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Örneholm H, Mevik J, Wenger D. Above-ankle Reamputation and Mortality following Transmetatarsal Amputation in Diabetic and Nondiabetic Peripheral Artery Disease. J Foot Ankle Surg 2024; 63:584-592. [PMID: 38876207 DOI: 10.1053/j.jfas.2024.05.017] [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: 10/10/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024]
Abstract
The risk of above-ankle reamputation following a transmetatarsal amputation is around 30%. Patient selection may be crucial to achieve good outcomes, and to avoid futile operations and suffering. We are aware of no previous comparison between the two largest patient groups that undergo lower extremity amputations: patients with diabetes, and patients with non-diabetic peripheral artery disease. Patients with diabetes or nondiabetic peripheral artery disease who had undergone a transmetatarsal amputation from 2004 to 2018 at our institution were included. Patient characteristics and perioperative details were analyzed retrospectively. Subjects with diabetes were compared with subjects with nondiabetic peripheral artery disease regarding above-ankle reamputation, reamputation level, and mortality. Five-hundred-and-sixty transmetatarsal amputations in 513 subjects were included. The majority of transmetatarsal amputations (86%) occurred in diabetic subjects. Subjects with non-diabetic PAD had a higher risk of above-ankle reamputation (p = .008), and death (p < .001). At the time of data collection, only multiple-ray amputation (vs. single-ray) was an independent risk factor for above-ankle reamputation. Only age, medical comorbidity in general, and chronic heart failure were independent risk factors of death. To our knowledge, this study is the first to report marked differences in above-ankle reamputation rates and mortality following transmetatarsal amputation, comparing diabetics with non-diabetic patients with peripheral artery disease. However, the differences may be attributed to non-diabetics being older, having more medical comorbidities, and having more advanced foot ulcers at the time of transmetatarsal amputation. In patients exhibiting several of these risk factors, transmetatarsal amputation may be futile.
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Affiliation(s)
- Hedvig Örneholm
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden.
| | | | - Daniel Wenger
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences, Lund University, Lund, Sweden
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Cimino SR, Hitzig SL, Fung V, Dainty KN, MacKay C, Sale JEM, Mayo AL, Guilcher SJT. Quality of life following non-dysvascular lower limb amputation is contextualized through occupations: a qualitative study. Disabil Rehabil 2024; 46:3887-3894. [PMID: 37731381 DOI: 10.1080/09638288.2023.2258340] [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: 04/06/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE To understand how persons with non-dysvascular lower limb amputation (LLA) use occupations to contextualize their quality of life (QoL). METHODS A qualitative study using an interpretative description approach was conducted. Analysis of the interviews was guided by an occupational perspective, which considers the day-to-day activities that are important to an individual. RESULTS Twenty adults with an adult-acquired non-dysvascular amputation (e.g., trauma, cancer or infection) were interviewed. Following thematic analysis, two main themes were developed: (1) sense of self expressed through occupations; and (2) sense of belonging with others influenced by occupations. Participants expressed the way they felt about themselves through their activities and placed high value on whether they could participate in certain occupations. Participants also described how their sense of belonging was changed through the context of their changing occupations. CONCLUSION The findings from this work can be leveraged by clinicians and researchers alike to improve care for this population. Rehabilitation programs should consider interventions and programming that help to restore occupations or develop new ones given the importance placed on occupations by persons with non-dysvascular LLA.
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Affiliation(s)
- Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Therapy and Occupational Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vera Fung
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Katie N Dainty
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Crystal MacKay
- Westpark Health Care Centre, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joanna E M Sale
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara J T Guilcher
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Torbjörnsson E, Nilsson O. Development of an Education Material Targeting Patients Undergoing Lower Extremity Amputation due to Severe Limb Ischemia-A Qualitative Study. J Surg Res 2024; 299:205-212. [PMID: 38772269 DOI: 10.1016/j.jss.2024.04.031] [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: 12/21/2023] [Revised: 02/29/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Critical limb-threatening ischemia (CLTI) is associated with a high risk of amputation, yet patients undergoing amputation due to CLTI have little knowledge of the amputation process and the rehabilitation that awaits. The aim of the present study was to develop and validate information material for patients undergoing amputation. METHODS Nine participants were included in the study. Two focus group interviews were performed with seven patients who had undergone lower extremity amputation due to CLTI within the past 2 y. Additionally, two individual interviews were carried out. A semistructured interview guide was used, and the interviews were transcribed verbatim and analysed using qualitative content analysis with a deductive approach. RESULTS Three themes were identified as essential for the design of the written information: Perspectives on design and formatting, Providing information to enhance participation in care, and Accessibility to information and support. The prototyped information leaflet was perceived as acceptable, useable, relevant, and comprehensible by the participants. CONCLUSIONS For patients to actively engage in their care, it is vital that their information needs are met and that they are provided with psychosocial support when needed. Written and oral information should be provided by a trusted healthcare professional.
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Affiliation(s)
- Eva Torbjörnsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset, Stockholm, Sweden.
| | - Olga Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Toda H, Oshima T, Ibara T, Chin T. Longitudinal Alterations in the Control of Lateral Center of Mass Movement During Walking in a Patient With Unilateral Transtibial Amputation: A Case Study. Cureus 2024; 16:e61683. [PMID: 38975414 PMCID: PMC11223945 DOI: 10.7759/cureus.61683] [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] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
This study assessed longitudinal changes in the control of the center of mass (CoM) in the lateral direction through gait reacquisition in an individual with unilateral transtibial amputation (UTTA). We examined a male patient with UTTA who could walk on a parallel bar. The marker trajectories and ground reaction forces were measured every two weeks (total: four times) using an optical motion capture system and force plates. After two measurements, the samples were collected without a parallel bar. Subsequently, we evaluated the CoM movement and its segmental coordination through uncontrolled manifold (UCM) analysis. After the second measurement, the walking speed and step length increased. The lateral CoM movements gradually increased toward the prosthetic side until the third measurement. In the fourth measurement, the CoM movement towards the prosthetic side was the smallest and closest to the intact side at the end of the stance phase. In addition, segmental coordination improved significantly. Enhanced gait performance delayed the improvement of segmental coordination for CoM movement in the lateral direction.
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Affiliation(s)
- Haruki Toda
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
| | - Takashi Oshima
- Orthopaedics, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
| | - Takuya Ibara
- Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JPN
| | - Takaaki Chin
- Robot Rehabilitation Center, The Hyogo Institute of Assistive Technology, Kobe, JPN
- Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Center, Kobe, JPN
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Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PM R 2024; 16:462-473. [PMID: 37632836 PMCID: PMC10895070 DOI: 10.1002/pmrj.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Limited available data suggest that fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self-imposed declines in activity. There is a need to identify the validity of fear-of-falling-related activity avoidance scales in LLPUs. OBJECTIVE To evaluate the convergent, discriminant, and known-group construct validity of the modified Survey of Activities and FoF in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity. DESIGN Online survey. SETTING Not applicable. PARTICIPANTS Fifty-nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers. INTERVENTION Participants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear-of-falling-related activity avoidance (yes/no), as well as previously validated scales capturing related and unrelated constructs. T-tests were used to compare mSAFE score between yes/no respondents for known-group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis. MAIN OUTCOME MEASURES Not applicable. RESULTS Significant correlation coefficients of |0.440-0.825| were found for convergent validity with evidence of known-group construct validity (p < .021 for all comparisons). There was evidence for discriminant validity, with non-significant associations for two-of-three correlations. Results from validity analyses for a shortened 6-item mSAFE were similar to that for the full scale. CONCLUSION This study provided initial evidence regarding validity of the mSAFE as a measure to assess fear-of-falling-related activity avoidance in LLPUs. A 6-item scale may be appropriate if the full scale would be taxing or time-consuming.
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Affiliation(s)
- Noah J Rosenblatt
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Bobak Manesh
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Kristin Schneider
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Steven A Miller
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Grover P, Karuppan CM. The lower limb-loss rehabilitation continuum (LLRC) - a framework for program design and implementation. Disabil Rehabil 2024; 46:1652-1661. [PMID: 37147928 DOI: 10.1080/09638288.2023.2207221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
Purpose: The multistep journey to prosthetic device-enabled functioning following amputation requires a structured approach for optimal care delivery, but such program structures and outcomes are inadequately characterized. The study is responsive by describing an implementation framework for lower limb loss rehabilitation and evaluating its utility.Materials and methods: The lower limb loss rehabilitation continuum framework (LLRC) was developed using literature-based continuum of care and amputation phase concepts as well as input from limb loss rehabilitation stakeholders. LLRC structure includes five sequential steps (Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), Prosthetic Rehabilitation (PR)) between six touchpoints of patient-healthcare interaction (Surgery, Preprosthetic Rehabilitation Admission and Discharge, Functioning Evaluation and Prescription, Prosthetic Rehabilitation Admission and Discharge). The utility of this framework was evaluated through LLRC program implementation in a semiurban US setting and program functioning and process outcomes assessment from an IRB-approved, retrospective observational study about patients with unilateral lower-limb amputations completing this program.Results: Program functional (FIM gain; efficiency) scores were greater for PPR(32.6(8);3.1) compared with PR(24.3(8.5);3.8). Program completion duration was 149.7(63.4) days. LHM(75.8(58.5) days) and PF(51.4(24.3) days) were the longest steps. PR duration was significantly longer(p = 0.033) for the transfemoral level.Conclusion: The LLRC framework is useful for the design and implementation of structured limb loss rehabilitation programs.IMPLICATIONS FOR REHABILITATIONThe lower limb-loss rehabilitation continuum (LLRC) is a novel implementation framework with a five-step structure from limb loss to completion of prosthetic rehabilitation between six touchpoints of patient-healthcare interaction, with standardized terminology and baseline and outcome metrics. The utility of the program was demonstrated by successful program development in a suburban health setting and actionable process outcomes and superior functioning outcomes compared with literature.The LLRC can be adapted by health systems, institutions, and care providers for program development. Programs can expect high FIM gains and efficiency for Preprosthetic rehabilitation and Prosthetic rehabilitation steps. With an LLRC completion time of 5 months, long Limb healing and maturation and Prosthetic fitting steps present areas of opportunity for improvement.
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Affiliation(s)
- Prateek Grover
- Mercy Clinics and Mercy Rehabilitation Hospital, Springfield, MO, USA
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Norvell DC, Turner AP, Morgenroth DC, Henderson AW, Halsne EG, Hurwitz M, Czerniecki JM. The effect of depression on prosthesis prescription in men and women who have undergone a lower limb amputation. Disabil Rehabil 2024; 46:1204-1211. [PMID: 37035925 DOI: 10.1080/09638288.2023.2192976] [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: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE To determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease. MATERIALS AND METHODS A retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis prescription rates and time to prescription between men and women veterans. The primary exposure was gender. The primary outcome was a qualifying prosthesis prescription within 12 months of the incident amputation. The secondary outcome was time to prosthesis prescription. Multiple logistic and linear regression was used to control for potential confounders and identify potential effect modification. RESULTS 2,862 individuals met study criteria, with 1690 (60%) prescribed a qualifying prosthesis. Men were more likely to receive a prosthesis prescription than women (59% versus 45%, respectively; p = 0.03). This difference was observed primarily among those with a diagnosis of major depressive disorder. In this subgroup, the odds of men receiving a prosthesis over women was over 3 times (adjusted odds ratio = 3.3; 95% Confidence Interval, 1.5, 7.4). Men had a mean shorter time to prescription compared to women (112 ± 72 versus 136 ± 79 days, respectively, p = 0.08). Depression in women negatively impacts their prosthesis prescription rates and time to prescription compared to men. This disparity may have significant impacts on future function and quality of life.Implications for RehabilitationThis study found that men more commonly received a prosthesis prescription and received it earlier than women.This disparity was most extreme among women who had been diagnosed with major depressive disorder.Providers should identify at risk patients early and consider targeted interventions to address depression during the preoperative and immediate postoperative phases.Future research should continue to work to identify gender-specific needs that exacerbate disparity.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Alison W Henderson
- VA Puget Sound Health Care System, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Elizabeth G Halsne
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
| | - Max Hurwitz
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, PA, Pittsburgh
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, WA, Seattle
- Department of Rehabilitation Medicine, University of Washington, WA, Seattle
- Center for Limb Loss and Mobility (CLiMB), Seattle, WA
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Sjödin LS, Ottosson CC, Lapidus LJ. Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease. Prosthet Orthot Int 2024; 48:25-29. [PMID: 37910598 DOI: 10.1097/pxr.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/17/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Our aim was to compare transfemoral amputation (TFA) to knee disarticulation (KD) as a reamputation level after failed transtibial amputation (TTA) in patients with peripheral vascular disease and/or diabetes. METHODS We studied 152 patients undergoing reamputation, 86 TFA and 66 KD, after a failed TTA. The primary outcome was reamputation and reoperation, and secondary outcomes were prosthetic fitting and mortality. Logistic regression analyses were performed to identify factors associated with the outcome. RESULTS The reamputation rate was 36% after KD and 15% after TFA ( p = 0.004). The multivariable analysis showed that TFA was associated with a significantly reduced risk of reamputation, odds ratio (OR) = 0.31 (95% confidence interval [95% CI], 0.1-0.7). The overall reoperation rate was 38% after KD and 22% after TFA ( p = 0.03). This reduction of risk for TFA was not significant in the multivariable analysis, OR = 0.49 (95% CI, 0.2-1.0). Prosthetic limb fitting was possible in 30% after KD and 19% after TFA ( p = 0.1). Previous amputation in the contralateral leg was the only factor associated with reduced ability for prosthetic fitting in the multivariable analysis, OR = 0.15 (95% CI, 0.03-0.7). Mortality at 30 d was 17% and 53% at 1 year. No independent factors affected 30-d mortality in the multivariable analysis. CONCLUSIONS In this study, we found a significantly lower risk of reamputation after TFA compared with KD after a failed TTA. We consider TFA to be the reamputation level of choice, especially when there is a need of reducing risk of further reamputations.
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Affiliation(s)
- Lina S Sjödin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Unit of Orthopaedics, Södersjukhuset AB, Stockholm, Sweden
| | - Carin C Ottosson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Wound Centre, Södersjukhuset AB, Stockholm, Sweden
| | - Lasse J Lapidus
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Unit of Orthopaedics, Södersjukhuset AB, Stockholm, Sweden
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Shiraev T, de Boer M, Qasabian R. Indications for and outcomes of major lower limb amputations at a tertiary-referral centre in Australia. Vascular 2023; 31:941-947. [PMID: 35484725 DOI: 10.1177/17085381221080811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Major amputations are classically associated with significant morbidity and mortality. With the increasing prevalence of risk factors for amputation, namely, diabetes and peripheral arterial disease, we sought to identify the major indications for lower limb amputation in an Australian cohort. A secondary aim was to assess the outcomes, namely, mortality, of amputees over the previous decade. METHODS This study assessed all patients undergoing major lower limb amputations between 2012 and 2020. Variables analysed included comorbidities, indication for amputation, in-hospital complications and mortality, duration of hospital stay, and out-patient mortality. RESULTS 317 amputations were performed on 269 patients. 55% of amputations were below knee, 45% above knee, with one through-knee amputation. Indications included ischaemia (55.2%), infection (30.6%), malignancy (6.9%), trauma (4.4%), and chronic pain or instability (2.5%). In-patient mortality rate was 7.6%, with mortality rates of 21.5% at one year, and 70.1% at 10 years. Post-operative complications occurred in 43% of amputations. Rural, regional, and remote (RRR) patients did not suffer disproportionately from major amputations, however, were more likely to require amputations for ischaemia. Patients undergoing amputation for infective causes demonstrated lower mid-term mortality rates compared to those undergoing amputations for ischaemia (56.1 vs 60.4% at 5 years, p = 0.007). CONCLUSION Major amputations continue to be associated with significant morbidity and mortality, both in the short and long term. Patients undergoing amputations for ischaemic causes demonstrate poorer outcomes than their infective counterparts, with outcomes being even worse in RRR populations. Prevention of amputations via intense management of comorbidities would benefit both patients and the healthcare system.
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Affiliation(s)
- Timothy Shiraev
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, AU
- School of Medicine, University of Notre Dame, Darlinghurst, NSW, AU
| | - Madeleine de Boer
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, AU
| | - Raffi Qasabian
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, AU
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10
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England DL, Miller TA, Stevens PM, Campbell JH, Wurdeman SR. GGEM: Gender, Geography, and EMployment differences based on mobility levels among lower limb prosthesis users living in the United States. Prosthet Orthot Int 2023; 47:265-271. [PMID: 36787381 PMCID: PMC10249601 DOI: 10.1097/pxr.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND For individuals with a disability, an increase in functional mobility may improve their quality of life and well-being. Greater understanding is needed on how factors such as gender, geography, and employment may play a role in mobility levels among individuals with lower limb amputation. OBJECTIVES To assess the relationship between gender, geography, and employment status on mobility among lower limb prosthesis users. METHODS A cross-sectional analysis of 7,524 patient mobility outcomes completed across the United States was performed. The regression model included the independent variables, such as age, gender, region, employment status, and amputation level. Mobility was entered as the dependent variable. RESULTS Individuals who were employed had 3.6 times the odds of reaching increased mobility (Prosthetic Limb Users' Survey of Mobility ≥ 50) than those unemployed (odds ratio 3.56, 95% confidence interval 3.10-4.09). Gender and geography were significantly associated with mobility as well. CONCLUSIONS Being employed is associated with greater odds of reaching increased mobility. Addressing factors such as returning to employment may aid in improving mobility levels among prosthesis users.
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Affiliation(s)
- Dwiesha L. England
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
| | - Taavy A. Miller
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
| | - Phillip M. Stevens
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT
| | - James H. Campbell
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
| | - Shane R. Wurdeman
- Hanger Institute for Clinical Research and Education, Hanger Clinic, Austin, TX
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE
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11
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Madsen UR, Biesbjerg CB, Mikkelsen TB, Marsaa K, Olsen Zwisler AD, Vedste Aagaard T. Considerable gaps and differences in rehabilitation after major lower extremity amputations across regions and municipalities in Denmark - A national survey. Scand J Caring Sci 2023; 37:595-607. [PMID: 36727432 DOI: 10.1111/scs.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/14/2022] [Accepted: 01/05/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Equal access to healthcare is a fundamental principle in the fully tax-financed Danish healthcare system. This study reveals whether this system lives up to the principle of equal access when it comes to the rehabilitation of patients who have major lower extremity amputations. METHODS With the aim of exploring possible inequality in rehabilitation for patients having major lower extremity amputation in Denmark, a nationwide electronic survey was conducted in the autumn of 2020, which included all hospitals and municipalities in Denmark. RESULTS Eighty six percent of hospitals (n = 19) and 97% (n = 95) of municipalities responded. Of the 32% (n = 6) of hospitals and 78% (n = 74) of municipalities that provided prosthesis rehabilitation, the majority (hospitals 50% /municipalities 91%) provided prostheses for <10 patients in 2019, and 36% reported having competencies at only a general level among physiotherapists performing prosthetic training. Psychosocial rehabilitation modalities were lacking overall. CONCLUSIONS This national study documents pronounced geographic inequality in access to qualified rehabilitation services for the relatively few patients undergoing lower extremity amputations in Denmark. The decentralised organisation of amputation rehabilitation makes it difficult to build and maintain specialist competencies among healthcare professionals. Inconsistent availability of psychosocial rehabilitation modalities of all kinds found in this study points to a need for action particularly among patients not in prosthetic rehabilitation where palliative needs should also be considered.
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Affiliation(s)
- Ulla Riis Madsen
- Department of Orthopedic Surgery, Holbaek Hospital, Holbaek, Denmark.,REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Holbaek, Denmark
| | | | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Ann-Dorthe Olsen Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Vedste Aagaard
- Department of Orthopedic Surgery, Holbaek Hospital, Holbaek, Denmark.,Department of Physiotherapy and Occupational Therapy, Holbaek Hospital, Holbaek, Denmark.,Department of Orthopaedic Surgery, Zealand University Hospital, Koege, Denmark
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12
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Corap Y, Brix M, Brandt JR, Emmeluth C, Lindberg-Larsen M. Knee function, quality of life, pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications. BMC Musculoskelet Disord 2023; 24:9. [PMID: 36609249 PMCID: PMC9817378 DOI: 10.1186/s12891-022-06104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Distal femoral resection knee arthroplasty is a limb salvage procedure. The impact of distal femoral resection arthroplasty on patient function and health status is unknown. The aim of this study was to report knee function, quality of life, knee pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications. METHODS Of 52 patients (52 knees) undergoing distal femoral resection knee arthroplasty in a single institution between 2012 and 2021, 22 were excluded as 3 patients had ≤90 days follow-up, 6 had died, and 13 declined or were unable to participate for unrelated reasons. Thus, 30 patients were included and interviewed by telephone in March 2021 (mean follow-up 3.5 years after surgery). Patient completed the Oxford Knee Score (0-48, 48 best), EQ-5D-5L, and the Copenhagen Knee ROM, and information on pain and living conditions was obtained. RESULTS The mean age was 67.9 years (SD 13.6), and 21 (70%) were female. Mean total Oxford Knee Score was 29.9 (SD 10.5), mean Copenhagen Knee ROM flexion was 116° (SD 21.6), and mean extension was - 2° (SD10.1). Mobility aids were used by 18 (60%) patients, i.e. a cane (30%), walker (26.7%) or wheelchair (3.3%). Mean EQ-5Dindex score was 0.70 (SD 0.22) and mean EQ-5D VAS score was 55.4 (SD 23.9). Nine (30%) patients used paracetamol or NSAID and 2 (6.7%) used opioids for knee pain. Mean VAS knee pain score was 1.30 (SD 2.2) at rest and 2.8 (SD 3.1) when walking. Most (90%) patients lived in their own home, with only 3 patients in nursing homes. Two-thirds (66.7%) required no home care, 5 (16.6%) received home care 1-2 times over 2 weeks, and 5 (16.6%) every day. CONCLUSION Distal femoral resection knee arthroplasty appears to be a viable treatment option for non-tumor indications. Acceptable patient outcomes were achieved in terms of functional status and quality of life, especially considering treatment alternatives such as femoral amputation.
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Affiliation(s)
- Yasemin Corap
- grid.7143.10000 0004 0512 5013Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Michael Brix
- grid.7143.10000 0004 0512 5013Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julie R. Brandt
- grid.7143.10000 0004 0512 5013Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Emmeluth
- grid.7143.10000 0004 0512 5013Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Lindberg-Larsen
- grid.7143.10000 0004 0512 5013Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Ichimura D, Hobara H, Hisano G, Maruyama T, Tada M. Acquisition of bipedal locomotion in a neuromusculoskeletal model with unilateral transtibial amputation. Front Bioeng Biotechnol 2023; 11:1130353. [PMID: 36937747 PMCID: PMC10014613 DOI: 10.3389/fbioe.2023.1130353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Adaptive locomotion is an essential behavior for animals to survive. The central pattern generator in the spinal cord is responsible for the basic rhythm of locomotion through sensory feedback coordination, resulting in energy-efficient locomotor patterns. Individuals with symmetrical body proportions exhibit an energy-efficient symmetrical gait on flat ground. In contrast, individuals with lower limb amputation, who have morphologically asymmetrical body proportions, exhibit asymmetrical gait patterns. However, it remains unclear how the nervous system adjusts the control of the lower limbs. Thus, in this study, we investigated how individuals with unilateral transtibial amputation control their left and right lower limbs during locomotion using a two-dimensional neuromusculoskeletal model. The model included a musculoskeletal model with 7 segments and 18 muscles, as well as a neural model with a central pattern generator and sensory feedback systems. Specifically, we examined whether individuals with unilateral transtibial amputation acquire prosthetic gait through a symmetric or asymmetric feedback control for the left and right lower limbs. After acquiring locomotion, the metabolic costs of transport and the symmetry of the spatiotemporal gait factors were evaluated. Regarding the metabolic costs of transportation, the symmetric control model showed values approximately twice those of the asymmetric control model, whereas both scenarios showed asymmetry of spatiotemporal gait patterns. Our results suggest that individuals with unilateral transtibial amputation can reacquire locomotion by modifying sensory feedback parameters. In particular, the model reacquired reasonable locomotion for activities of daily living by re-searching asymmetric feedback parameters for each lower limb. These results could provide insight into effective gait assessment and rehabilitation methods to reacquire locomotion in individuals with unilateral transtibial amputation.
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Affiliation(s)
- Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
- *Correspondence: Daisuke Ichimura,
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan
- Research Fellow of Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Tsubasa Maruyama
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
| | - Mitsunori Tada
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo, Japan
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14
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Kasprzak J, Frey S, Oetlinger H, Benedikt Westphalen C, Erickson N, Heinemann V, Nasseh D. Swapping data: A pragmatic approach for enabling academic-industrial partnerships. Digit Health 2023; 9:20552076231172120. [PMID: 37188076 PMCID: PMC10176540 DOI: 10.1177/20552076231172120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Objectives Academic institutions have access to comprehensive sets of real-world data. However, their potential for secondary use-for example, in medical outcomes research or health care quality management-is often limited due to data privacy concerns. External partners could help achieve this potential, yet documented frameworks for such cooperation are lacking. Therefore, this work presents a pragmatic approach for enabling academic-industrial data partnerships in a health care environment. Methods We employ a value-swapping strategy to facilitate data sharing. Using tumor documentation and molecular pathology data, we define a data-altering process as well as rules for an organizational pipeline that includes the technical anonymization process. Results The resulting dataset was fully anonymized while still retaining the critical properties of the original data to allow for external development and the training of analytical algorithms. Conclusion Value swapping is a pragmatic, yet powerful method to balance data privacy and requirements for algorithm development; therefore, it is well suited to enable academic-industrial data partnerships.
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Affiliation(s)
- Julia Kasprzak
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Simon Frey
- Roche Pharma AG, Grenzach-Wyhlen, Germany
| | | | | | - Nicole Erickson
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK, partner
site Munich), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Nasseh
- Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
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15
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Ichimura D, Amma R, Hisano G, Murata H, Hobara H. Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis. PLoS One 2022; 17:e0279593. [PMID: 36548294 PMCID: PMC9778493 DOI: 10.1371/journal.pone.0279593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.
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Affiliation(s)
- Daisuke Ichimura
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- * E-mail:
| | - Ryo Amma
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Genki Hisano
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan
- Research Fellow of the Japan Society for the Promotion of Science (JSPS), Japan
| | - Hiroto Murata
- Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
- Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Hiroaki Hobara
- Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
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16
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Brix ATH, Nymark T, Schmal H, Lindberg-Larsen M. Pneumatic tourniquet versus no tourniquet in transfemoral amputation - a study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:1088. [PMID: 36514077 PMCID: PMC9746170 DOI: 10.1186/s12891-022-06000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lower extremity amputation patients represent a frail group with extensive comorbidity. Transfemoral amputation is a high-risk procedure with 37-50% risk of mortality in the first year. Substantial blood loss during surgery increases the risk of anemic complications and death for these already weakened patients. The use of tourniquet during surgery may reduce blood loss, the need for blood transfusions, the related complications as well as the length of the surgery. However the use of tourniquet may be related to impaired wound healing and hence the use should be investigated in a randomized controlled trial. The primary aim of this study is to investigate the total blood loss and secondary to investigate differences in complications after transfemoral amputation between patients operated with or without tourniquet. METHODS The total blood loss is calculated using Nadlers approach. Based on data from a pilot series, the sample size was calculated to 124, allocated 1:1 in two groups of 62 participants to ensure detection of at least 200 mL difference in the total blood loss. The primary outcome is the total blood loss. Secondary outcomes are blood transfusions, duration of surgery, length of hospital stay and risk of complications within 90 days (re-admissions, re-operations and mortality). Explorative outcomes are 1 year mortality and re-operation risk. Further explorative outcomes are postoperative quality of life (questionnaire EQ-5D-5L) and evaluation of number of prosthesis users including evaluation of prosthesis-specific function measured 3, 6, and 12 months postoperatively. DISCUSSION The possibility to enhance patient safety is highly relevant and this trial will provide data for evidence based recommendations of best practice in amputation surgery. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov with ID: NCT05550623. Initial release: 13/09 2022.
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Affiliation(s)
- Anna Trier Heiberg Brix
- grid.7143.10000 0004 0512 5013Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tine Nymark
- grid.7143.10000 0004 0512 5013Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hagen Schmal
- grid.7143.10000 0004 0512 5013Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark ,grid.7708.80000 0000 9428 7911Department of Orthopedics and Traumatology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Martin Lindberg-Larsen
- grid.7143.10000 0004 0512 5013Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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17
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Dickinson A, Gates L, Metcalf C, Owen C, Kheng S, Harte C, Bunthoeun S, Simpson S, Worsley P, Ostler C, Donovan-Hall M, Channon A. Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: An exemplar study across three clinics in Cambodia. J Glob Health 2022; 12:04083. [PMID: 36259231 PMCID: PMC9579830 DOI: 10.7189/jogh.12.04083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Prosthetic service development and delivery rely on data describing population needs. These needs are context-specific, but most existing data come from high-income countries or small geographic areas, which are often not comparable. This study analysed routinely collected digital patient record data at multiple time points to provide insights into characteristics of people accessing Cambodian prosthetic services. Methods We investigated trends in birth year, sex, year and reason for limb absence, and prosthesis type, over three decades. Then, we observed data from 2005 and 2019 indicating how the population actively accessing prosthetics services has changed. Results Temporal trends in prosthetics service user demographics corresponded with events in Cambodia’s socio-political history. The predominant historical reason for limb absence prior to 2000 was weapon trauma during and following conflict. Since 2000, this was replaced by non-communicable disease and road accidents. Transtibial remained the most prevalent amputation level but transfemoral amputation had higher incidence for people with limb loss from road accidents, and people with limb loss due to disease were older. These observations are important as both transfemoral and older-aged groups experience particular rehabilitation challenges compared to the young, transtibial group. Conclusions The study shows how standardised, routinely collected data across multiple clinics within a country can be used to characterise prosthetics service user populations and shows significant changes over time. This indicates the need to track client characteristics and provides evidence for adapting services according to population dynamics and changes in patient need.
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Affiliation(s)
- Alex Dickinson
- Faculty of Engineering & Physical Sciences, University of Southampton, UK.,Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK
| | - Lucy Gates
- Institute for Life Sciences, University of Southampton, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Cheryl Metcalf
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK.,Faculty of Medicine, University of Southampton, UK
| | - Charlotte Owen
- Centre for Global Health and Policy (GHAP), University of Southampton, UK
| | - Sisary Kheng
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Phnom Penh, Cambodia
| | - Carson Harte
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Lisburn, UK
| | | | - Sam Simpson
- Exceed Research Network, Lisburn, UK.,Exceed Worldwide, Lisburn, UK
| | - Peter Worsley
- Institute for Life Sciences, University of Southampton, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Chantel Ostler
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK.,Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Maggie Donovan-Hall
- Institute for Life Sciences, University of Southampton, UK.,Exceed Research Network, Lisburn, UK.,Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - Amos Channon
- Exceed Research Network, Lisburn, UK.,Centre for Global Health and Policy (GHAP), University of Southampton, UK
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18
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Ichimura D, Hisano G, Murata H, Kobayashi T, Hobara H. Centre of pressure during walking after unilateral transfemoral amputation. Sci Rep 2022; 12:17501. [PMID: 36261465 PMCID: PMC9582189 DOI: 10.1038/s41598-022-22254-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/12/2022] [Indexed: 01/12/2023] Open
Abstract
Lower-limb amputation imposes a health burden on amputees; thus, gait assessments are required prophylactically and clinically, particularly for individuals with unilateral transfemoral amputation (UTFA). The centre of pressure (COP) during walking is one of the most useful parameters for evaluating gait. Although superimposed COP trajectories reflect the gait characteristics of individuals with neurological disorders, the quantitative characteristics based on the COP trajectories of individuals with UTFA remain unclear. Thus, these COP trajectories were investigated across a range of walking speeds in this study. The COP trajectories were recorded on a split-belt force-instrumented treadmill at eight walking speeds. Asymmetry and variability parameters were compared based on the COP trajectories of 25 individuals with UTFA and 25 able-bodied controls. The COP trajectories of the individuals with UTFA were significantly larger in lateral asymmetry and variability but did not show significant differences in anterior-posterior variability compared with those of the able-bodied controls. Further, the individuals with UTFA demonstrated larger lateral asymmetry at lower speeds. These results suggest that (1) individuals with UTFA adopt orientation-specific balance control strategies during gait and (2) individuals with UTFA could also be exposed to a higher risk of falling at lower walk speeds.
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Affiliation(s)
- Daisuke Ichimura
- grid.208504.b0000 0001 2230 7538Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan
| | - Genki Hisano
- grid.208504.b0000 0001 2230 7538Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan ,grid.32197.3e0000 0001 2179 2105Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan ,grid.54432.340000 0001 0860 6072Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Hiroto Murata
- grid.208504.b0000 0001 2230 7538Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan ,grid.143643.70000 0001 0660 6861Department of Mechanical Engineering, Tokyo University of Science, Chiba, Japan
| | - Toshiki Kobayashi
- grid.16890.360000 0004 1764 6123Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hiroaki Hobara
- grid.208504.b0000 0001 2230 7538Artificial Intelligence Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tokyo, Japan ,grid.143643.70000 0001 0660 6861Faculty of Advanced Engineering, Tokyo University of Science, Tokyo, Japan
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19
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Miller TA, Campbell JH, Bloom N, Wurdeman SR. Racial Disparities in Health Care With Timing to Amputation Following Diabetic Foot Ulcer. Diabetes Care 2022; 45:2336-2341. [PMID: 36069831 PMCID: PMC9862414 DOI: 10.2337/dc21-2693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/09/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine variations in timing of lower-limb amputation (LLA) across race/ethnicity and sex among older adults with a diabetic foot ulcer (DFU). It was hypothesized Black/African Americans were more likely to have LLA post-DFU earlier compared with non-Hispanic/Whites, and more men would receive LLA earlier post-DFU compared with women. RESEARCH DESIGN AND METHODS This was a retrospective cohort analysis of enrolled Medicare fee-for-service (FFS) beneficiaries with a diagnosis of DFU during the study period (2012-2017), allowing up to 5 years post-DFU. Final analytic sample contained 643,287 individuals; the subsample consisted of 68,633 individuals with LLA only. The primary outcome was mutually exclusive groups based on timing of LLA. Multinomial logistic regression was applied to assess likelihood of membership into a group post-DFU based on characteristics such as sex and race/ethnicity. RESULTS Black/African American beneficiaries had 1.98 (95% CI 1.93-2.03) times the odds of receiving an LLA within 1 year of DFU diagnosis compared with non-Hispanic/White beneficiaries relative to no amputation. Female beneficiaries had increased odds (odds ratio [OR] 1.07, 95% CI 1.02-1.11] between 1 and 3 years and OR 1.08 [95% CI 1.03-1.12] in ≥3 years) of a delayed LLA compared with men among those that underwent LLA. CONCLUSIONS Notably, these results present novel evidence on timing of LLA between racial groups and sex for Medicare FFS beneficiaries post-DFU. Results may be generalizable to individuals with Medicare FFS and DFU. Clinically more targeted, evidence-based decision making informs care decisions with opportunities to address inequities related to the social determinants of health that may lead to LLA.
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Affiliation(s)
- Taavy A Miller
- Hanger Institute for Clinical Research and Education, Austin, TX.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James H Campbell
- Hanger Institute for Clinical Research and Education, Austin, TX
| | | | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, Austin, TX
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20
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Kuhlmann A, Hagberg K, Kamrad I, Ramstrand N, Seidinger S, Berg H. The Kenevo microprocessor-controlled prosthetic knee compared with non-microprocessor-controlled knees in individuals older than 65 years in Sweden: A cost-effectiveness and budget-impact analysis. Prosthet Orthot Int 2022; 46:414-424. [PMID: 35511441 PMCID: PMC9554759 DOI: 10.1097/pxr.0000000000000138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Growing evidence suggests that individuals with transfemoral amputation or knee disarticulation using a prosthesis equipped with a microprocessor-controlled knee (MPK) benefit from enhanced mobility and safety, including less falls. In elderly individuals, high mortality rates are assumed to reduce the expected useful life of MPKs, and this raises concerns regarding their economic effectiveness. OBJECTIVE To investigate the cost-effectiveness and budget impact of the Kenevo/MPK (Ottobock, Germany) compared with non-microprocessor-controlled knees (NMPKs) in people older than 65 years at the time of transfemoral amputation/knee disarticulation, from a Swedish payer's perspective. METHODS A decision-analytic model was developed to conduct the economic analysis of the Kenevo/MPK. Model parameters were derived from Swedish databases and published literature. Univariate and probabilistic sensitivity analyses were performed to explore parameter uncertainty. RESULTS Compared with NMPKs, the Kenevo/MPK reduced the frequency of hospitalizations by 137 per 1,000 person years while the frequency of fatal falls was reduced by 19 per 1,000 person-years in the simulation. Over a 25-year time horizon, the incremental cost-effectiveness ratio was EUR11,369 per quality-adjusted life year. The probability of the MPK being cost-effective at a threshold of EUR40,000 per quality-adjusted life year was 99%. The 5-year budget impact model predicted an increase in payer expenditure of EUR1.76 million if all new patients received a Kenevo/MPK, and 50% of current NMPK users switched to the MPK. CONCLUSIONS Results of the modeling suggest that the Kenevo/MPK is likely to be cost-effective for elderly individuals, primarily because of a reduction in falls.
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Affiliation(s)
| | - Kerstin Hagberg
- Sahlgrenska University Hospital, Gothenburg, Sweden and Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ilka Kamrad
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital Malmö Sweden
| | | | | | - Hans Berg
- Karolinska University Hospital and Division of Orthopedics and Biotechnology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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21
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From outcome measurement to improving health outcomes after lower limb amputation-A narrative review exploring outcome measurement from a clinical practice perspective. Prosthet Orthot Int 2022; 46:e341-e350. [PMID: 35357360 DOI: 10.1097/pxr.0000000000000100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional body encouragement, and successful examples of system level outcome measurement within some health care settings, many barriers still exist preventing outcome measurement from becoming embedded in clinical practice. This paper presents a narrative review which aims to describe the state of the outcome measurement evidence base in prosthetic rehabilitation, as applied in clinical practice, with a view to identifying areas for future work aimed at making outcome measurement in prosthetic rehabilitation a meaningful reality. A literature search of four databases was undertaken, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis principals appropriate to narrative reviews, and using the search terms outcome, measur*, tool, scale, instrument, prosthe*, amput* and limb loss. A total of 1116 papers were identified. Following screening 35 papers, focusing on four main themes, were included in the review. Themes were: 1) What outcome domains should be measured? 2) How can these outcome domains be measured? 3) What are the barriers to outcome measurement? and 4) What can be learnt from examples of ROM in prosthetic rehabilitation? Findings suggest that successful outcome measurement is multifaceted. Understanding and embedding value at every step appears to be key to success. Addressing the questions of 'what' outcome domains to measure and 'how' to measure them, may help establish consensus. Routine outcome measurement practice at the clinical level should ensure data collection is valuable to clinical practice, makes use of information technology solutions and has organisational engagement.
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22
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Cross-Sectional Analysis of 180,595 Lower Limb Amputations in the State of Sao Paulo Over 12 Years. World J Surg 2022; 46:2498-2506. [PMID: 35842543 DOI: 10.1007/s00268-022-06631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Lower limb amputations represent a high social, economic and health burden. Most of them are preventable and reflect areas for improvement in health care, making it essential to know their epidemiology. MATERIALS AND METHODS This is a retrospective population-based cross-sectional analysis on all lower limb amputations performed in public hospitals in Sao Paulo between 2009 and 2020, the most populous Brazilian state, with 46 million inhabitants. Using a public database, we evaluated types, rates and trends of the amputations performed, main etiologies leading to the indication for amputation, hospital length of stay and in-hospital mortality rates, demographics of the amputees and procedure costs. RESULTS In total, 180,595 lower limb amputations and surgical revision of amputations were performed, with toe amputations (45%) and major amputations (33%) being the most frequent types of surgeries, with a recent significant increase in the rates for both these procedures. Peripheral artery disease was the most frequent etiology, followed by diabetes mellitus, with both showing an upward trend over the years. Most patients were male (69.3%), Caucasians (55.6%) and elderly. August was the month with the highest number of amputations in all years. Overall in-hospital mortality after lower limb amputations was 6.6%. Total reimbursed by the government was US$ 67,675,875.55. CONCLUSIONS Peripheral artery disease is the most frequent underlying diagnosis for lower limb amputations, followed by diabetes mellitus, with both showing an upward trend over the years. We observed seasonality in procedure rates, with peaks in August in all years.
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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.
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Mellema M, Risnes M, Mirtaheri P, Gjøvaag T. Impact of the COVID-19 restrictions on physical activity and quality of life in adults with lower limb amputation. Prosthet Orthot Int 2022; 46:213-219. [PMID: 35704602 PMCID: PMC9201933 DOI: 10.1097/pxr.0000000000000078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/08/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study investigated the impact of COVID-19 restrictions on ambulatory activity and health-related quality of life (HR-QoL) in people with a lower limb amputation (LLA) in Norway. We hypothesized that the restrictions would negatively affect HR-QoL and decrease prosthetic wear time and ambulatory activity in participants with already limited mobility. METHODS Twenty individuals with LLA (age and time since amputation 56.2 ± 11.9 and 22.3 ± 20.1 years, respectively) participated. Ambulatory activity (stepwatch: prosthetic wear time; steps per day; minutes of low-intensity (1-15 steps min-1), moderate-intensity (16-40 steps min-1), and high-intensity ambulation (>40 steps min-1)) and HR-QoL (EQ-5D-5L) data were collected prepandemic and 8-12 months later during pandemic restrictions. Semistructured interviews identified personal experiences of coping with restrictions. RESULTS Prosthetic wear time decreased significantly (-1.0 ± 1.5 hours day-1, p < 0.05). Steps per day (440 ± 1481), moderate-intensity and high-intensity ambulation (3.7 ± 23.4, and 4.8 ± 13.9 minutes day-1, respectively), and EQ-5D-5L index (.02 ± .10) increased, whereas low-intensity ambulation decreased (-1.5 ± 16.1 minutes day-1), all nonsignificant changes. Qualitative analysis identified three themes related to coping with restrictions: (1) personal situation, (2) a prosthetic user's perspective, and (3) mindset. CONCLUSIONS Increased time spent at home might explain the decreased prosthetic wear time. Contrary to the hypothesis, participants did not decrease their physical activity, and the declined low-intensity ambulation was offset by increased moderate-intensity and high-intensity ambulation. A positive mindset, intrinsic motivation, and health awareness may be important factors for maintaining ambulatory activity and HR-QoL in people with LLA.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Martha Risnes
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Peyman Mirtaheri
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
| | - Terje Gjøvaag
- Department of Occupational therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Mellema M, Gjøvaag T. Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:2243. [PMID: 35336412 PMCID: PMC8955603 DOI: 10.3390/s22062243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. METHODS The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. RESULTS AND CONCLUSIONS 98 articles met the inclusion criteria. According to the included studies' main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
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Pran L, Baijoo S, Harnanan D, Slim H, Maharaj R, Naraynsingh V. Quality of Life Experienced by Major Lower Extremity Amputees. Cureus 2021; 13:e17440. [PMID: 34589346 PMCID: PMC8462540 DOI: 10.7759/cureus.17440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Abstract
Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported. However, there is a lack of evidence that assess the quality of life experienced in such amputees. This study aimed to determine the health-related quality of life (HRQoL) in patients after a major lower limb amputation. Data collection was performed for all major lower limb amputations undertaken at a tertiary care institution in Trinidad and Tobago, between January 2012 to December 2016. The quality of life for patients who were accessible, alive, and willing to participate was assessed using the EuroQol 5D-5L tool. Statistical analysis was performed using the Mann-Whitney U and Kruskal-Wallis tests comparing medians across various subgroups. A total of 134 individuals were still alive and willing to participate in the study. The average EQ-5D-5L index value for the cohort was (0.598), which was significantly lower compared to EQ-5D-5L population norms for Trinidad and Tobago p < 0.05. Statistically significant differences were also seen in median EQ-5D-5L index value for patients who ambulated with a prosthesis (0.787) compared to those who used another device for mobilization (0.656), p < 0.05, and to those patients who did not ambulate (0.195), p < 0.05. A comparable Quality of life was seen between the level of amputation (transtibial versus transfemoral) and gender (males versus females), p-values were 0.21 and 1.0, respectively. Overall quality of life after major amputation, as well as independent mobilization with a prosthesis, continues to be problematic in the Caribbean population. Factors adversely related to the quality of life post major amputation include increasing age, problems related to mobility, and non-ambulatory patients.
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Affiliation(s)
- Lemuel Pran
- Surgery, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Shanta Baijoo
- Surgery, Eric Williams Medical Sciences Complex, Mt. Hope, TTO
| | - Dave Harnanan
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Hani Slim
- Vascular Surgery, King's College Hospital, London, GBR
| | - Ravi Maharaj
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Vijay Naraynsingh
- Clinical Surgical Sciences, The University of the West Indies, St. Augustine, TTO.,Surgery, Medical Associates Hospital, St. Joseph, TTO
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Kannenberg A, Seidinger S. Health Economics in the Field of Prosthetics and Orthotics: A Global Perspective. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:35298. [PMID: 37615010 PMCID: PMC10443514 DOI: 10.33137/cpoj.v4i2.35298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The rapid advancement of prosthetic and orthotic (P&O) technology raises the question how the industry can ensure that patients have access to the benefits and providers get paid properly and fairly by healthcare payers. This is a challenge that not only P&O but all areas of health technology face. In many areas of medicine and health products, such as drugs and medical devices, health-technology assessments (HTA) have become a standard procedure in the coverage and reimbursement process. In most countries, P&O is lagging behind that development, although some countries have already formalized HTA for prosthetic and orthotic products and may even use cost-effectiveness analyses to determine pricing and payment amounts. This article gives an overview on the coverage and reimbursement processes in the United States, Canada, Germany, France, Sweden, the United Kingdom, Poland, Japan, and China. This selection reflects the variety and diversity of coverage and reimbursement processes that the P&O industry faces globally. The paper continues with an overview on the necessary research and investment efforts that manufacturers will have to make in the future, and contemplates the likely consequences for the manufacturer community in the market place. Health economics may help support the transition from price-based to value-based coverage and reimbursement but will come at considerable costs to the industry.
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Pellegrini R, Denza G, Brunelli S, Zenardi D, Imperio M, Vannozzi G, Traballesi M. The Hybrid Subischial Socket for Persons With Transfemoral Amputation: Gait Parameters and Clinical Assessment of a Case Series. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36252. [PMID: 37614930 PMCID: PMC10443468 DOI: 10.33137/cpoj.v4i1.36252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The subischial socket interface design is a promising new shape of socket for persons with transfemoral amputation. Typically, the proximal trim line is located distal to the ischial tuberosity, improving comfort in prosthetic users without interfering with gait parameters compared to Ischial Containment Socket (ICS). No studies have investigated the performances of a subischial sockets with suction suspension system. A new subischial socket (Hybrid Subischial Socket - HySS) combined with a hypobaric passive suspension system has been recently developed. OBJECTIVE To assess the effects of HySS in terms of comfort, hip range-of-motion and gait parameters. METHODOLOGY Three persons with transfemoral amputation were tested first using their usual ICS and then after one month of continuous use of HySS. FINDINGS The following parameters improved in all participants using HySS: 1) hip range-of-motion, 2) walking speed and distance, 3) Timed-Up-and-Go-Test time, 4) stride length, 5) double support duration, 6) peak value of hip extension during stance, 7) satisfaction with the prosthesis. CONCLUSION These findings suggest that the use of HySS could allow improvements for prosthetic use.
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Affiliation(s)
- R Pellegrini
- ITOP Spa, Officine Ortopediche, Palestrina, Rome, Italy
| | - G Denza
- ITOP Spa, Officine Ortopediche, Palestrina, Rome, Italy
| | - S Brunelli
- Fondazione Santa Lucia, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy
| | - D Zenardi
- ITOP Spa, Officine Ortopediche, Palestrina, Rome, Italy
| | - M Imperio
- Department of Movement, Human and Health Sciences, Foro Italico, University of Rome, Rome, Italy
| | - G Vannozzi
- Department of Movement, Human and Health Sciences, Foro Italico, University of Rome, Rome, Italy
| | - M Traballesi
- Fondazione Santa Lucia, Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy
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Petkovšek-Gregorin R. Razjede in njihovo celjenje pri pacientih po amputaciji. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.2.2987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Najpogostejši vzroki, ki vplivajo na celjenje razjed pri pacientih po amputaciji, so periferna arterijska bolezen, sladkorna bolezen in kronična venska insuficienca. Namen raziskave je bil prepoznati dejavnike, ki lahko vplivajo na celjenje razjede na amputacijskem krnu.Metode: Uporabljena je bila kvantitativna neeksperimentalna raziskovalna metodologija. Izvedena je bila retrospektivna raziskava s pregledom negovalne dokumentacije o spremljanju razjede. V raziskavo je bilo vključenih 134 pacientov po amputaciji spodnjega uda z razjedo, hospitaliziranih v letu 2017. Uporabljeni sta bili opisna statistika in logistična regresija.Rezultati: Razjedo, nastalo zaradi različnih vzrokov, je imelo 134 pacientov. Ženske imajo v primerjavi v moškimi več možnosti za prisotnost razjede ob odpustu (RO = 4,8, 95 % IZ: 1–22), prav tako pacienti, ki so imeli razjedo že ob sprejemu (RO = 7,7, 95 % IZ: 3–19,2), in tisti z več kot eno razjedo (RO = 4,7, 95 % IZ: 1–22,3). Pri pacientih, ki imajo razjedo na amputacijskem krnu, imajo večjo možnost, da se bo ta do konca rehabilitacije zacelila (RO = 0,2, 95 % IZ: 0,1–0,6 p = 0,004).Diskusija in zaključek: Ugotovitve nakazujejo, da je pri ženskah večja verjetnost, da razjeda ob odpustu ne bo zaceljena, kot pri pacientih, pri katerih je bila razjeda prisotna že ob sprejemu, in pri tistih, ki imajo več razjed. Treba bi bilo izvesti raziskavo, ki bi zajela večje število pacientov. Prav tako bi bilo treba natančneje določiti parametre spremljanja.
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Walker J, Marable W, Smith C, Sigurjónsson B, Atlason I, Johannesson G. Clinical Outcome of Transfemoral Direct Socket Interface (Part 2). CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:36065. [PMID: 37614937 PMCID: PMC10443471 DOI: 10.33137/cpoj.v4i1.36065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Amputation at the transfemoral (TF) level reduces the rate of successful prosthetic fitting, functional outcome, and quality of life (QoL) compared with transtibial amputation. The TF socket interface is considered the most critical part of the prosthesis, but socket discomfort is still the most common user complaint. Direct Socket for transfemoral prosthesis users is a novel interface fabrication process where the socket is shaped and laminated directly on the residual limb and delivered in a single visit. OBJECTIVES The aim of this study was to investigate if prosthetic users' quality of life (QoL), comfort, and mobility with a Direct Socket TF interface were comparable to their experience with their previous prostheses. METHODOLOGY The pre/post design prospective cohort study included 47 subjects. From this cohort, 36 subjects completed the 6-months follow-up (mean age 58 years, 27 males). Outcomes at baseline included EQ-5D-5L®, PLUS-M™, CLASS, ABC, AMPPRO, and TUG. At 6-weeks and 6-months, subjects repeated all measures. Seven Certified Prosthetist (CP) investigators performed observations and data collection at six different sites (from July 2018 to April 2020). FINDINGS Results showed significant improvement in all outcome measures for the 36 subjects that completed both 6-weeks and 6-months follow-ups. CLASS sub-scales showed significantly improved stability, suspension, comfort, and socket appearance. Improvement in K-Level and less use of assistive devices were observed with the AMPPRO instrument, indicating improved user mobility and performance. QoL was also increased, as measured in Quality-Adjusted-Life-Years (QALY) from the EQ-5D-5L. CONCLUSIONS Evidence from the findings demonstrate that the Direct Socket TF system and procedure can be a good alternative to the traditional method of prosthetic interface delivery.
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Affiliation(s)
- J. Walker
- Virginia Prosthetic & Orthotics, Roanoke, Virgina, USA
| | - W.R. Marable
- össur HF, Foothill Ranch, California, USA
- össur HF, Reykjavik, Iceland
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McDonald CL, Westcott-McCoy S, Weaver MR, Haagsma J, Kartin D. Global prevalence of traumatic non-fatal limb amputation. Prosthet Orthot Int 2021; 45:105-114. [PMID: 33274665 DOI: 10.1177/0309364620972258] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reliable information on both global need for prosthetic services and the current prosthetist workforce is limited. Global burden of disease estimates can provide valuable insight into amputation prevalence due to traumatic causes and global prosthetists needed to treat traumatic amputations. OBJECTIVES This study was conducted to quantify and interpret patterns in global distribution and prevalence of traumatic limb amputation by cause, region, and age within the context of prosthetic rehabilitation, prosthetist need, and prosthetist education. STUDY DESIGN A secondary database descriptive study. METHODS Amputation prevalence and prevalence rate per 100,000 due to trauma were estimated using the 2017 global burden of disease results. Global burden of disease estimation utilizes a Bayesian metaregression and best available data to estimate the prevalence of diseases and injuries, such as amputation. RESULTS In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide. Leading traumatic causes of limb amputation were falls (36.2%), road injuries (15.7%), other transportation injuries (11.2%), and mechanical forces (10.4%). The highest number of prevalent traumatic amputations was in East Asia and South Asia followed by Western Europe, North Africa, and the Middle East, high-income North America and Eastern Europe. Based on these prevalence estimates, approximately 75,850 prosthetists are needed globally to treat people with traumatic amputations. CONCLUSION Amputation prevalence estimates and patterns can inform prosthetic service provision, education and planning.
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Affiliation(s)
- Cody L McDonald
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sarah Westcott-McCoy
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Marcia R Weaver
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Inter-limb weight transfer strategy during walking after unilateral transfemoral amputation. Sci Rep 2021; 11:4793. [PMID: 33637849 PMCID: PMC7910552 DOI: 10.1038/s41598-021-84357-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 01/31/2023] Open
Abstract
Although weight transfer is an important component of gait rehabilitation, the biomechanical strategy underlying the vertical ground reaction force loading/unloading in individuals with unilateral transfemoral amputation between intact and prosthetic limbs remains unclear. We investigated weight transfer between limbs at different walking speeds in 15 individuals with unilateral transfemoral amputation and 15 individuals without amputation as controls, who walked on an instrumented treadmill. The normalized unloading and loading rates were calculated as the slope of decay and rise phase of the vertical ground reaction force, respectively. We performed linear regression analyses for trailing limb's unloading rate and leading limb's loading rate between the prosthetic, intact, and control limbs. While loading rate increased with walking speed in all three limbs, the greatest increase was observed in the intact limb. In contrast to the other limbs, the prosthetic limb unloading rate was relatively insensitive to speed changes. Consequently, the regression line between trailing prosthetic and leading intact limbs deviated from other relationships. These results suggest that weight transfer is varied whether the leading or trailing limb is the prosthetic or intact side, and the loading rate of the leading limb is partially affected by the unloading rate of the contralateral trailing limb.
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Marable W, Smith C, Sigurjónsson B, Atlason I, Johannesson G. Transfemoral Socket Fabrication Method Using Direct Casting: Outcomes Regarding Patient Satisfaction with Device and Services. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2020; 3:34672. [PMID: 37614404 PMCID: PMC10443499 DOI: 10.33137/cpoj.v3i2.34672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Direct Socket for transfemoral (DS-TF) prosthetic user is a novel method of fabricating a laminated interface on to the residual limb but requires different training, production method and service model than what most prosthetists are familiar with. This method and model may improve patient satisfaction by enabling interface fabrication and delivery in one visit. OBJECTIVES Document patient satisfaction regarding DS-TF interface versus the prosthetic users' previous socket in terms of interface function and the clinic service model. METHODOLOGY In this longitudinal study (from July 2018 to April 2020), the DS-TF was implemented in six prosthetic clinics across the United States. Certified prosthetists (CP) and assistants were trained using a standard protocol. 47 prosthetic users participated, both those in need of a new socket and those without need. Two modules from the Orthotics and Prosthetics Users' Survey (OPUS), involving questions related to satisfaction with the Device and Services, was used to evaluate each DS-TF user outcome vs. baseline. The only part of the prosthesis that was replaced was the interface, except in 2 cases. FINDINGS Each DS-TF interface was fabricated, fit and delivered in a single clinic visit. At 6-months follow-up, 38 users reported an average of 29.8% increase in satisfaction with their new interface compared with original, and a 14.8% increase in satisfaction with the services they received from the clinic in providing of the new prosthesis vs. their original prosthesis. The main outcome increases were between baseline (initial fitting) and 6-week follow-up and remained consistent after 6 months. This improvement was consistent irrespective if the user needed a new socket for clinical reasons or not. CONCLUSIONS This study shows that after a standardized training and implementation, the DS-TF fabrication process including a new interface, improves the user's satisfaction with their prosthetic device and services.
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Affiliation(s)
| | - C Smith
- Össur Americas, Foothill Ranch, California, USA
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