Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation

Low Back Pain in People With Lower Limb Amputation: A Cross-Sectional Study

STUDY DESIGN

A cross-sectional study based on an online questionnaire.

OBJECTIVE

The aim was to investigate the prevalence and intensity of low back pain (LBP) in people with lower limb amputation (LLA) and to analyze the association factors that can influence the genesis of LBP.

SUMMARY OF BACKGROUND DATA

It is still unclear whether LBP is more prevalent in the amputated population than in its nonamputated counterpart. Given the multifactorial nature of LBP, it is necessary to explore possible factors that can influence its presence and intensity, to build a solid background to define a better rehabilitation pathway for the management of these people.

METHODS

The online questionnaire included six sections: informed consent of the study, demographic information, comorbid conditions, history of LLA, history of LBP, and acceptance of the amputation.

RESULTS

Between March and June 2021, 239 participants [mean age (SD): 49.2 (11.5); female 11%] completed the survey (response rate: 32%). From the results of this study, LBP in LLA showed a prevalence of 82% postamputation and 70% in the last year. A logistic regression with a backward method showed that participants who had problems in the not affected leg presented 1.58 (95% confidence interval: 0.70; 2.45) times higher odds to have LBP after the amputation.

CONCLUSION

This study shows that the prevalence of LBP in lower limb amputees appears to be higher than in the general population, with similar levels of pain intensity and frequency. The highest percentage of people with a sedentary lifestyle not practicing any kind of sports emphasizes the importance of educating this population on the importance of physical activity. New strategies to invest in the education of this population in terms of physical activity are needed.

LEVEL OF EVIDENCE

Level 4.

Distribution of joint work during walking on slopes among persons with transfemoral amputation

Persons with above-knee amputation have increased energy consumption and greater difficulty in negotiating uphill and downhill slopes. Walking on slopes requires an adaptation of the positive and negative work performed by the joints of the lower limb to propel the center of mass. Modern prosthetic feet and knees can only partially adapt to changes in inclination, and the redistribution of joint work among persons with above-knee amputation is not described in the literature. Level, upslope and downslope walking (at 5% and 12% inclinations) were investigated for twelve subjects with transfemoral amputation fitted with an Energy Storing And Return foot (ESAR) and a Microprocessor controlled Prosthetic Knee (MPK) versus a control group of seventeen asymptomatic subjects. Lower limb joint and individual limb power and work were compared between prosthetic, contralateral and control limbs. The prosthesis dissipates less energy than the joints of the lower limb of the control group when descending the slope, but the demand on the contralateral limb is limited by a lower speed and step length. The huge deficit of positive work produced by the prosthetic ankle cannot be compensated by the residual hip during level and slope ascent which transfers the demand for energy production to the contralateral limb up to 40% on a 12% slope. This study highlights that prosthetic devices (ESAR foot and MPK) for persons with above-knee amputation present some limitations during slope walking that cannot be compensated by the residual hip and increase the work performed by the contralateral limb.