prosthesis users and three Veterans who were experienced prosthesis users. RESULTS AND CONCLUSIONS We collected sensor data during walking trials while participants wore varying numbers of sock plies and qualitative feedback on the design of the socket fit sensor system. For analysis, peak sensor measurements during walking cycles were identified and combined with socket fit data (i.e., a clinician-determined level of "good," "too tight," or "too loose" and the number of sock ply worn each trial). We found consistent relationships between peak sensor measurements and socket fit in our sample. Also, all users expressed an interest in the device, highlighting its potential benefits during early prosthesis training.Implications for RehabilitationEnsuring socket fit is challenging for many prosthesis users.A novel wearable sensor system can be used to identify socket fit issues for some prosthesis users.This type of system could be most helpful for new prosthesis users and those with sensory and cognitive challenges.
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Affiliation(s)
- Tonya L Rich
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Greg Voss
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Stuart Fairhurst
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Mary Matsumoto
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Steven Brielmaier
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Karl Koester
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America
| | - Theoden I Netoff
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew H Hansen
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America.,Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - John E Ferguson
- Minneapolis VA Health Care System, Minneapolis, Minnesota, United States of America.,Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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45
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Sawers A, Fatone S. Normalization alters the interpretation of hip strength in established unilateral lower limb prosthesis users. Clin Biomech (Bristol, Avon) 2022; 97:105702. [PMID: 35714413 DOI: 10.1016/j.clinbiomech.2022.105702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Valid comparisons of muscle strength between individuals or legs that differ in size requires normalization, often by simple anthropometric variables. Few studies of muscle strength in lower-limb prosthesis users have normalized strength data by any anthropometric variable, potentially confounding our understanding of strength deficits in lower-limb prosthesis users. The objective of this pilot study was to determine the need for as well as effectiveness and impact of normalizing hip strength in lower-limb prosthesis users. METHODS Peak isometric hip extension and abduction torques were collected from 28 lower-limb prosthesis users. Allometric scaling was used to determine if hip torque values were significantly associated with, and therefore needed to be adjusted for, body mass, thigh length, or body mass x thigh length, and whether normalization was effective in reducing any associations. Between limb differences in peak hip torque, and correlations with balance ability, were inspected pre- and post-normalization. FINDINGS Hip torques were consistently and significantly associated with body-mass x thigh length. Associations between peak hip torque and body-mass x thigh length were reduced by normalization. After normalization by body-mass x thigh length, between limb differences in hip extension torque, as well as the correlation between hip abduction torque and balance ability, changed from non-significant to significant. INTERPRETATION In the absence of normalization, hip strength (i.e., peak torque) in lower-limb prosthesis users remains dependent on basic anthropometric variables, masking relationships between hip strength and balance ability, as well as between limb differences.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology, University of Illinois at Chicago, Chicago, IL 60612, United States of America.
| | - Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, United States of America; Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, United States of America
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46
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Nugent K, Payne MW, Viana R, Unger J, Hunter SW. A concern for falling impacts quality of life for people with a lower limb amputation. Int J Rehabil Res 2022; 45:253-259. [PMID: 35754349 DOI: 10.1097/mrr.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this web-based survey study was to comprehensively evaluate subdomains of concern for falling and its association with quality of life (QoL) among people with lower-limb amputations (PLLA). Forty-eight adults (mean 61.8 ± 11.6 years) with a major (i.e. transtibial or transfemoral) amputation participated. Individuals were currently using a prosthesis for ambulation, completed a prosthetic rehabilitation program, had functional use of English and had access to an internet-connected device (e.g. laptop). Five standardized scales assessed a concern for falling: Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC) Scale, Prosthetic Limb Users Survey - Mobility (PLUS-M), Consequences of Falling Scale and Perceived Ability to Manage Falls Scale. QoL was evaluated using the WHO QoL-100 questionnaire. Spearman correlation analysis evaluated the relationship between the five concerns for falling scales. Five independent linear regression modeling evaluated the association of each concern for falling measure on QoL. Strong statistically significant correlations were found between mSAFFE and PLUS-M (rs = -0.87; P < 0.05). Three scales were significantly associated with QoL: mSAFFE [-1.16 (95% CI, -2.04 to -0.29)], ABC [0.36 (95% CI, 0.11-0.61)] and PLUS-M [0.50 (95% CI, 0.05-0.95)]. This is the first study to evaluate multiple concerns for falling subdomains among PLLA. Concern for falling should be addressed in prosthetic rehabilitation to improve community re-integration and QoL.
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Affiliation(s)
- Kristin Nugent
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy
| | - Michael W Payne
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Janelle Unger
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Susan W Hunter
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
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Clemens SM, Kershaw KN, McDonald CL, Darter BJ, Bursac Z, Garcia SJ, Rossi MD, Lee SP. Disparities in functional recovery after dysvascular lower limb amputation are associated with employment status and self-efficacy. Disabil Rehabil 2022:1-8. [PMID: 35723056 DOI: 10.1080/09638288.2022.2087762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Employment status is considered a determinant of health, yet returning to work is frequently a challenge after lower limb amputation. No studies have documented if working after lower limb amputation is associated with functional recovery. The study's purpose was to examine the influence of full-time employment on functioning after lower limb amputation. METHODS Multisite, cross-sectional study of 49 people with dysvascular lower limb amputation. Outcomes of interest included performance-based measures, the Component Timed-Up-and-Go test, the 2-min walk test, and self-reported measures of prosthetic mobility and activity participation. RESULTS Average participant age was 62.1 ± 9.7 years, 39% were female and 45% were persons of color. Results indicated that 80% of participants were not employed full-time. Accounting for age, people lacking full-time employment exhibited significantly poorer outcomes of mobility and activity participation. Per regression analyses, primary contributors to better prosthetic mobility were working full-time (R2 ranging from 0.06 to 0.24) and greater self-efficacy (R2 ranging from 0.32 to 0.75). CONCLUSIONS This study offers novel evidence of associations between employment and performance-based mobility outcomes after dysvascular lower limb amputation. Further research is required to determine cause-effect directionalities. These results provide the foundation for future patient-centered research into how work affects outcomes after lower limb amputation. IMPLICATIONS FOR REHABILITATIONLower limb amputation can pose barriers to employment and activity participation, potentially affecting the quality of life.This study found that the majority of people living with lower limb amputation due to dysvascular causes were not employed full-time and were exhibiting poorer prosthetic outcomes.Healthcare practitioners should consider the modifiable variable of employment when evaluating factors that may affect prosthetic mobility.The modifiable variable of self-efficacy should be assessed by healthcare professionals when evaluating factors that may affect prosthetic mobility.
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Affiliation(s)
- Sheila M Clemens
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Cody L McDonald
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Stephanie J Garcia
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Mark D Rossi
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Szu Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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48
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Morgan SJ, Askew RL, Hafner BJ. Measurements of Best, Worst, and Average Socket Comfort Are More Reliable Than Current Socket Comfort in Established Lower Limb Prosthesis Users. Arch Phys Med Rehabil 2022; 103:1201-1204. [PMID: 34748757 PMCID: PMC9072595 DOI: 10.1016/j.apmr.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate test-retest reliability and related measurement properties of items developed to assess best, worst, and average prosthetic socket comfort. DESIGN Methodological research to assess test-retest reliability of 4 individual socket comfort survey items. Socket comfort items were included in a self-report paper survey, which was administered to participants 2 to 3 days apart. SETTING General community. PARTICIPANTS A minimum convenience sample of participants (N=63) was targeted for this study; 72 lower limb prosthesis users (>1y postamputation) completed the survey and were included in the final dataset. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The expanded socket comfort score (ESCS) was adapted from the original socket comfort score (SCS). The original SCS is a single-item self-report instrument developed to assess a lower limb prosthesis user's current socket comfort. Three additional items were designed to assess the user's best, worst, and average socket comfort over the previous 7 days. RESULTS Best, worst, and average socket comfort items demonstrated better reliability, as indicated by higher intraclass correlation coefficients. As such, these items also exhibited lower measurement error and smaller minimal detectable change values than the item that measured current socket comfort. However, test-retest coefficients for all 4 ESCS items were below the level desired for evaluation of within-individual changes of socket comfort. CONCLUSIONS Items that assess best, worst, and average comfort provide a more stable measurement of socket fit than the existing SCS instrument. Although administration of all 4 ESCS items may provide more comprehensive assessment of a lower limb prosthesis user's socket fit, administrators should expect variations in scores over time owing to the variable nature of the underlying construct over time. Future research should examine whether the ESCS provides an improved overall assessment of socket fit.
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Affiliation(s)
- Sara J Morgan
- Gillette Children's Specialty Healthcare, St. Paul, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | | | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
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49
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Does socket liner material affect clinical outcomes in lower limb prosthesis users? Insights from a randomized control trial. Prosthet Orthot Int 2022; 46:199-201. [PMID: 35085177 DOI: 10.1097/pxr.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
Among the noted disadvantages of prosthesis suspension by flexible liner is the increased rate of perspiration within the socket, which has the potential to cause discomfort, suspension issues, and tissue damage. In recent years, phase change material technology has been adopted for the use in prosthesis liners. These promise to improve temperature control and, consequently, reduce sweating. Previous work has demonstrated that this approach is effective in slowing the temperature increase at the limb-socket interface, but it was not clear how this would translate to clinical outcomes. This study had the aim to compare conventional and phase change material liners regarding prosthesis utilization, physical performance, and patient-reported outcome measures. A randomized double-blind cross-over study design with 6-month intervention periods was used. Of the 42 enrolled participants, only 50% completed the protocol. The high attrition was in large part because of the COVID-19 pandemic that started disrupting daily life and thereby the data collection midway through the study period. The findings indicate that the temperature control liners were, by trend, associated with better prosthesis utilization. The found effects did not reach the level of statistical significance, which is likely a result of the unduly reduced sample size.
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50
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Saha R, Wu K, Bloom RP, Liang S, Tonini D, Wang JP. A review on magnetic and spintronic neurostimulation: challenges and prospects. NANOTECHNOLOGY 2022; 33:182004. [PMID: 35013010 DOI: 10.1088/1361-6528/ac49be] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
In the treatment of neurodegenerative, sensory and cardiovascular diseases, electrical probes and arrays have shown quite a promising success rate. However, despite the outstanding clinical outcomes, their operation is significantly hindered by non-selective control of electric fields. A promising alternative is micromagnetic stimulation (μMS) due to the high permeability of magnetic field through biological tissues. The induced electric field from the time-varying magnetic field generated by magnetic neurostimulators is used to remotely stimulate neighboring neurons. Due to the spatial asymmetry of the induced electric field, high spatial selectivity of neurostimulation has been realized. Herein, some popular choices of magnetic neurostimulators such as microcoils (μcoils) and spintronic nanodevices are reviewed. The neurostimulator features such as power consumption and resolution (aiming at cellular level) are discussed. In addition, the chronic stability and biocompatibility of these implantable neurostimulator are commented in favor of further translation to clinical settings. Furthermore, magnetic nanoparticles (MNPs), as another invaluable neurostimulation material, has emerged in recent years. Thus, in this review we have also included MNPs as a remote neurostimulation solution that overcomes physical limitations of invasive implants. Overall, this review provides peers with the recent development of ultra-low power, cellular-level, spatially selective magnetic neurostimulators of dimensions within micro- to nano-range for treating chronic neurological disorders. At the end of this review, some potential applications of next generation neuro-devices have also been discussed.
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Affiliation(s)
- Renata Saha
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Kai Wu
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Robert P Bloom
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Shuang Liang
- Department of Chemical Engineering and Material Science, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Denis Tonini
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Jian-Ping Wang
- Department of Electrical and Computer Engineering, University of Minnesota, Minneapolis, MN 55455, United States of America
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