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Kohler F, Halford GRJ, Lukin M, Hafner BJ, Boone DA, Desmond DM, Franchignoni F, Gailey RS, Hagberg K, Major MJ, Resnik L, Tan JM. Categorization and recommendations for outcome measures for lower limb absence by an expert panel. Prosthet Orthot Int 2023; 47:565-574. [PMID: 37878250 DOI: 10.1097/pxr.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Understanding the psychometric strengths and limitations of outcome measures for use with people with lower limb absence (LLA) is important for selecting measures suited to evaluating patient outcomes, answering clinical and research questions, and informing health care policy. The aim of this project was to review the current psychometric evidence on outcome measures in people with LLA to determine which measures should be included in a stakeholder consensus process. METHODS An expert panel was assembled, and a 3-stage review process was used to categorize outcome measures identified in a systematic literature review into 3 distinct categories (recommended for measures with better than adequate psychometric properties; recommended with qualification; and unable to recommend). Panelists were asked to individually categorize measures based on results of a systematic review of identified measures' psychometric properties. Each measure's final categorization was based on ≥70% agreement by all panelists. RESULTS No outcome measure attained the ≥70% consensus threshold needed to achieve a rating of "recommend." Hence, panelists suggested combining "recommend" and "recommend with qualifications" into a single category of "recommend with qualifications." Using this approach, consensus was reached for 59 of 60 measures. Consensus could not be reached on 1 outcome measure (socket comfort score). Thirty-six outcome measures were categorized as "unable to recommend" based on available evidence; however, 23 (12 patient-reported measures and 11 performance-based measures) demonstrated adequate psychometric properties in LLA samples and were thus rated as "recommend with qualification" by the expert panel. The panel of experts were able to recommend 23 measures for inclusion in the subsequent stakeholder review. A key strength of this process was bringing together international researchers with extensive experience in developing and/or using LLA outcome measures who could assist in identifying psychometrically sound measures to include in a subsequent stakeholder consensus process. CONCLUSION The above categorizations represent the current state of psychometric evidence on outcome measures for people with LLA and hence may change over time as additional research becomes available. The results will be used to achieve wider consensus from clinicians, health policymakers, health clinic managers, researchers, and end users (i.e., individuals with LLA) on outcome measures for the International Society of Prosthetics and Orthotics lower limb Consensus Outcome Measures for Prosthetic and Amputation ServiceS.
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Affiliation(s)
- Friedbert Kohler
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
| | - Gregory R J Halford
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Martina Lukin
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- South Western Sydney Clinical School, Medicine and Health, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Braeside Hospital, HammondCare Health, Sydney, Australia
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - David A Boone
- Orthocare Innovations, Edmonds, WA
- Prosthetics and Orthotics International, Brussels, Belgium
- Exceed Worldwide, Belfast, United Kingdom
| | - Deirdre M Desmond
- Assisting Living and Learning Institute and Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Franco Franchignoni
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Robert S Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL
| | - Kerstin Hagberg
- Department of Orthopaedics, Sahlgrenska University Hospital and Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, Chicago, IL
| | - Linda Resnik
- Providence VA Medical Center, Providence, RI
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI
| | - Jade M Tan
- School of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Providence VA Medical Center, Providence, RI
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Ostler C, Donovan-Hall M, Dickinson A, Metcalf C. Exploring meaningful outcome domains of recovery following lower limb amputation and prosthetic rehabilitation: the patient's perspective. Disabil Rehabil 2023; 45:3937-3950. [PMID: 36368639 DOI: 10.1080/09638288.2022.2138989] [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: 01/12/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE There is currently no consensus regarding what outcome domains to measure following lower limb prosthetic rehabilitation. Prosthetic users have a unique insight into important outcome domains, little is currently known about their critical viewpoint. MATERIALS AND METHODS A total of 37 participants who underwent lower limb amputation in the last five years were recruited from UK limb fitting centres and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis. RESULTS Five themes were identified. 1) The ability to participate in important activities, 2) how participants were able to undertake these activities, i.e., independently, with ease, safely and with minimal equipment. 3) A comfortable, easy-to-use prosthesis, 4) the importance of managing pain and finally, 5) adjusting and accepting their new normal. These five themes, or outcome domains, did not exist in isolation, but appeared to interact with each other, contributing to, or inhibiting the participant's holistic sense of recovery. CONCLUSIONS Understanding important outcome domains that define what recovery means to people following amputation can help to inform domain consensus, as well as direct the focus of rehabilitation. Domain consensus would guide the selection of measurement tools that evaluate prosthetic interventions in a meaningful way.IMPLICATIONS FOR REHABILITATIONThere is currently no consensus around which outcome domains should be measured following prosthetic rehabilitation.Outcome domains of importance from a patient's perspective focus on participation in important activities, prosthesis comfort, pain management, and acceptance of their new normal.Identifying these domains can help direct the focus of rehabilitation as well as inform outcome measurement practice.The interrelated nature of these domains suggests the need for a physical and psychosocial multi-domain approach to outcome measurement in prosthetic rehabilitation, with patient priorities at its centre.
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Affiliation(s)
- Chantel Ostler
- Portsmouth Enablement Centre, Portsmouth Hospitals University Trust, University of Southampton, Portsmouth, UK
| | | | - Alex Dickinson
- Faculty of Engineering, University of Southampton, Southampton, UK
| | - Cheryl Metcalf
- Faculty of Engineering, University of Southampton, Southampton, UK
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Essop-Adam A, Daynes E, Houghton JSM, Nickinson ATO, Sayers RDS, Haunton VJ, Pepper C, Singh SJ. Clinimetrics of performance-based functional outcome measures for vascular amputees: A systematic review. Ann Phys Rehabil Med 2023; 66:101756. [PMID: 37276748 DOI: 10.1016/j.rehab.2023.101756] [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: 05/17/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 06/07/2023]
Abstract
BACKGROUND Objective physical performance-based outcome measures (PerBOMs) are essential tools for the holistic management of people who have had an amputation due to vascular disease. These people are often non-ambulatory, however it is currently unclear which PerBOMs are high quality and appropriate for those who are either ambulatory or non-ambulatory. RESEARCH QUESTION Which PerBOMs have appropriate clinimetric properties to be recommended for those who have had amputations due to vascular disease ('vascular amputee')? DATA SOURCES MEDLINE, CINAHL, EMBASE, EMCARE, the Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus databases were searched for the terms: "physical performance" or "function", "clinimetric properties", "reliability", "validity", "amputee" and "peripheral vascular disease" or "diabetes". REVIEW METHODS A systematic review of PerBOMs for vascular amputees was performed following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology and PRISMA guidelines. The quality of studies and individual PerBOMs was assessed using COSMIN risk of bias and good measurement properties. Overall PerBOM quality was evaluated with a modified GRADE rating. Key clinimetric properties evaluated were reliability, validity, predictive validity and responsiveness. RESULTS A total of 15,259 records were screened. Forty-eight studies (2650 participants) were included: 7 exclusively included vascular amputees only, 35 investigated validity, 20 studied predictive validity, 23 investigated reliability or internal consistency and 7 assessed responsiveness. Meta-analysis was neither possible nor appropriate for this systematic review in accordance with COSMIN guidelines, due to heterogeneity of the data. Thirty-four different PerBOMs were identified of which only 4 are suitable for non-ambulatory vascular amputees. The Amputee Mobility Predictor no Prosthesis (AMPnoPro) and Transfemoral Fitting Predictor (TFP) predict prosthesis use only. PerBOMs available for assessing physical performance are the One-Leg Balance Test (OLBT) and Basic Amputee Mobility Score (BAMS). CONCLUSION At present, few PerBOMs can be recommended for vascular amputees. Only 4 are available for non-ambulatory individuals: AMPnoPro, TFP, OLBT and BAMS.
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Affiliation(s)
- Amirah Essop-Adam
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - Enya Daynes
- National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom; Centre of Exercise and Rehabilitation Sciences, Leicester NIHR Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Sciences, University of Leicester, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - John S M Houghton
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - Andrew T O Nickinson
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - Robert D S Sayers
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, United Kingdom.
| | - Coral Pepper
- Library Service, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - Sally J Singh
- National Institute for Health Research Leicester Biomedical Research Centre, The Glenfield Hospital, Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom; Centre of Exercise and Rehabilitation Sciences, Leicester NIHR Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Respiratory Sciences, University of Leicester, Groby Road, Leicester, LE3 9QP, United Kingdom.
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Tan JM, Halford GRJ, McBain BK, Lukin M, Kohler F. Psychometric properties of outcome measures for lower-limb absence: A protocol for a systematic review. Prosthet Orthot Int 2023; 47:293-299. [PMID: 36811955 DOI: 10.1097/pxr.0000000000000220] [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: 10/31/2021] [Accepted: 01/14/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Outcome measures are an important part of clinical practice to assist with the care of individuals with lower-limb absence (LLA). They aid with the devising and evaluation of rehabilitation plans, and guide decisions regarding the provision and funding of prosthetic services worldwide. To date, no outcome measure has been identified as a gold standard for use in individuals with LLA. Furthermore, the large number of outcome measures available has created uncertainty regarding outcome measures that are most appropriate for individuals with LLA. OBJECTIVE To critically appraise the existing literature related to the psychometric properties of outcome measures for use in individuals with LLA and provide evidence as to which outcome measures may be most appropriate for this clinical population. STUDY DESIGN This is a systematic review protocol. METHODS CINAHL, Embase, MEDLINE (PubMed), and PsycINFO databases will be searched using a combination of Medical Subject Headings terms and keywords. Search terms that define the population (people with LLA or amputation), intervention (outcome measures), and outcome (psychometric properties) will be used to identify studies. The reference lists of included studies will be hand-search to identify other pertinent articles, with a further search conducted through Google Scholar to ensure that all studies not yet indexed through MEDLINE are captured. Full-text peer-reviewed journal studies published in English will be included, with no date limit set. Included studies will be appraised using the 2018 and 2020 COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklists. Data extraction and study appraisal will be completed by two authors, with a third author serving as an adjudicator. Quantitative synthesis will be used to summarize characteristics of the included studies, with kappa statistics used to determine agreement between authors for study inclusion and the application of COSMIN. Qualitative synthesis will be conducted to report on both quality of the included studies and psychometric properties of the included outcome measures. CONCLUSION This protocol was designed to identify, appraise, and summarize patient-reported and performance-based outcome measures that have been psychometrically tested in people with LLA. Results from this review will be used to guide a consensus process on outcome measure use for people with LLA.Systematic review registration: PROSPERO registry number: CRD42020217820.
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Affiliation(s)
- Jade M Tan
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Center, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Gregory R J Halford
- Department of Physiotherapy, Podiatry, and 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
| | - Brodwen K McBain
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Center, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Martina Lukin
- Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, School of Allied Health, Human Services, and Sport, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Center, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- Braeside Hospital, HammondCare Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Friedbert Kohler
- International Society of Prosthetics and Orthotics (ISPO), Copenhagen, Denmark
- Braeside Hospital, HammondCare Health, Sydney, Australia
- University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
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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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Lathouwers E, Díaz MA, Maricot A, Tassignon B, Cherelle C, Cherelle P, Meeusen R, De Pauw K. Therapeutic benefits of lower limb prostheses: a systematic review. J Neuroeng Rehabil 2023; 20:4. [PMID: 36639655 PMCID: PMC9840272 DOI: 10.1186/s12984-023-01128-5] [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: 02/28/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Enhancing the quality of life of people with a lower limb amputation is critical in prosthetic development and rehabilitation. Yet, no overview is available concerning the impact of passive, quasi-passive and active ankle-foot prostheses on quality of life. OBJECTIVE To systematically review the therapeutic benefits of performing daily activities with passive, quasi-passive and active ankle-foot prostheses in people with a lower limb amputation. METHODS We searched the Pubmed, Web of Science, Scopus and Pedro databases, and backward citations until November 3, 2021. Only English-written randomised controlled trials, cross-sectional, cross-over and cohort studies were included when the population comprised individuals with a unilateral transfemoral or transtibial amputation, wearing passive, quasi-passive or active ankle-foot prostheses. The intervention and outcome measures had to include any aspect of quality of life assessed while performing daily activities. We synthesised the participants' characteristics, type of prosthesis, intervention, outcome and main results, and conducted risk of bias assessment using the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021290189. RESULTS We identified 4281 records and included 34 studies in total. Results indicate that quasi-passive and active prostheses are favoured over passive prostheses based on biomechanical, physiological, performance and subjective measures in the short-term. All studies had a moderate or high risk of bias. CONCLUSION Compared to passive ankle-foot prostheses, quasi-passive and active prostheses significantly enhance the quality of life. Future research should investigate the long-term therapeutic benefits of prosthetics devices.
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Affiliation(s)
- Elke Lathouwers
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Alejandra Díaz
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Alexandre Maricot
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Bruno Tassignon
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | | | | | - Romain Meeusen
- grid.8767.e0000 0001 2290 8069Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050 Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, 1050, Brussels, Belgium. .,Brussels Human Robotics Research Center (BruBotics), Vrije Universiteit Brussel, 1050, Brussels, Belgium.
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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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Evidence-Based Amputee Rehabilitation: a Systematic Approach to the Restoration of Function in People with Lower Limb Loss. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-021-00335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lannan FM, Powell J, Kim GM, Hansen CR, Pasquina PF, Smith DG. Hyperhidrosis of the residual limb: a narrative review of the measurement and treatment of excess perspiration affecting individuals with amputation. Prosthet Orthot Int 2021; 45:477-486. [PMID: 34723907 DOI: 10.1097/pxr.0000000000000040] [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: 01/18/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hyperhidrosis (HH) is a relatively common disorder involving excessive sweating, typically of the palms or axilla. HH can also frequently occur after limb amputation, where the remaining residual limb excessively perspires, leading to an increased risk of dermatological disorders and functional limitations, such as the inability to comfortably or safely wear a prosthesis. Although many treatments have been proposed to treat HH within the dermatology community, they are not widely known by healthcare providers typically involved in caring for individuals with acquired limb loss. OBJECTIVES To appraise the current state of quantitative and qualitative assessment of HH within the residual limb and examine existing and future treatment strategies for this problem. STUDY DESIGN Narrative Literature Review. METHODS A literature review focused on the assessment and treatment of excessive sweating of residual limbs. RESULTS There is currently no objective or subjective standard to assess or diagnose HH of the residual limb. Conventional therapies for HH do not always translate to the population of individuals with limb loss. Emerging modalities for treating HH show promise toward a permanent resolution of excess perspiration but require additional studies within people with amputation. CONCLUSIONS Further research is needed to quantify standard values to objectively and subjectively assess and diagnose hyperhidrosis of the residual limb. New and developing treatments for hyperhidrosis require additional studies to assess efficacy and safety in the residual limb.
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Affiliation(s)
- Ford M Lannan
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jordan Powell
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Gabriel M Kim
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Colby R Hansen
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Paul F Pasquina
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Douglas G Smith
- Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Orthopaedic Surgery at the University of Washington, Seattle, Washington
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10
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Ranker A, Örgel M, Schiller J, Egen C, Ranker AH, Greitemann B, Gutenbrunner C. [Translation, Adaptation, Reliability and Validity of the German Version of the Prosthesis Mobility Questionnaire 2.0 (PMQ) on Patients with Major Lower Limb Amputation]. REHABILITATION 2021; 60:374-383. [PMID: 34293808 DOI: 10.1055/a-1506-7603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this prospective validation study was to translate the Prosthesis Mobility Questionnaire 2.0 (PMQ) into German based on a guideline, following by psychometric testing for its validity and reliability using classical test theory. METHODS The PMQ was translated into German according to ISPOR guidelines using double forward and double backward translations, finalized by pilot testing (N=10). Subsequently, assessment of the validity and reliability was performed from March 2020 to August 2020 on N=61 patients with unilateral lower limb amputation. Construct validity was determined by using the German version of the Locomotor Capabilities Index-5 (LCI-5-D), the Rivermead Mobility Index (RMI), the Timed up and go Test (TUG), and K-levels. Cronbach's alpha was calculated to check internal consistency and discriminatory power was determined by item correlations. Test-retest reliability was calculated using ICC (2,1). Based on the ICC, the minimum detectable difference (MDC) was calculated. RESULTS The translation process required small changes after the pilot test. The validation study was performed on N=61 patients (56.59±13.16 years, m/f=38/23). A mean PMQ of 26.23±8.89 points was achieved. Ceilings or floor effects for total score did not appear. Construct validity showed strong positive correlations to LCI-5-D (r=0.74, p<0.001), RMI (r=0.63 p<0.001) as well as k-levels (r=0.61 p<0.001) and moderate negative correlation to TUG (r=- 0.49, p<0.001). Internal consistency was excellent with Cronbach's alpha=0.95). All items showed a value greater than r=0.40 for item-to-total score correlation. Test-retest reliability was excellent with an ICC (2,1)=0.98 with a timespan between T0 and T1 of 3.2±2.83 days. Based on this results, the MDC was 3.40 points. CONCLUSION The German version of the Prosthesis Mobility Questionnaire 2.0 is a valid, reliable patient reported outcome measure (PROM) for measuring mobility and functional ability of patients with exoprosthesis due to unilateral lower limb amputation. It can be used for a German-speaking population.
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Affiliation(s)
- Alexander Ranker
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover
| | - Marcus Örgel
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover
| | - Jörg Schiller
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover
| | - Christoph Egen
- Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover
| | - Anna Helena Ranker
- Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität (LMU), München
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11
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Karczewski AM, Dingle AM, Poore SO. The Need to Work Arm in Arm: Calling for Collaboration in Delivering Neuroprosthetic Limb Replacements. Front Neurorobot 2021; 15:711028. [PMID: 34366820 PMCID: PMC8334559 DOI: 10.3389/fnbot.2021.711028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few decades there has been a push to enhance the use of advanced prosthetics within the fields of biomedical engineering, neuroscience, and surgery. Through the development of peripheral neural interfaces and invasive electrodes, an individual's own nervous system can be used to control a prosthesis. With novel improvements in neural recording and signal decoding, this intimate communication has paved the way for bidirectional and intuitive control of prostheses. While various collaborations between engineers and surgeons have led to considerable success with motor control and pain management, it has been significantly more challenging to restore sensation. Many of the existing peripheral neural interfaces have demonstrated success in one of these modalities; however, none are currently able to fully restore limb function. Though this is in part due to the complexity of the human somatosensory system and stability of bioelectronics, the fragmentary and as-yet uncoordinated nature of the neuroprosthetic industry further complicates this advancement. In this review, we provide a comprehensive overview of the current field of neuroprosthetics and explore potential strategies to address its unique challenges. These include exploration of electrodes, surgical techniques, control methods, and prosthetic technology. Additionally, we propose a new approach to optimizing prosthetic limb function and facilitating clinical application by capitalizing on available resources. It is incumbent upon academia and industry to encourage collaboration and utilization of different peripheral neural interfaces in combination with each other to create versatile limbs that not only improve function but quality of life. Despite the rapidly evolving technology, if the field continues to work in divided "silos," we will delay achieving the critical, valuable outcome: creating a prosthetic limb that is right for the patient and positively affects their life.
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Affiliation(s)
| | - Aaron M. Dingle
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin–Madison, Madison, WI, United States
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12
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van Rooij WM, Maas-van Weert KC, van Kempen RW, de Laat FA, Geertzen JH. A modified Gritti-Stokes amputation technique as a solution for recurring aseptic loosening of a knee arthroplasty: A single-patient case study. Prosthet Orthot Int 2021; 45:85-88. [PMID: 33834749 DOI: 10.1177/0309364620946913] [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] [Indexed: 02/03/2023]
Abstract
CASE DESCRIPTION A 56-year-old man with persistent knee pain and poor physical functioning due to recurring loosening of a (revised) total knee arthroplasty, was treated with a modified Gritti-Stokes amputation. OBJECTIVES to describe the modified Gritti-Stokes amputation technique as an ultimate therapy for failed total knee arthroplasty and to assess the functional outcome for one patient 1 year post-surgery. STUDY DESIGN a single patient case study. TREATMENT a modified Gritti-Stokes amputation, with removal of the overlying cartilage and subchondral surfaces of both the patella and femur after removing the total knee arthroplasty. OUTCOMES After rehabilitation, the patient has a fully end-bearing residual limb, is able to walk without pain (with a prosthesis) and perform his daily activities. CONCLUSIONS In cases of recurring loosening of a (revised) total knee arthroplasty, a modified Gritti-Stokes amputation can create an end-bearing residual limb without pain and with good functional outcome.
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Affiliation(s)
| | | | - Robin Wtm van Kempen
- Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Fred A de Laat
- Libra Rehabilitation & Audiology, Eindhoven, The Netherlands
| | - Jan Hb Geertzen
- Department of Rehabilitation Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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13
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Miller R, Ambler GK, Ramirez J, Rees J, Hinchliffe R, Twine C, Rudd S, Blazeby J, Avery K. Patient Reported Outcome Measures for Major Lower Limb Amputation Caused by Peripheral Artery Disease or Diabetes: A Systematic Review. Eur J Vasc Endovasc Surg 2020; 61:491-501. [PMID: 33388237 DOI: 10.1016/j.ejvs.2020.11.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Most major lower limb amputations are related to peripheral artery disease (PAD) or diabetes. Just 40% of patients who undergo major lower limb amputation will use a prosthesis yet measures of surgical success commonly focus on prosthesis use. Patient reported outcome measures (PROMs) are valuable to comprehensively evaluate health related quality of life (HRQL) after surgery. This systematic review aimed to identify and describe PROMs available to assess HRQL in patients after amputation for PAD or diabetes. METHODS A search was conducted based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for systematic reviews of PROMs. Ovid MEDLINE, Ovid EMBASE, PsycINFO, CINAHL, and Cochrane CENTRAL were also searched from inception until August 2019. Included were articles describing the development, measurement properties, or evaluation of HRQL via a PROM in adult patients after amputation for PAD or diabetes. Studies of amputation exclusively for trauma or malignancy were excluded. Data were collected on study characteristics, PROM characteristics (generic/disease specific), and properties of amputation specific PROMs. RESULTS Of 3 317 abstracts screened, 111 full text articles were assessed for eligibility and 64 included. Fifty-six studies evaluated HRQL, with 23 (46%) of these using an amputation specific PROM to do so. Eleven different amputation specific PROMs were identified, 10 (91%) of which were developed only for prosthesis users. One measure was suitable for use in all patients after amputation. This "Amputee single item mobility measure" includes a single item evaluating mobility. Nine studies reported some psychometric testing of an amputation specific PROM. CONCLUSION A well tested, multidimensional PROM applicable to wheelchair and prosthetic users after amputation is lacking and urgently needed for studies in this field. Future work to develop an appropriate measure is required.
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Affiliation(s)
- Rachael Miller
- Centre for Surgical Research, University of Bristol, UK; North Bristol NHS Trust, Bristol, UK.
| | - Graeme K Ambler
- Centre for Surgical Research, University of Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | - Jozel Ramirez
- Centre for Surgical Research, University of Bristol, UK; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Rees
- Centre for Surgical Research, University of Bristol, UK; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Robert Hinchliffe
- Centre for Surgical Research, University of Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | | | | | - Jane Blazeby
- Centre for Surgical Research, University of Bristol, UK; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Kerry Avery
- Centre for Surgical Research, University of Bristol, UK
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14
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Lee SP, Chien LC, Chin T, Fox H, Gutierrez J. Financial difficulty in community-dwelling persons with lower limb loss is associated with reduced self-perceived health and wellbeing. Prosthet Orthot Int 2020; 44:290-297. [PMID: 32484076 PMCID: PMC8247678 DOI: 10.1177/0309364620921756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Socioeconomic status has been shown to be an important factor in the disparate prevalence and selected treatment of limb loss, but how personal financial difficulty affects patients' health outcomes is currently unclear. OBJECTIVE Examining how presence and experience of personal financial difficulty affects perceived health and wellbeing in individuals with lower limb loss. STUDY DESIGN Cross-sectional study. METHODS A total of 90 participants (68 males, mean age 58.7 ± 16.7 years) were recruited from local physical therapy and prosthetic and orthotic clinics, rehabilitation hospitals, and a regional amputee patient support group. All participants were community-dwelling, non-military adults with amputation involving at least one major lower limb joint. Participants were interviewed, and each completed a survey that included basic demographic/medical information, self-reported health and wellbeing (Short-Form Health Survey, SF-36v2), and a question to determine their financial situation after limb loss. Multiple regression analyses were used to examine the effect of financial difficulty on the eight subscales of SF-36v2 while accounting for age, gender, and amputation level. RESULTS Experiencing financial difficulty significantly and negatively affected Role-Physical and Role-Emotional subscale scores (p < 0.01 and p = 0.02, respectively). Individuals with financial difficulty scored approximately 60% lower in these two specific subscales. CONCLUSION Experiencing financial difficulty is a significant predictor for diminished work or daily activity participation due to physical and emotional stresses. Clinicians and health policy makers need to understand how socioeconomic factors may prevent individuals with lower limb loss from achieving higher levels of functional recovery and community re-integration after amputation. CLINICAL RELEVANCE Our findings showed that presence or experience of financial difficulty was significantly associated with diminished community re-integration in community-dwelling, non-military adults with lower limb loss. It affects both physical and emotional aspects of wellbeing. Clinicians should be aware how socioeconomic factors may affect social re-integration after amputation.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Lung-Chang Chien
- Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Tyler Chin
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Heather Fox
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Juan Gutierrez
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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15
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Gailey R, Gaunaurd I, Raya M, Kirk-Sanchez N, Prieto-Sanchez LM, Roach K. Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial. Phys Ther 2020; 100:773-787. [PMID: 31951260 DOI: 10.1093/ptj/pzaa008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/06/2019] [Accepted: 11/24/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Despite the prevalence of lower limb amputation (LLA), only a small percentage of people with LLA actually receive physical therapy post amputation and are rehabilitated to their full potential level of function. There is a need for the development of a rehabilitation program that targets impairments and limitations specific to people with LLA. OBJECTIVE The objective of this study was to determine whether the Evidence-Based Amputee Rehabilitation program would improve functional mobility of people with unilateral transtibial amputation (TTA) who have already completed physical therapy and prosthetic training. DESIGN This study was a randomized, wait-list control, single-blinded pilot clinical trial. SETTING This study researched participants who had received postamputation rehabilitation to varying degrees, either in an inpatient and/or outpatient settings. PARTICIPANTS The participants in this study included veterans and nonveterans with unilateral TTA due to dysvascular disease and trauma. INTERVENTION This study included a prescription-based rehabilitation program for people with amputations. MEASUREMENTS Results were measured with The Amputee Mobility Predictor with (AMPPro) and without a prosthesis (AMPnoPro) and 6-Minute Walk Test (6MWT) at baseline and at the end of the 8-week intervention. RESULTS The intervention group improved on the AMPPro scores (36.4 to 41.7), AMPnoro scores (23.2 to 27.1), and 6MWT distance (313.6 to 387.7 m). The effect size for the intervention was very large (1.32). In contrast, the wait-list control group demonstrated no change in AMPPro scores (35.3 to 35.6), AMPnoPro scores (24.7 to 25.0), and 6MWT distance (262.6 m to 268.8 m). LIMITATIONS The sample size was small. A total 326 potential candidates were screened with 306 unable to meet inclusion criteria or unwilling to participate. CONCLUSION People with unilateral TTA who received Evidence-Based Amputee Rehabilitation program demonstrated significant improvement in functional mobility, with most participants (66.7%) improved at least 1 K-level (58.3%) and greater than the minimal detectable change (66.7%).
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Affiliation(s)
- Robert Gailey
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Boulevard, 5th Floor, Coral Gables, FL 33146 USA.,Functional Outcomes Research and Evaluation (FORE) Center, University of Miami.,Research Department, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Ignacio Gaunaurd
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Boulevard, 5th Floor, Coral Gables, FL 33146 USA.,Functional Outcomes Research and Evaluation (FORE) Center, University of Miami.,Research Department, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Michele Raya
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Boulevard, 5th Floor, Coral Gables, FL 33146 USA
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Boulevard, 5th Floor, Coral Gables, FL 33146 USA
| | | | - Kathryn Roach
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Boulevard, 5th Floor, Coral Gables, FL 33146 USA
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Long-term quality of life after preoperative radiochemotherapy in patients with localized and locally advanced breast cancer. Strahlenther Onkol 2020; 196:386-397. [PMID: 31919547 DOI: 10.1007/s00066-019-01557-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/21/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Preoperative radiotherapy (PRT) or radiochemotherapy (PRCT) is used in different tumor sites. The aim of the study was to examine the long-term quality of life (QoL) of localized / locally advanced breast cancer patients treated with PRT/PRCT followed by breast-conserving surgery (BCS) or mastectomy (ME). METHODS Assessment of QoL was done using EORTC QLQ-C30 questionnaires for overall QoL and EORTC QLQ-BR23 for breast-specific QoL. The summary scores were categorized into 4 distinct groups to classify the results. Furthermore, a comparative analysis was performed between the study cohort and a previously published reference cohort of healthy adults. We assessed the impact of different clinical, prognostic, and treatment-related factors on selected items from C30 and BR23 using a dependence analysis. RESULTS Out of 315 patients treated with PRT/PCRT in the years 1991 to 1999, 203 patients were alive at long-term follow-up after a mean of 17.7 years (range 14-21). 37 patients were lost to follow-up and 61 patients refused to be contacted, leading to 105 patients (64 patients after BCS and 41 after ME) being willing to undergo further clinical assessment regarding QoL outcome. Overall, QoL (QLQ-C30) was rated "excellent" or "good" in 85% (mean value) of all patients (BCS 83%, ME 88%). Comparative analysis between the study cohort and a published healthy control group revealed significantly better global health status and physical and role functioning scores in the PRT/PRCT group. The analysis demonstrates no differences in nausea/vomiting, dyspnea, insomnia, constipation, or financial difficulties. According to the dependence analysis, global QoL was associated with age, operation type and ME reconstruction. CONCLUSION We did not detect any inferiority of PRT/PRCT compared to a healthy reference group with no hints of a detrimental long-term effect on general and breast-specific quality of life.
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