1
|
Dupuis F, Ginis KAM, MacKay C, Best KL, Blanchette V, Cherif A, Robert MT, Miller WC, Gee C, Habra N, Brousseau-Foley M, Zidarov D. Do Exercise Programs Improve Fitness, Mobility, and Functional Capacity in Adults With Lower Limb Amputation? A Systematic Review on the Type and Minimal Dose Needed. Arch Phys Med Rehabil 2024; 105:1194-1211. [PMID: 37926223 DOI: 10.1016/j.apmr.2023.10.011] [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: 04/11/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? DESIGN Systematic review. SETTING Outpatient intervention, outside of the prosthetic rehabilitation phase. PARTICIPANTS Adults with lower limb amputation living in the community. INTERVENTION Any physical activity or exercise intervention. OUTCOMES AND MEASURES Any fitness, mobility, or functional capacity indicators and measurements. RESULTS Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower-limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. CONCLUSION Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status.
Collapse
Affiliation(s)
- Frédérique Dupuis
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Kathleen A Martin Ginis
- Department of Medicine and Centre for Chronic Disease Prevention and Management and International Collaboration on Repair Discoveries, Faculty of Medicine, School of Health and Exercise Sciences, Faculty of Health and Social Development, and Reichwald Health Sciences Centre, University of British Columbia, Kelowna, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, York, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Krista L Best
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Virginie Blanchette
- Université du Québec à Trois-Rivières, Department of Human Kinetics and Podiatric Medicine and VITAM: Sustainable Health Research Centre, Trois-Rivières, Canada
| | - Amira Cherif
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - Maxime T Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Québec, Canada; Université Laval, Faculty of Medicine, Department of Rehabilitation, Québec, Canada
| | - William C Miller
- University of British Columbia, Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Vancouver, Canada
| | - Cameron Gee
- University of British Columbia, Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Vancouver, Canada
| | - Natalie Habra
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Magalie Brousseau-Foley
- Université du Québec à Trois-Rivières, Department of Human Kinetics and Podiatric Medicine, Trois-Rivières, Canada
| | - Diana Zidarov
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.
| |
Collapse
|
2
|
Wijekoon A, Jayawardana S, Milton-Cole R, Chandrathilake K, Jones A, Cook S, Morrison E, Sheehan KJ. Response to Letter to the Editor on "Effectiveness and Equity in Community-based Rehabilitation on Pain, Physical Function, and Quality of Life Following Unilateral Lower Limb Amputation: A Systematic Review". Arch Phys Med Rehabil 2024; 105:1221-1222. [PMID: 38521497 DOI: 10.1016/j.apmr.2024.02.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Ashan Wijekoon
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhian Milton-Cole
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| | - Krm Chandrathilake
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Amy Jones
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, Bowley Close, Farquhar Road, London SE19 SZ, UK
| | - Sophie Cook
- Amputee Rehabilitation Unit, Lambeth Community Care Centre, Guys and St Thomas' NHS Foundation Trust, Monkton Street, Kennington, London SE11 4TX, UK
| | - Ed Morrison
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, Bowley Close, Farquhar Road, London SE19 SZ, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London SE1 1UL, UK
| |
Collapse
|
3
|
Kurtoğlu A, Konar N, Akçınar F, Alotaibi MH, Elkholi SM. The Response of the Amputee Athlete Heart to Chronic Core Exercise: A Study on Hematological and Biochemical Parameters, and N-Terminal Pro Brain Natriuretic Peptide. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:784. [PMID: 38792967 PMCID: PMC11123260 DOI: 10.3390/medicina60050784] [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: 04/17/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: mortality and morbidity due to cardiovascular causes are frequently experienced in amputees. Research on the effects of chronic exercise on biomarkers and cardiac damage indicators in these individuals is limited. The aim of this study was to investigate the effects of a core training program on brain natriuretic-related peptide, as well as hematological and biochemical parameters in amputee soccer players. Materials and Methods: The participants were randomly allocated to the following two groups: a core exercise group (CEG) and a control group (CG). While the CG continued routine soccer training, the CEG group was included in a core exercise program different from this group. During the study, routine hemogram parameters of the participants, various biochemical markers, and the concentration of brain natriuretic-related peptide (NT-pro-BNP) were analyzed. Results: after the training period, notable improvements in various hematological parameters were observed in both groups. In the CEG, there were significant enhancements in red blood cell count (RBC), hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular hemoglobin (MCH) values. Similarly, the CG also showed substantial improvements in RBC, HCT, mean corpuscular volume (MCV), MCHC, MCH, red cell distribution width-standard deviation (RDW-SD), platelet-to-lymphocyte ratio (PLCR), mean platelet volume (MPV), and platelet distribution width (PDW). Moreover, in the CEG, serum triglycerides (TG) and maximal oxygen uptake (MaxVO2) exhibited significant increases. Conversely, TG levels decreased in the CG, while high-density lipoprotein (HDL), low-density lipoprotein (LDL), and MaxVO2 levels demonstrated substantial elevations. Notably, the N-terminal pro-brain natriuretic peptide (BNP) levels did not undergo significant changes in either the CEG or the CG following the core exercise program (p > 0.05). However, in the CEG, a meaningful positive correlation was observed between NT-pro-BNP and creatine kinase (CK) levels before and after the core exercise program. Conclusions: the findings emphasized the potential benefits of core training in enhancing specific physiological aspects, such as erythrocyte-related parameters and lipid metabolism, as well as aerobic capacity. Furthermore, the observed correlation between NT-pro-BNP and CK levels in the CEG provides intriguing insights into the unique physiological adaptations of amputee athletes.
Collapse
Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandirma Onyedi Eylul University, 10200 Balikesir, Turkey
| | - Nurettin Konar
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Bandirma Onyedi Eylul University, 10200 Balikesir, Turkey
| | - Faruk Akçınar
- Department of Coaching Education, Faculty of Sport Science, Inonu University, 44000 Malatya, Turkey
| | - Madawi H. Alotaibi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Safaa M. Elkholi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| |
Collapse
|
4
|
Yıldırım Şahan T, Aydoğan Arslan S, Söyler O. Investigation of the validity and reliability of the 3-meter backward walk test in high functional level adults with lower limb amputation. Prosthet Orthot Int 2024; 48:190-195. [PMID: 38091353 DOI: 10.1097/pxr.0000000000000310] [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: 09/06/2022] [Accepted: 10/22/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Backward walk training has an important place in the rehabilitation programs of lower extremity amputees. OBJECTIVE This study aimed to investigate the test-retest validity and reliability of the 3-meter backward walk test (3MBWT), minimal detectable change, and the cutoff time in high functional level adults with lower limb amputations (LLAs). Adults with LLA (n = 30) and healthy adults (n = 29) were included in the study. STUDY DESIGN This is a randomized cross-sectional study. METHODS The Modified Fall Efficacy Score, Rivermead Mobility Index, and Timed Up and Go test with the 3MBWT were used to evaluate the concurrent validity of the test. The second evaluation (retest) was performed by the same physiotherapist 1 week following the first evaluation (test). The validity was assessed by correlating the 3MBWT times with the scores of other measures and by comparing the 3MBWT times between adults with LLA and healthy adults. RESULTS Test-retest reliability of the 3MBWT was excellent. The intraclass correlation coefficient for the 3MBWT was 0.950. The standard error of measurement and minimal detectable change values were 0.38 and 0.53, respectively. A moderate correlation was found between the 3MBWT, Modified Fall Efficacy Score, Timed Up and Go test, and Rivermead Mobility Index ( p < 0.001). Significant differences in the 3MBWT times were found between adults with LLA and healthy controls ( p < 0.001). The cutoff time of 3.11 s discriminates healthy adults from high functional level adults with LLA. CONCLUSIONS The 3MBWT was determined to be valid, reliable, and easy-to-apply tool in high functional level adults with LLA. This assessment is a useful and practical measurement for dynamic balance in high functional level adults with LLA.
Collapse
Affiliation(s)
- Tezel Yıldırım Şahan
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Science Turkey, Ankara, Turkey
| | - Saniye Aydoğan Arslan
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - Osman Söyler
- Physiotherapy and Rehabilitation Department, Institute of Health Science, Lokman Hekim University, Ankara, Turkey
| |
Collapse
|
5
|
Madou E, Sureshkumar A, Payne MW, Viana R, Hunter SW. The effect of exercise interventions on gait outcomes in subacute and chronic rehabilitation from lower-limb amputation: A systematic review and meta-analysis. Prosthet Orthot Int 2024; 48:128-148. [PMID: 37615607 DOI: 10.1097/pxr.0000000000000255] [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: 07/21/2022] [Accepted: 06/09/2023] [Indexed: 08/25/2023]
Abstract
Successful walking is a substantial contributor to quality of life in people with lower-limb amputation (PLLA), yet gait difficulties are common. Evidence-based exercise guidelines are necessary for PLLA with different clinical characteristics and at different phases of recovery. To systematically review the literature evaluating effects of exercise interventions on gait outcomes in PLLA at subacute and chronic stages of recovery. Databases MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, and the Cochrane Library were searched (inception to May 10, 2022). Inclusion criteria: randomized controlled trials assessing gait outcomes following exercise intervention; subjects were PLLA ≥18 years of age and used a prosthesis for walking. Meta-analysis using random effects with inverse variance to generate standardized mean differences (SMDs) was completed for primary gait outcomes. Subgroup analysis was conducted for the recovery phase (i.e., subacute and chronic) and level of amputation (e.g., transfemoral and transtibial). Of 16 included articles, 4 studies examined the subacute phase of recovery, whereas 12 examined the chronic phase. Subacute interventions were 30 minutes, 1-7 times/week, for 2-12 weeks. Chronic interventions were 15-60-minutes, 2-3 times/week, for 4-16 weeks. Low-moderate level evidence was shown for a small improvement in the subacute phase (SMD = 0.42, 95% confidence interval [0.06-0.79], I 2 = 46.0%) and a moderate improvement in the chronic phase (SMD = 0.67, 95% confidence interval [0.40-0.94], I 2 = 0.0%) in favor of exercise intervention groups. Multicomponent exercise programs consisting of gait, balance, and strength training are effective at improving gait outcomes in PLLA at subacute and chronic phases of recovery. The optimal duration and frequency of exercise is unclear because of variation between interventions, highlighting an area for future work.
Collapse
Affiliation(s)
- Edward Madou
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Ashvene Sureshkumar
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Michael W Payne
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
6
|
Asher M, Strike S, Diss C. Training program intervention to encourage physical activity for health in people with transtibial amputation: A feasibility study. Prosthet Orthot Int 2024; 48:122-127. [PMID: 37708344 DOI: 10.1097/pxr.0000000000000280] [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: 09/08/2022] [Accepted: 07/20/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND People with transtibial amputation (PTTA) would benefit from increased physical activity levels (PAL) but generic programs developed to support increased PAL do not address the barriers which PTTA experience. OBJECTIVE To evaluate the effect of a 12-week training program, developed for PTTA, on their PAL. METHODS Ten PTTA participated in a 12-week training program, which involved one instructor-led supervised group session per week. The program incorporated balance, flexibility, cardiovascular endurance, strength, and agility, as well as educational elements. Personalized starting level and progression intensity were based on the instructor's assessment in the first training session. The effect of the intervention on PAL (self-report questionnaire and accelerometer), fitness, walking symmetry, and adverse effects was determined by analysis of variance before and after the intervention. RESULTS There was a significant increase in self-reported time in moderate-intensity activity and accelerometer-measured step count and time in movement after the program compared with baseline ( p = 0.02). The distance walked in the Six-Minute Walk Test (6MWT) ( p < 0.001), time to perform agility test ( p = 0.01), and lower-limb strength power ( p = 0.01) and endurance ( p = 0.01) were significantly greater after the program, and no adverse effects were identified. CONCLUSIONS This study demonstrated an intervention designed specifically for PTTA that can increase PAL.
Collapse
Affiliation(s)
- Miranda Asher
- Life Sciences Department, University of Roehampton, London, United Kingdom
| | | | | |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Clemens S, Pew C. A pilot study comparing prosthetic to sound limb gait mechanics during a turning task in people with transtibial amputation. Clin Biomech (Bristol, Avon) 2023; 109:106077. [PMID: 37643570 DOI: 10.1016/j.clinbiomech.2023.106077] [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: 03/06/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Observational gait analysis is frequently used by clinicians to subjectively assess straight walking but is not often used to examine turning. Interlimb comparisons of phase- specific turning biomechanics in people with unilateral lower limb amputation has not previously been documented. METHODS A retrospective examination of gait kinematics and kinetics from five participants with unilateral transtibial amputation was performed. Data were collected during 90° step and spin turns capturing three distinct turning steps. Gait metrics of interest included: total turn time, stance time, peak knee flexion angle during Pre-Swing and Initial Swing gait phases, peak hip flexion and extension, ground reaction impulse, and whole body angular momentum. Statistical comparisons were made based on turn type between sound and prosthetic limbs. FINDINGS During the three turn steps (approach, apex, depart), participants spent significantly more time (P < 0.01) on their sound limb compared to their prosthetic limb regardless of turn type. Additionally, the prosthetic limb hip and knee exhibited more flexion (P < 0.05) during the apex step of turns, and whole body angular momentum was higher when the sound limb was used during the apex step of a turn (P < 0.05). INTERPRETATION This descriptive study offers the first phase-specific quantification of turning biomechanics in people with lower limb amputation. Results indicate that people with unilateral transtibial amputation spend more time on and experience higher impulses through their sound compared to their prosthetic limb during 90° turns, and that the prosthetic limb is performing differently than the sound limb, potentially increasing risks of injury or falls.
Collapse
Affiliation(s)
- Sheila Clemens
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY 40536, USA.
| | - Corey Pew
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT 59717, USA
| |
Collapse
|
9
|
Wijekoon A, Jayawardana S, Milton-Cole R, Chandrathilaka M, Jones A, Cook S, Morrison E, Sheehan KJ. Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review. Arch Phys Med Rehabil 2023; 104:1484-1497. [PMID: 36893877 DOI: 10.1016/j.apmr.2023.02.009] [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: 08/01/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial amputation on pain, physical function, and quality of life and (2) the extent of inequities (unfair, avoidable differences in health) in access to identified interventions. DATA SOURCES Embase, MEDLINE, PEDro, Cinahl, Global Health, PsycINFO, OpenGrey, and ClinicalTrials.gov were systematically searched from inception to August 12, 2021, for published, unpublished, and registered ongoing randomized controlled trials. STUDY SELECTION Three review authors completed screening and quality appraisal in Covidence using the Cochrane Risk of Bias Tool. Included were randomized controlled trials of exercise-based rehabilitation interventions based in the community or at home for adults with transfemoral or transtibial amputation that assessed effectiveness on pain, physical function, or quality of life. DATA EXTRACTION Effectiveness data were extracted to templates defined a priori and the PROGRESS-Plus framework was used for equity factors. DATA SYNTHESIS Eight completed trials of low to moderate quality, 2 trial protocols, and 3 registered ongoing trials (351 participants across trials) were identified. Interventions included cognitive behavioral therapy, education, and video games, combined with exercise. There was heterogeneity in the mode of exercise as well as outcome measures employed. Intervention effects on pain, physical function, and quality of life were inconsistent. Intervention intensity, time of delivery, and degree of supervision influenced reported effectiveness. Overall, 423 potential participants were inequitably excluded from identified trials (65%), limiting the generalizability of interventions to the underlying population. CONCLUSIONS Interventions that were tailored, supervised, of higher intensity, and not in the immediate postacute phase showed greater promise for improving specific physical function outcomes. Future trials should explore these effects further and employ more inclusive eligibility to optimize any future implementation.
Collapse
Affiliation(s)
- Ashan Wijekoon
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhian Milton-Cole
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Amy Jones
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Cook
- Amputee Rehabilitation Unit, Lambeth Community Care Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Ed Morrison
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
10
|
Deans S, Kirk A, McGarry A, Rowe DA, Dall PM. A Comparison of Objectively Measured Free-Living Physical Behaviour in Adults with and without Lower Limb Amputation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6198. [PMID: 37444046 PMCID: PMC10340783 DOI: 10.3390/ijerph20136198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
Objectively monitored free-living physical behaviours of adults with and without lower limb amputation (LLA) were compared. METHODS 57 adults with LLA wore an activPAL3™ for 8 days. A comparison data set (n = 57) matched on gender, age and employment status was used. Variables included: time sitting; standing; stepping; sit-to-stand transitions; step count and cadence. Comparisons were made between adults with and without LLA and between gender, level and cause of amputation. RESULTS Participants with LLA due to trauma versus circulatory causes were less sedentary and more active; however, no difference in physical behaviour was recorded across gender or level of amputation. Participants with LLA spent more time sitting (p < 0.001), less time standing and stepping (p < 0.001) and had a lower step count (p < 0.001). Participants with LLA took more steps in cadence bands less than 100 steps·min-1 and fewer steps in cadence bands greater than 100 steps·min-1 compared to participants without LLA. CONCLUSIONS People with LLA were less active and more sedentary than people without LLA and participated in less activity at a moderate or higher intensity when matched on age, gender and employment. Interventions are needed to promote active lifestyles in this population.
Collapse
Affiliation(s)
- Sarah Deans
- National Centre for Prosthetics and Orthotics, Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NS, UK; (S.D.); (A.M.)
| | - Alison Kirk
- Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK;
| | - Anthony McGarry
- National Centre for Prosthetics and Orthotics, Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NS, UK; (S.D.); (A.M.)
| | - David A. Rowe
- Physical Activity for Health, School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1QE, UK;
| | - Philippa M. Dall
- Research Centre for Health, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| |
Collapse
|
11
|
Zhu Y, Wu X, Zhang W, Zhang H. Limb-salvage surgery versus extremity amputation for early-stage bone cancer in the extremities: a population-based study. Front Surg 2023; 10:1147372. [PMID: 37325420 PMCID: PMC10264616 DOI: 10.3389/fsurg.2023.1147372] [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: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background Many attempts have been made to induce limb salvage as an alternative to amputation for primary bone cancer in the extremities, but efforts to establish its benefits over amputation yielded inconsistent results with regard to outcomes and functional recovery. This study aimed to investigate the prevalence and therapeutic efficiency of limb-salvage tumor resection in patients with primary bone cancer in the extremities, and to compare it with extremity amputation. Methods Patients diagnosed with T1-T2/N0/M0 primary bone cancer in the extremities between 2004 and 2019 were retrospectively identified from the Surveillance, Epidemiology, and End Results program database. Cox regression models were used to test for statistical differences between overall survival (OS) and disease-specific survival (DSS). The cumulative mortality rates (CMRs) for non-cancer comorbidities were also estimated. The evidence level in this study was Level IV. Results A total of 2,852 patients with primary bone cancer in the extremities were included in this study, among which 707 died during the study period. Of the patients, 72.6% and 20.4% underwent limb-salvage resection and extremity amputation, respectively. In patients with T1/T2-stage bone tumors in the extremities, limb-salvage resection was associated with significantly better OS and DSS than extremity amputation (OS: adjusted HR, 0.63; 95% confidence interval [CI], 0.55-0.77; p < 0.001; DSS: adjusted HR, 0.70; 95% CI, 0.58-0.84; p < 0.001). Limb-salvage resection was associated with significantly better OS and DSS than extremity amputation for patients with limb osteosarcoma (OS: adjusted HR, 0.69; 95% CI, 0.55-0.87; p = 0.001; DSS: adjusted HR, 0.73; 95% CI, 0.57-0.94; p = 0.01). Mortality from cardiovascular diseases and external injuries was remarkably declined in primary bone cancer in the extremities patients who underwent limb-salvage resection (cardiovascular diseases, p = 0.005; external injuries, p = 0.009). Conclusion Limb-salvage resection exhibited excellent oncological superiority for T1/2-stage primary bone tumors in the extremities. We recommend that patients with resectable primary bone tumors in the extremities undergo limb-salvage surgery as the first choice of treatment.
Collapse
|
12
|
Grecco MV, Brech GC, Soares-Junior JM, Baracat EC, Greve JMD, Silva PRS. Effect of concurrent training in unilateral transtibial amputees using Paralympic athletes as a control group. Clinics (Sao Paulo) 2023; 78:100165. [PMID: 37037074 PMCID: PMC10126662 DOI: 10.1016/j.clinsp.2023.100165] [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: 07/20/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 04/12/2023] Open
Abstract
CONTEXT Transtibial Amputation (TA) predisposes to a sedentary lifestyle. OBJECTIVES To evaluate the efficiency of a short-term (8-week) Concurrent Training (CT) program in Unilateral Transtibial Amputees (UTA) and to compare it with the physical condition of a group of Paralympic athletes in preparation for the Rio de Janeiro Paralympics. DESIGN This was a longitudinal, prospective and controlled trial study. METHODS Thirty-four male subjects with UTA and using prostheses for six months or more were selected for this study. They were divided into two groups: Group 1 (G1) ‒ 17 non-athlete and untrained UTA and Group 2 (G2) ‒ 17 paralympic athletes with active UTA in the training phase. G1 was evaluated before and after eight weeks of CT and G2 made a single evaluation for control. All were submitted to anamnesis, clinical evaluation (blood pressure, electrocardiogram, and heart rate) and cardiopulmonary exercise testing on a lower limb cycle ergometer, and isokinetic knee dynamometry. The CT of G1 included resistance exercise and aerobic interval training on a stationary bicycle and G2 followed the training of the Paralympic teams. RESULTS Patients were retested by the same methods after CT. The two most important central dependent variables (maximal oxygen uptake and muscular strength) increased by 22% and knee extensor and flexor strength by 106% and 97%, respectively. CONCLUSION After eight weeks of CT, there was an improvement in general functional condition, muscle strength, and cardiorespiratory performance improving protection against chronic diseases and quality of life.
Collapse
Affiliation(s)
- Marcus Vinicius Grecco
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Sports Medicine Division, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; FIFA Medical Centre of Excellence, São Paulo, SP, Brazil
| | - Guilherme Carlos Brech
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Graduate Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil.
| | - Jose Maria Soares-Junior
- Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Júlia Maria D'Andrea Greve
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Sports Medicine Division, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; FIFA Medical Centre of Excellence, São Paulo, SP, Brazil
| | - Paulo Roberto Santos Silva
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Sports Medicine Division, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; FIFA Medical Centre of Excellence, São Paulo, SP, Brazil
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Finco MG, Sumien N, Moudy SC. Clinical evaluation of fall risk in older adults who use lower-limb prostheses: A scoping review. J Am Geriatr Soc 2023; 71:959-967. [PMID: 36648090 PMCID: PMC10023358 DOI: 10.1111/jgs.18223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND No reviews or evidence-based clinical protocols exist to evaluate fall risk in older adults who use lower-limb prostheses, despite falls being prevalent and costly in this population. This scoping review sought to determine assessments, defined as clinical outcome measures and gait parameters, associated with fall risk in this population to determine if a systematic review is warranted and help inform an evidence-based clinical protocol. METHODS Google Scholar, PubMed, and Scopus were searched on April 19th, 2022 to include peer-reviewed original research. Included articles reported relationships between falls and clinical outcome measures or gait parameters in older adults who use transtibial or transfemoral prostheses. Clinical outcome measures included self-reported questionnaires and functional mobility tests. Gait parameters included spatiotemporal, kinematic, and kinetic data during walking and stair negotiation. RESULTS Nineteen articles were included. Clinical outcome measure scores, gait parameter data, and cutoff scores by fall status (nonfallers, single fallers, recurrent fallers) were summarized. Six articles determined clinical outcome measures that had statistically significant associations with falls, and two articles determined gait parameters that had statistically significant associations with falls. CONCLUSIONS The majority of articles found no clinical outcome measure or gait parameter alone was effective at identifying fall risks in this population. Future research should evaluate a combination of assessments and collect prospective fall data to move towards establishing an evidence-based protocol to evaluate fall risk in older adults using lower-limb prostheses.
Collapse
Affiliation(s)
- M G Finco
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Nathalie Sumien
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sarah C Moudy
- Department of Family and Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| |
Collapse
|
15
|
Fard B, Persoon S, Jutte PC, Daemen JWHC, Lamprou DAA, Hoope WT, Prinsen EC, Houdijk H, Olsman J, Holling T, De Wever HPPR, Schrier E, Donders N, Rietman JS, Geertzen JHB. Amputation and prosthetics of the lower extremity: The 2020 Dutch evidence-based multidisciplinary guideline. Prosthet Orthot Int 2023; 47:69-80. [PMID: 36112468 DOI: 10.1097/pxr.0000000000000170] [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: 08/03/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lower-limb amputations are rare but debilitating events in the lives of affected persons. Treatment of persons with amputation inherently involves many different health care professions at different stages leading to and after an amputation. There are prevailing clinical questions within the work field related to different facets of care including peri/postoperative aspects, prosthetic components, rehabilitation treatment, and health care processes. OBJECTIVES To provide an up-to-date multidisciplinary evidence-based guideline for health care professionals involved in the treatment of persons with lower-limb amputation in the Netherlands. METHODS Identification of key questions in a focus group, systematic review of the evidence (up to March 2019, using Embase and MEDLINE databases), and weighing considerations, culminating in clinical recommendations. RESULTS Twelve key questions were formulated. Recommendations of two key questions were upheld in line with the previous 2012 guideline. Ten systematic literature searches were performed, leading to the inclusion of 59 studies. CONCLUSION A summary of evidence-based conclusions, considerations, and recommendations of the 2020 guideline is presented.
Collapse
Affiliation(s)
- Behrouz Fard
- Roessingh Center for Rehabilitation, Enschede, The Netherlands
| | - Saskia Persoon
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Paul C Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Erik C Prinsen
- Roessingh Research and Development, Enschede, The Netherlands
| | - Han Houdijk
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Ernst Schrier
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | |
Collapse
|
16
|
Tong J, Lu Z, Cen X, Chen C, Ugbolue UC, Gu Y. The effects of ankle dorsiflexor fatigue on lower limb biomechanics during badminton forward forehand and backhand lunge. Front Bioeng Biotechnol 2023; 11:1013100. [PMID: 36798592 PMCID: PMC9927012 DOI: 10.3389/fbioe.2023.1013100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Background: Local muscle fatigue may have an adverse effect on the biomechanics of the lunge movement and athletic performance. This study analyzed the biomechanical indicators of the forward lunge in badminton players before and after fatigue of the ankle dorsiflexors. Methods: Using the isometric muscular strength testing system, 15 badminton players underwent an ankle dorsiflexor fatigue test. Before and after the fatigue experiment, five lunges were done in both the forehand forward (FH) and backhand forward (BH) directions, five in each direction. A Vicon motion capture system and an AMTI force measuring station were used to record lower limb kinematic and ground reaction force (GRF). Pre-fatigue and post-fatigue variability were determined using paired-samples t-tests, Wilcoxon signed rank test, and Statistical Non-parametric Mapping (SNPM). Result: The results showed that after fatigue, the peak angle of ankle dorsiflexion was significantly reduced (p = 0.034), the range of motion (ROM) of the ankle sagittal plane (p = 0.000) and peak angle of ankle plantarflexion (p = 0.001) was significantly increased after forehand landing. After fatigue, ankle inversion was significantly increased after forehand and backhand landings (FH: p = 0.033; BH: p = 0.015). After fatigue, peak knee flexion angles increased significantly (FH: Max: p = 0.000, Min: p = 0.000; BH: Max: p = 0.017, Min: p = 0.037) during forehand and backhand landings and ROM in knee flexion and extension increased (p = 0.009) during forehand landings. Knee inversion range of motion was significantly increased after fatigue (p = 0.024) during forehand landings. Peak hip flexion angle (p = 0.000) and range of motion (p = 0.000) were significantly reduced in forehand landings after fatigue. The mean loading rate (p = 0.005) and the maximum loading rate (p = 0.001) increased significantly during backhand landings after fatigue. Post-fatigue, the center of pressure (COP) frontal offset increased significantly (FH: p = 0.000; BH: p = 0.000) in the forehand and backhand landings. Conclusion: These results indicate that when the ankle dorsiflexors are fatigued, the performance of the forehand is significantly negatively affected, and the impact force of the backhand is greater.
Collapse
Affiliation(s)
- Jianhua Tong
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Zhenghui Lu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Xuanzhen Cen
- Faculty of Sports Science, Ningbo University, Ningbo, China,Doctoral School on Safety and Security Sciences, Obuda University, Budapest, Hungary
| | - Chaoyi Chen
- Faculty of Sports Science, Ningbo University, Ningbo, China,*Correspondence: Chaoyi Chen, ; Yaodong Gu,
| | - Ukadike Chris Ugbolue
- School of Health and Life Science, University of the West of Scotland, Scotland, United Kingdom
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China,Doctoral School on Safety and Security Sciences, Obuda University, Budapest, Hungary,Research Academy of Medicine Combining Sports, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China,*Correspondence: Chaoyi Chen, ; Yaodong Gu,
| |
Collapse
|
17
|
Bosman CE, van der Sluis CK, Geertzen JHB, Kerver N, Vrieling AH. User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results. PLoS One 2023; 18:e0276874. [PMID: 36649233 PMCID: PMC9844830 DOI: 10.1371/journal.pone.0276874] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Persons with a transfemoral amputation or knee-disarticulation are heavily reliant on an adequate set of components for their prosthesis. To improve the process of adjusting the specific prosthetic properties to the expectations of the prosthesis users, it is of importance to first identify which factors have an influence on prosthesis use. Therefore, we aimed to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. METHODS A qualitative meta-synthesis was conducted by searching five databases (last update January 20th 2022). Studies were considered eligible if they contained qualitative data about adult persons with a transfemoral amputation or knee-disarticulation with experience in using a prosthesis and focused on the users' opinions. All eligible studies were independently screened by two reviewers. The results sections of the included studies were entered in Atlas.ti software (v8) and coded using the framework approach. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) qualitative research checklist. Results of the meta-synthesis were validated with prosthesis users (n = 8) in a focus group. RESULTS Out of 5757 articles, 14 studies were included. An overview of seven themes ('prosthesis related'; 'rehabilitation, costs and prosthetist'; 'mental'; 'physical'; 'social'; 'activities and participation' and 'walking') containing 84 factors was created. Ten factors were added during the focus group, resulting in an overview of 94 factors that may influence the prosthesis use of lower-limb prosthesis users. Participants would like more user-involvement from the rehabilitation team. The development of a patient decision aid could help this process in the future. CONCLUSION The large number of factors demonstrates that there is a great variety between prosthesis users and the factors that influence their prosthesis use. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.
Collapse
Affiliation(s)
- Charlotte E. Bosman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aline H. Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
Grecco MV, Brech GC, Camargo CP, Santos-Silva PR, D'Andréa Greve JM. The eight-week concurrent training effect on functional capacity in person living with unilateral transtibial amputation: A randomized controlled trial. J Bodyw Mov Ther 2023; 33:164-170. [PMID: 36775514 DOI: 10.1016/j.jbmt.2022.09.027] [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: 06/12/2020] [Revised: 08/11/2021] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The main causes of amputation include vascular diseases, trauma, cancer, and congenital limb abnormalities. The person with transtibial amputation (TA) is affected by a greater cardiorespiratory, metabolic, and muscular load to walk and perform daily activities. The sedentary lifestyle contributes to the process of chronic non-communicable diseases. The purpose of the study was to compare the effects of eight-week concurrent training (CT) for dependent variables as muscle strength, cardiorespiratory fitness, agility, and postural balance in persons with unilateral TA. METHODS A eight-week, randomized, controlled trial. Thirty-one people using prostheses for three or more months were selected. They were randomly divided into two groups: Experimental Group (EG; n = 17) - concurrent training and Control group (CG; n = 14) - no training. All patients were evaluated at the baseline and after eight weeks by the functional performance, isokinetic knee evaluation, static and dynamic posturography and cardiopulmonary test. RESULTS The patients showed improvements in all measures after training (size effect >0.80). CONCLUSION The main limitations are the sample size, related to the socioeconomic status and availability training and no comparison to other types of training. Eight weeks of CT was effective and favorably modified the dependent variables in TA patients. Therefore, CT is a good option to improve functional performance after the regular rehabilitation program discharge and decreases the metabolic and functional deficits of these patients.
Collapse
Affiliation(s)
- Marcus Vinicius Grecco
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP, Brazil
| | - Guilherme Carlos Brech
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP, Brazil; Graduate Program in Aging Sciences from the University São Judas Tadeu (USJT), SP, Brazil.
| | - Cristina Pires Camargo
- Division of Plastic Surgery, Laboratory of Microsurgery and Plastic Surgery (LIM-04), Medical School, HC da FMUSP, SP, Brazil
| | - Paulo Roberto Santos-Silva
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP, Brazil
| | - Julia Maria D'Andréa Greve
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia Do Hospital Das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), SP, Brazil
| |
Collapse
|
19
|
Finco MG, Patterson RM, Moudy SC. A pilot case series for concurrent validation of inertial measurement units to motion capture in individuals who use unilateral lower-limb prostheses. J Rehabil Assist Technol Eng 2023; 10:20556683231182322. [PMID: 37441370 PMCID: PMC10334000 DOI: 10.1177/20556683231182322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Inertial measurement units (IMUs) may be viable options to collect gait data in clinics. This study compared IMU to motion capture data in individuals who use unilateral lower-limb prostheses. Methods Participants walked with lower-body IMUs and reflective markers in a motion analysis space. Sagittal plane hip, knee, and ankle waveforms were extracted for the entire gait cycle. Discrete points of peak flexion, peak extension, and range of motion were extracted from the waveforms. Stance times were also extracted to assess the IMU software's accuracy at detecting gait events. IMU and motion capture-derived data were compared using absolute differences and root mean square error (RMSE). Results Five individuals (n = 3 transtibial; n = 2 transfemoral) participated. IMU prosthetic limb data was similar to motion capture (RMSE: waveform ≤4.65°; discrete point ≤9.04°; stance ≤0.03s). However, one transfemoral participant had larger differences at the microprocessor knee joint (RMSE: waveform ≤15.64°; discrete ≤29.21°) from IMU magnetometer interference. Intact limbs tended to have minimal differences between IMU and motion capture data (RMSE: waveform ≤6.33°; discrete ≤9.87°; stance ≤0.04s). Conclusion Findings from this pilot study suggest IMUs have the potential to collect data similar to motion capture systems in sagittal plane kinematics and stance time.
Collapse
Affiliation(s)
- MG Finco
- Department of Anatomy and
Physiology, University of North Texas Health
Science Center, Fort Worth, TX, USA
| | - Rita M Patterson
- Department of Family and
Osteopathic Medicine, University of North Texas Health
Science Center, Fort Worth, TX, USA
| | - Sarah C Moudy
- Department of Anatomy and
Physiology, University of North Texas Health
Science Center, Fort Worth, TX, USA
- Department of Family and
Osteopathic Medicine, University of North Texas Health
Science Center, Fort Worth, TX, USA
| |
Collapse
|
20
|
Development of a Digital Healthcare Management System for Lower-Extremity Amputees: A Pilot Study. Healthcare (Basel) 2022; 11:healthcare11010106. [PMID: 36611566 PMCID: PMC9819425 DOI: 10.3390/healthcare11010106] [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: 10/26/2022] [Revised: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
The research, which was designed as a "pre- and post-single group" study, included patients with lower-limb amputation and aimed to evaluate the effectiveness of self-directed physical-strength training and cardiovascular exercise using a novel digital healthcare management service three times a week for 12 weeks. Muscle strength, thigh circumference, lipid profile and glycated hemoglobin levels, pulmonary function, quality of life, and physical activity level were evaluated before and after the intervention, while satisfaction was measured after the study. Among the 14 included patients, the proportion of adherence to the physical-strength training and physical-strengthening activity were 85.2% and 75.8%, respectively. The level of satisfaction with the digital healthcare management system was high. Significant changes were observed in the muscle-strength tests (dominant grip power and muscle strength of knee flexion and extension of the intact side), thigh circumference, and glycated hemoglobin levels. Further, the quality-of-life score showed improvement, although without significant differences. Individualized exercise management using the novel digital healthcare management system for lower-limb amputees could induce interest in self-care and promote physical activity and healthy behavior. Through this effect, we can expect a reduction in the incidence of cardiovascular diseases, diabetes mellitus, dyslipidemia, and severe injuries from falling.
Collapse
|
21
|
Wong CK, Vandervort EE, Moran KM, Adler CM, Chihuri ST, Youdan GA. Walking asymmetry and its relation to patient-reported and performance-based outcome measures in individuals with unilateral lower limb loss. Int Biomech 2022; 9:33-41. [PMID: 36414237 PMCID: PMC9704090 DOI: 10.1080/23335432.2022.2142160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Gait asymmetry persists for most people after lower limb amputation and is associated with slower walking speeds. However, the relationship between gait asymmetry and patient-reported function remains unclear because they are not commonly assessed together. The purpose of this study was to determine relationships between gait asymmetries in people with lower limb loss and (1) patient-reported outcomes and (2) performance-based prosthetic functional measures. This cross-sectional analysis included nine people with unilateral limb loss aged 48.2 ± 13.1 years of mixed amputation etiology. Patient-reported outcomes included the Prosthetic Evaluation Questionnaire mobility subscale and Activities-specific Balance Confidence scale. Performance outcomes included the Berg Balance Scale and the 30-second sit-to-stand test. Walking performance measures included the 2-Minute Walk Test, during which APDM Opal sensors recorded spatiotemporal gait parameters, and daily step-counts from StepWatch4 activity monitors. The study found that the most asymmetric gait symmetry ratios (prosthetic-limb divided by intact-limb) could be attributed to prosthetic foot dorsiflexion-plantarflexion and rotation motion limitations: prosthetic-limb trailing double support (0.789 ± 0.052), toe-off (0.760 ± 0.068) and toe-out angle (0.653 ± 0.256). Single limb stance, and stance and swing phase durations were most strongly associated with balance and walking performance measures. Notably, no symmetry ratio was significantly associated with patient-reported prosthetic function (unadjusted Pearson correlation coefficients r < 0.50, P > 0.05). More gait symmetry was associated with better balance and walking performance but had no significant relationship with patient-reported function. Although achieving gait symmetry after lower limb loss is a common walking goal, symmetry was unrelated to the perception of functional mobility for people with lower limb loss.
Collapse
Affiliation(s)
- Christopher K. Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA,CONTACT Christopher K. Wong Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th St, Georgian-311, New York, NY10032, USA
| | | | - Kayla M. Moran
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Carly M. Adler
- Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Stanford T. Chihuri
- School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | | |
Collapse
|
22
|
Einfeldt AK, Brinck AK, Schiller S, Borgetto BM. [Gait Training for Lower Limb Amputees - A Systematic Review Based on the Research Pyramid]. DIE REHABILITATION 2022; 61:373-382. [PMID: 35172351 DOI: 10.1055/a-1719-3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lower extremity amputation patients have gait asymmetries which can lead to further complaints in other joints of the body. METHOD Five relevant databases were systematically searched for studies about gait training methods among people with transtibial and transfemoral amputations, followed by an evaluation of the methodical power of the eight references. Subsequently, the studies were categorized into the evidence classes of the research pyramid. The aim was to give treatment recommendations for this patient group. RESULTS All training methods show an improvement in gait parameters of the patients. In seven studies at least four different training forms are used within one training intervention. Therefore, a combination of different forms seems promising. A long-term statement among these methods could not be made. Due to the high variability in intervention methods and outcome parameters, an aggregation of data and meta-analyses were not possible. CONCLUSION The Evidence-Based Amputee Rehabilitation Program provides a good basis for a standardized training method. It should be supplemented with functional dual-task training and education. In further research a specific duration and intensity of such a program needs to be investigated. On top of that further qualitative and observational research is needed to generate statements which optimize the gait training in the physiotherapeutic routine practice.
Collapse
Affiliation(s)
- Ann-Kathrin Einfeldt
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen.,Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover
| | - Ann-Kathrina Brinck
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Sandra Schiller
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | | |
Collapse
|
23
|
Impact of Kinesiotherapy and Hydrokinetic Therapy on the Rehabilitation of Balance, Gait and Functional Capacity in Patients with Lower Limb Amputation: A Pilot Study. J Clin Med 2022; 11:jcm11144108. [PMID: 35887872 PMCID: PMC9316740 DOI: 10.3390/jcm11144108] [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] [Received: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
The purpose of this pilot study was to identify impact differences in the rehabilitation of balance, gait and functional capacity in patients with lower limb amputation performing hydrokinetic therapy and kinesiotherapy programs during the pre-prosthetic and prosthetic phases. The study included 16 male patients aged 40–60 years with amputated lower limbs for 6 to 12 months, which involved transfemoral amputation (TFA), transtibial amputation (TTA), traumatic and vascular amputation, who were divided into the following two groups: the hydrokinetic therapy (HKT) group and the kinesiotherapy (KT) group, named after the content of the rehabilitation programs that were implemented for 2 weeks in the pre-prosthetic and prosthetic periods. The initial and final evaluation of the participants included the following tests: the Berg Scale and the four square test for the evaluation of the balance; the PodoSmart device for gait assessment; through the walking test over 6 min, we evaluated the functional capacity. The results were processed in SPSS 24. Analysis of the results on balance rehabilitation through the Berg Scale highlighted that the progress related to the mean of the total score was 7.62 points, p = 0.00 for the HKT group and 7.50 points, p = 0.00 for the KT group, while in the four square step test, the mean of progress was 6.125 s, p = 0.00 for the HKT group and 6 s, p = 0.000 for the KT group. The PodoSmart gait analysis revealed that the HKT group showed a progress mean of 4.875%, p = 0.00, for the foot symmetry parameter, which was 1.875% less than the score achieved by the KT group whose symmetry progress mean was 6.75%, p = 0.00, while the average progress mean for the cadence parameter was 2.75 steps/min higher for the KT group than the HKT group. The comparative analysis of the impact of these two programs on the patients’ functional capacity indicated that the score recorded by the KT group was a progress mean of 15.12 m, p = 0.00 better than the HKT group for the travelled distance parameter; the implementation of the hydrokinetic therapy program led to better exercise adaptation for the HKT group compared to the KT group at an average HR (HRavg) with 0.50 BPM, p = 0.00. After analyzing the results, it has been found that hydrokinetic therapy programs have a greater impact on balance rehabilitation and exercise adaptation, while kinesiotherapy programs have a greater impact on gait rehabilitation and functional capacity optimization for the travelled distance parameter.
Collapse
|
24
|
Effectiveness of (Active) Lifestyle Interventions in People With a Lower Limb Amputation: A Systematic Review. Arch Rehabil Res Clin Transl 2022; 4:100207. [PMID: 36545531 PMCID: PMC9761262 DOI: 10.1016/j.arrct.2022.100207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To explore the effectiveness of (active) lifestyle interventions for the health of people with a lower limb amputation in order to offer effective interventions during rehabilitation that may improve physical and psychosocial functioning of people with lower limb amputation. Data Sources PubMed, CINAHL and Embase were searched from inception to February 2021. Study Selection Inclusion criteria were (1) (quasi-)randomized controlled trial; (2) minimum of 10 participants with a lower limb amputation; (3) lifestyle intervention focusing on physical activity, smoking habits, alcohol use, nutrition, and/or stress management; (4) focus on health outcomes; (5) participants older than 18 years; (6) studies in Dutch, German, or English; and (7) primary research. Title, abstract, and full-text screening and quality assessment were performed by 2 independent assessors. Data Extraction Of 2460 studies identified, 13 studies were included in this review. Two studies were of moderate methodological quality, 2 studies were of medium quality, and 9 studies were of poor quality. Data Synthesis Lifestyle interventions in the included studies focused on physical activity and stress management. These interventions seemed effective for improving physical fitness, walking capacity, changes in body mass, quality of life, and intensity of physical activity. Conclusion Lifestyle interventions focusing on physical activity and stress management seem effective for improving physical and psychosocial functioning of people with a lower limb amputation. However, the findings should be interpreted with caution given the limited methodological quality of the included studies. Future research should evaluate the effectiveness of interventions on nutrition, smoking habits, and alcohol use and the effectiveness of combined interventions in people with a lower limb amputation.
Collapse
|
25
|
Assessment of the relationship between rectus femoris cross-sectional area and knee extension strength in the prosthesis users with transtibial amputation: A case-control study. Turk J Phys Med Rehabil 2022; 68:222-230. [PMID: 35989968 PMCID: PMC9366482 DOI: 10.5606/tftrd.2022.7655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to investigate cross-sectional area of the amputated-limb rectus femoris compared to the intact-limb and controls and to determine its correlation with functional strength and walking tests in prosthesis users with transtibial amputation.
Patients and methods
Between October 2018 and April 2019, a total of 14 prosthesis users (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) who met the inclusion criteria, and 14 age-, sex-, and dominancy-matched able-bodied controls (12 males, 2 females; mean age: 47.1±16.2 years; range, 26 to 73 years) were included in this case-control study. Cross-sectional area of rectus femoris (CSA-RF) was evaluated bilaterally by two independent examiners. Knee extension strength was measured bilaterally by using a handheld dynamometer. Functional strength and walking were assessed by Step-Up-Over and Walk-Across tests of the NeuroCom Balance Master® device.
Results
The CSA-RF was found to be reduced in amputated-limb compared to the intact-limb and able-bodied controls (p<0.01). In the prosthesis users, the cross-sectional area difference between both limbs rectus femoris muscles was shown to be correlated with actual and functional knee extension strength, step length, and walking speed (p<0.05). Intra- and inter-observer reliability of CSA-RF on both sides were found to be good to excellent (intraclass correlation coefficient: 0.856-0.936).
Conclusion
Ultrasonographic measurement of CSA-RF is a valid and reliable tool to assess the functional strength and walking in the prosthesis users with unilateral transtibial amputation.
Collapse
|
26
|
De Marchis C, Ranaldi S, Varrecchia T, Serrao M, Castiglia SF, Tatarelli A, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:804746. [PMID: 36189078 PMCID: PMC9397865 DOI: 10.3389/fresc.2022.804746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect.
Collapse
Affiliation(s)
- Cristiano De Marchis
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
- Department of Engineering, University of Messina, Messina, Italy
- *Correspondence: Cristiano De Marchis
| | - Simone Ranaldi
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
| | - Tiwana Varrecchia
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Mariano Serrao
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Stefano Filippo Castiglia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonella Tatarelli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Alberto Ranavolo
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Draicchio
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Conforto
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
| |
Collapse
|
27
|
Abou L, Fliflet A, Zhao L, Du Y, Rice L. The Effectiveness of Exercise Interventions to Improve Gait and Balance in Individuals with Lower Limb Amputations: A Systematic Review and Meta-analysis. Clin Rehabil 2022; 36:857-872. [PMID: 35254152 DOI: 10.1177/02692155221086204] [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: 11/17/2022]
Abstract
OBJECTIVE To investigate the effectiveness of exercise interventions to improve gait and balance in individuals with lower limb amputations. METHODS A systematic search was conducted on the PubMed, Scopus, Web of Science, SPORTDiscuss, and CINAHL databases until January 2022. Only randomized control trials that evaluated adults (>18 years old) with lower limb amputations and compared any exercise intervention with a traditional prosthetic training were included in the study. Two independent researchers screened articles for inclusion, extracted data, and evaluated the methodological quality of the trials. Findings were summarized and meta-analysis was conducted. RESULTS Fifteen randomized clinical trials with 594 participants were included in the study and 12 in quantitative synthesis. Meta-analysis indicates that exercise interventions significantly improved walking distance measured with the 2-Minute Walking Test compared to traditional training (mean difference-MD: 8.38, 95% CI: 2.54-14.23; P < 0.01). Gait speed performance also significantly improved after exercise interventions compared to traditional training (MD: 0.10, 95% CI, 0.03-0.16, P <0.01). Meta-analysis of exercise interventions compared to traditional training on the Locomotor Capabilities Index, Timed Up and Go, and Activities-specific Balance Confidence did not show a statistically significant difference (P > 0.05). However, the qualitative analysis demonstrated significant improvement in balance performance after different exercise interventions and traditional training. The studies demonstrated overall good methodological quality. CONCLUSION Specific exercise interventions are more effective than traditional prosthetic training to improve walking speed and walking distance among people with lower limb amputation. Findings on balance outcomes are inconsistent and deserve further exploration.
Collapse
Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Luqi Zhao
- Department of Kinesiology and Community Health, College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Yiting Du
- Department of Physical Therapy, Feinberg School of Medicine, 12244Northwestern University, Chicago, Illinois, USA
| | - Laura Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, 14589University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| |
Collapse
|
28
|
Fanciullacci C, McKinney Z, Monaco V, Milandri G, Davalli A, Sacchetti R, Laffranchi M, De Michieli L, Baldoni A, Mazzoni A, Paternò L, Rosini E, Reale L, Trecate F, Crea S, Vitiello N, Gruppioni E. Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses. J Neuroeng Rehabil 2021; 18:168. [PMID: 34863213 PMCID: PMC8643009 DOI: 10.1186/s12984-021-00944-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. METHODS A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. RESULTS The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features-with implications towards prosthesis design tradeoffs. CONCLUSIONS This study's findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.
Collapse
Affiliation(s)
- Chiara Fanciullacci
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Zach McKinney
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy.
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Giovanni Milandri
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Angelo Davalli
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Rinaldo Sacchetti
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| | - Matteo Laffranchi
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Lorenzo De Michieli
- Rehab Technologies, Istituto Italiano di Tecnologia (IIT), via Morego, 30, 16163, Genoa, Genoa, Italy
| | - Andrea Baldoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Linda Paternò
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Elisa Rosini
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
| | - Luigi Reale
- Healthcare Area, Fondazione ISTUD, Via Paolo Lomazzo, 19, 20154, Milano, Milan, Italy
| | - Fabio Trecate
- Dept. of Physical Medicine and Functional Re-Education, Istituto Palazzolo, Fondazione Don Carlo Gnocchi, Via Don Luigi Palazzolo, 21, 20149, Milano, Milan, Italy
| | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna (Pisa), Viale Rinaldo Piaggio 34, 56025, Pontedera, Pisa, Italy
- Dept. of Excellence in Robotics and AI, Scuola Superiore Sant'Anna (Pisa), Piazza Martiri della Libertà, 33, 56127, Pisa, Italy
- Institute of Recovery and Care of Scientific Character (IRCCS), Fondazione Don Carlo Gnocchi Florence, Florence, Firenze, Italy
| | - Emanuele Gruppioni
- Centro Protesi INAIL - REPAIR Lab, Via Rabuina, 14, 40054, Vigorso di Budrio, Bologna, Italy
| |
Collapse
|
29
|
Almeida LV, Fukuchi CA, Sakanaka TE, Cliquet A. A low-cost easily implementable physiotherapy intervention clinically improves gait implying better adaptation to lower limb prosthesis: a randomized clinical trial. Sci Rep 2021; 11:21228. [PMID: 34707169 PMCID: PMC8551177 DOI: 10.1038/s41598-021-00686-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Lower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68—2.98, 95% CI, 1.83, effect size ES) and cadence (0.56—2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73—3.11, 95% CI, 1.92, ES) and stride length (0.62—2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (− 1.33—0.62, 95% CI, − 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.
Collapse
Affiliation(s)
- Leticia Vargas Almeida
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil.
| | - Claudiane Arakaki Fukuchi
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Tania Emi Sakanaka
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil
| | - Alberto Cliquet
- Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas, São Paulo, Brazil.,Biocybernetics and Rehabilitation Engineering Lab., Department of Electrical Engineering, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
30
|
Schafer ZA, Vanicek N. A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation. Gait Posture 2021; 84:198-204. [PMID: 33360642 DOI: 10.1016/j.gaitpost.2020.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with a lower limb amputation (LLA) have an increased risk of falls and often report lower balance confidence. They must compensate for altered mechanics and prosthetic limitations in order to execute appropriate motor responses to postural perturbations. Personalised exercise could be an effective strategy to enhance balance and reduce falls. RESEARCH QUESTION In this study, we investigated whether a personalised exercise programme could improve postural control and self-reported balance confidence in individuals with an LLA. METHODS Participants were block randomised into two groups (exercise, n = 7; control, n = 7) based on age and level of amputation. The exercise group completed a 12-week personalised exercise programme, including home-based exercise sessions, consisting of balance, endurance, strength, and flexibility training. The control group continued with their normal daily activities. All participants performed the Sensory Organization Test (SOT) and Motor Control Test (MCT) on the NeuroCom SMART Equitest, and completed the Activities-specific Balance Confidence-UK (ABC) self-report questionnaire, at baseline and post-intervention. RESULTS AND SIGNIFICANCE Exercise group equilibrium scores improved significantly when standing on an unstable support surface with no visual input and inaccurate somatosensory feedback (SOT condition 5, P < 0.012, d = 1.45). There were significant group*time interactions for medium (P = 0.029) and large (P = 0.048) support surface forward translations, which were associated with a trend towards increased weight-bearing on the intact limb in the control group (medium: P = 0.055; large: P = 0.087). No significant changes in ABC score were observed. These results indicate reduced reliance on visual input, and/or enhanced interpretation of somatosensory input, following an exercise programme. However, objective improvements in aspects of postural control were not associated with subjective improvements in self-reported balance confidence. More weight-bearing asymmetry in the control group suggests that a lack of targeted exercise training may have detrimental effects, with potential adverse long-term musculoskeletal consequences, that were quantifiable within a short timeframe.
Collapse
Affiliation(s)
- Zoe A Schafer
- Department of Sport, Health and Exercise Science, University of Hull, Hull, HU6 7RX, United Kingdom
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, University of Hull, Hull, HU6 7RX, United Kingdom.
| |
Collapse
|
31
|
Abstract
BACKGROUND Strength deficits may play a central role in the severity of balance, mobility, and endurance impairments in lower limb prosthesis users. A body of literature detailing the scope and specifics of muscle weakness in lower limb prosthesis users is emerging, but has yet to be summarized. A synopsis of strength deficits, and their impact on functional abilities in lower limb prosthesis users, may inform rehabilitation and research needs. OBJECTIVES Synthesize reported strength deficits in lower limb prosthesis users, and discuss possible causes, consequences, and solutions. STUDY DESIGN Scoping review. METHODS A search of biomedical databases was performed, and inclusion/exclusion criteria were applied to identify publications relevant to the purpose of the review. RESULTS In all, 377 publications were identified, of which 12 met the inclusion/exclusion criteria. When compared with the controls and the intact limb, the primary strength outcome, peak torque, was lower in transtibial residual limb knee flexors and extensors, as well as transfemoral residual limb hip muscles. CONCLUSIONS The reviewed studies provide evidence of strength deficits in lower limb prosthesis users. These deficits appear to be consequential, as they may contribute to balance, mobility, and endurance impairments. Additional research exploring alternative strength metrics, clinical tests, and causal links to functional impairments is required. CLINICAL RELEVANCE Evidence of muscle weakness among lower limb prosthesis users, and its influence on balance, mobility, and endurance, suggests that greater clinical attention and scientific inquiry into physical conditioning of lower limb prosthesis users is merited and required.
Collapse
Affiliation(s)
- Alex Hewson
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaquitta Dent
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew Sawers
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
32
|
Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation. CURRENT GERIATRICS REPORTS 2020; 9:134-141. [PMID: 34790518 DOI: 10.1007/s13670-020-00328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose of Review People living with lower limb amputation are at an increased risk of falling compared with the healthy geriatric population. Factors of increased age and increased number of comorbidities could compound the already increased risk. The purpose of this article is to highlight recent research associated with fall risk in amputees and provide the reader with evidence to help guide clinical interventions. Recent Findings Though research on the topic of falls in people with amputation is becoming more common, there is still a dearth of evidence regarding what contributes to increased fall risk and how to address it in this population. There are recent studies that have examined therapy and prosthetic interventions that could mitigate fall risk in people with amputation, yet there is not enough evidence to develop a consensus on the topic. More research is required to determine what contributes to increased fall rates in people with amputation, and what detriments to an amputee's function or psyche may result after incurring a fall. Summary Borrowing from what is known about geriatric fall risk and combining the information with novel and existing approaches to fall mitigation in amputees can offer clinicians the opportunity to develop evidence-based programs to address fall risk in their patients with lower limb amputation.
Collapse
|
33
|
Bouzas S, Molina AJ, Fernández-Villa T, Miller K, Sanchez-Lastra MA, Ayán C. Effects of exercise on the physical fitness and functionality of people with amputations: Systematic review and meta-analysis. Disabil Health J 2020; 14:100976. [PMID: 32819852 DOI: 10.1016/j.dhjo.2020.100976] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN systematic review and meta-analysis. BACKGROUND Despite existing scientific evidence alluding to the positive effects of physical exercise on people with amputations, there is a lack of consistency between the results of past studies. OBJECTIVE To identify if people with amputations taking part in an exercise training programme can benefit from improvements in their health status as measured by changes in their physiological fitness and functionality levels. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed after searching within several databases up to October 2019. RESULTS Ten RCTs with satisfactory methodological quality were found. Five RCTs were pooled in the meta-analysis. Exercise programmes with a combination of activities were most commonly delivered. Exercise had positive effects on aerobic and muscular fitness parameters. Findings from the meta-analysis indicated that exercise improved distance walked but did not have a significant impact on functional mobility or self-reported functional capacity. CONCLUSION Combined exercise of muscular endurance and functional physical exercise appear to have greater positive effects on cardiorespiratory fitness, muscular fitness and functionality levels in adult prosthesis users with unilateral lower limb amputation. Future studies should include different profiles of patients with amputations that are poorly represented in the current scientific literature.
Collapse
Affiliation(s)
- Sara Bouzas
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain.
| | - Antonio J Molina
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, León, Spain
| | - Tania Fernández-Villa
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS), Instituto de Biomedicina (IBIOMED), University of León, León, Spain
| | | | - Miguel A Sanchez-Lastra
- Grupo de Investigación Healthy-Fit, Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | - Carlos Ayán
- Department of Special Didactics, University of Vigo, Pontevedra, Spain
| |
Collapse
|
34
|
Castiglia SF, Ranavolo A, Varrecchia T, De Marchis C, Tatarelli A, Magnifica F, Fiori L, Conte C, Draicchio F, Conforto S, Serrao M. Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation. Gait Posture 2020; 80:280-284. [PMID: 32563728 DOI: 10.1016/j.gaitpost.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking. RESEARCH QUESTION This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis. METHODS The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis. RESULTS Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls. SIGNIFICANCE Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
Collapse
Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Fabrizio Magnifica
- Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy; Italian Air Force Aerospace Medicine Department, Diagnostic Therapeutic and Rehabilitative Aeromedical Center, via Piero Gobetti 2, 00185, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121, Milan, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
| |
Collapse
|
35
|
Tatarelli A, Serrao M, Varrecchia T, Fiori L, Draicchio F, Silvetti A, Conforto S, De Marchis C, Ranavolo A. Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation. SENSORS 2020; 20:s20092543. [PMID: 32365715 PMCID: PMC7249183 DOI: 10.3390/s20092543] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022]
Abstract
The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.
Collapse
Affiliation(s)
- Antonella Tatarelli
- Department of Human Neurosciences, University of Rome Sapienza, 00185 Rome, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
- Correspondence:
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, 04100 Latina, Italy;
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Lorenzo Fiori
- Department of Physiology and Pharmacology, University of Rome Sapienza, 00185 Rome, Italy;
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Alessio Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| |
Collapse
|
36
|
Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
Collapse
Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| |
Collapse
|
37
|
Sederberg M, Tarkhan A, Ray LS, Lee ES, Lin C. Physical Activity in Adults With an Amputation as Assessed With a Self-Reported Exercise Vital Sign. PM R 2020; 12:861-869. [PMID: 31990141 DOI: 10.1002/pmrj.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Physical activity (PA) is important for the prevention and treatment of numerous chronic medical conditions. Individuals with a limb amputation face unique challenges for staying physically active. There are few studies evaluating PA of civilians with amputation in the United States. OBJECTIVE To evaluate self-reported PA in persons with an amputation in the outpatient setting using a standardized exercise vital sign (EVS) and correlate PA with demographic information, amputation characteristics, and disease burden. DESIGN Cross-sectional observational study. SETTING Outpatient rehabilitation clinic at a tertiary care institution. INTERVENTIONS N/A. PARTICIPANTS Two hundred twenty-nine patients with limb amputation. MAIN OUTCOME MEASUREMENTS EVS (self-reported weekly participation in moderate to vigorous intensity exercise), disease burden using a modified Charlson Comorbidity Index (CCI), possession of a prosthetic limb, amputation level, time from amputation, body mass index (BMI), gender, race, and age. RESULTS A total of 28.8% of patients with limb amputation self-reported exercising at or above 150 min/wk as recommended by the United States Department of Health and Human Services (HHS); 31.8% of patients with transfemoral amputations, 27.8% with transtibial amputations, and 36% with upper extremity amputations reported exercising the recommended amount. Those with a prosthesis exercised 0.91 h/wk more than those without a prosthesis (95% CI 0.01, 1.8, P = .047), and female patients exercised 1.09 h/wk less than male patients (95% confidence interval [CI] 1.69-0.49, P < .001). Increasing age (P = .045), CCI (P = .006), and BMI (P = .005) all had a small but significant correlation with lower EVS. There was no statistically significant correlation between EVS and amputation level, race, or time from amputation. CONCLUSIONS Less than one-third of patients with an amputation meet HHS recommendations for aerobic exercise. Male patients, those with a prosthesis, lower CCI, lower BMI, and younger age reported higher PA rates. Assessing EVS can help clinicians to identify patients with amputation that are not sufficiently active and may benefit from PA counseling and prescription.
Collapse
Affiliation(s)
- Mark Sederberg
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Lisa S Ray
- University of Washington Population Health Analytics, Seattle, WA
| | - E Sally Lee
- University of Washington Population Health Analytics, Seattle, WA
| | - Cindy Lin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA.,The Sports Institute at UW Medicine, Seattle, WA
| |
Collapse
|
38
|
Meigh NJ, Keogh JWL, Schram B, Hing WA. Kettlebell training in clinical practice: a scoping review. BMC Sports Sci Med Rehabil 2019; 11:19. [PMID: 31497302 PMCID: PMC6719359 DOI: 10.1186/s13102-019-0130-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND A scoping review of scientific literature on the effects of kettlebell training. There are no authoritative guidelines or recommendations for using kettlebells within a primary care setting. Our review objectives were to identify the extent, range and nature of the available evidence, to report on the types of evidence currently available to inform clinical practice, to synthesise key concepts, and identify gaps in the research knowledge base. METHODS Following the PRISMA-ScR Checklist, we conducted a search of 10 electronic databases from inception to 1 February 2019. There were no exclusions in searching for publications. A single reviewer screened the literature and abstracted data from relevant publications. Articles were grouped and charted by concepts and themes relevant to primary care, and narratively synthesised. Effect sizes from longitudinal studies were identified or calculated, and randomised controlled trials assessed for methodological quality. RESULTS Eight hundred and twenty-nine records were identified to 1 February 2019. Four hundred and ninety-six were screened and 170 assessed for eligibility. Ninety-nine publications met the inclusion criteria. Effect sizes were typically trivial to small. One trial used a pragmatic hardstyle training program among healthy college-age participants. Two trials reported the effects of kettlebell training in clinical conditions. Thirty-three studies explicitly used 'hardstyle' techniques and 4 investigated kettlebell sport. Also included were 6 reviews, 22 clinical/expert opinions and 3 case reports of injury. Two reviewers independently evaluated studies using a modified Downs & Black checklist. CONCLUSIONS A small number of longitudinal studies, which are largely underpowered and of low methodological quality, provide the evidence-informed therapist with little guidance to inform the therapeutic prescription of kettlebells within primary care. Confidence in reported effects is low to very low. The strength of recommendation for kettlebell training improving measures of physical function is weak, based on the current body of literature. Further research on reported effects is warranted, with inclusion of clinical populations and investigations of musculoskeletal conditions common to primary care. There is a need for an externally valid, standardised approach to the training and testing of kettlebell interventions, which better informs the therapeutic use of kettlebells in primary care.
Collapse
Affiliation(s)
- Neil J. Meigh
- Faculty of Health Sciences and Medicine, Bond University, Institute of Health & Sport, Gold Coast, Queensland 4226 Australia
| | - Justin W. L. Keogh
- Faculty of Health Sciences and Medicine, Bond University, Institute of Health & Sport, Gold Coast, Queensland 4226 Australia
- Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand
- Kasturba Medical College, Manipal Academy of Higher Education Mangalore, Manipal, Karnataka India
| | - Ben Schram
- Faculty of Health Sciences and Medicine, Bond University, Institute of Health & Sport, Gold Coast, Queensland 4226 Australia
| | - Wayne A. Hing
- Faculty of Health Sciences and Medicine, Bond University, Institute of Health & Sport, Gold Coast, Queensland 4226 Australia
| |
Collapse
|
39
|
Varrecchia T, Serrao M, Rinaldi M, Ranavolo A, Conforto S, De Marchis C, Simonetti A, Poni I, Castellano S, Silvetti A, Tatarelli A, Fiori L, Conte C, Draicchio F. Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components. Hum Mov Sci 2019; 66:9-21. [PMID: 30889496 DOI: 10.1016/j.humov.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.
Collapse
|