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Gaffney BMM, Davis-Wilson HC, Awad ME, Tracy J, Melton DH, Lev G, Stoneback JW, Christiansen CL. Daily steps and stepping cadence increase one-year following prosthesis osseointegration in people with lower-limb amputation. Disabil Rehabil 2024; 46:1432-1437. [PMID: 37073780 PMCID: PMC10584988 DOI: 10.1080/09638288.2023.2200036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE People with lower-limb loss participate in less physical activity than able-bodied individuals, which increases the mortality risk and incidence of metabolic syndromes. This study evaluated the effect of lower-limb prosthesis osseointegration on physical activity, including daily steps and stepping cadence. METHODS Free-living walking activity was assessed from 14 patients scheduled to undergo prosthesis osseointegration at two time points (within 2 weeks prior to osseointegration surgery and 12-months following). Daily step count, stepping time, number of walking bouts, average step cadence per bout, maximum step cadence per bout, and time spent in bands of step cadence were compared before and after osseointegration. RESULTS Twelve months after prosthesis osseointegration, participants increased daily steps, daily stepping time, average step cadence, and maximum cadence per walking bout compared to pre-osseointegration. CONCLUSIONS Participants engaged in more daily steps, higher stepping cadence, and longer bouts at higher cadence one year following osseointegration compared to when using a socket prosthesis. As a novel intervention that is becoming more common, it is important to understand walking activity outcomes as these are critical for long-term health.
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Affiliation(s)
- Brecca M. M. Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver CO, USA
- Center for Bioengineering, University of Colorado Denver, Aurora, CO, USA
| | - Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Mohamed E. Awad
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Tracy
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Danielle H. Melton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Guy Lev
- University of Colorado Hospital, Aurora, CO, USA
| | - Jason W. Stoneback
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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Hanlon SL, Swink LA, Akay RB, Fields TT, Cook PF, Gaffney BMM, Juarez-Colunga E, Christiansen CL. Walking Exercise Sustainability Through Telehealth for Veterans With Lower-Limb Amputation: A Study Protocol. Phys Ther 2024; 104:pzad112. [PMID: 37615982 PMCID: PMC10979409 DOI: 10.1093/ptj/pzad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/13/2023] [Accepted: 06/24/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE This randomized controlled superiority trial will determine if an 18-month telehealth walking exercise self-management program produces clinically meaningful changes in walking exercise sustainability compared to attention-control education for veterans living with lower-limb amputation. METHODS Seventy-eight participants with lower-limb amputation (traumatic or nontraumatic) aged 50 to 89 years will be enrolled. Two groups will complete 6 one-on-one intervention sessions, and 6 group sessions over an 18-month intervention period. The experimental arm will receive a self-management program focusing on increasing walking exercise and the control group will receive attention-control education specific to healthy aging. Daily walking step count (primary outcome) will be continuously monitored using an accelerometer over the 18-month study period. Secondary outcomes are designed to assess potential translation of the walking exercise intervention into conventional amputation care across the Veteran Affairs Amputation System of Care. These secondary outcomes include measures of intervention reach, efficacy, likelihood of clinical adoption, potential for clinical implementation, and ability of participants to maintain long-term exercise behavior. IMPACT The unique rehabilitation paradigm used in this study addresses the problem of chronic sedentary lifestyles following lower-limb amputation through a telehealth home-based walking exercise self-management model. The approach includes 18 months of exercise support from clinicians and peers. Trial results will provide rehabilitation knowledge necessary for implementing clinical translation of self-management interventions to sustain walking exercise for veterans living with lower-limb amputation, resulting in a healthier lifestyle.
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Affiliation(s)
- Shawn L Hanlon
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Laura A Swink
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Rachael Brink Akay
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Thomas T Fields
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Paul F Cook
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brecca M M Gaffney
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado, Denver, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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Yildirim Şahan T, Erbahçeci F. Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study. Games Health J 2023; 12:459-467. [PMID: 37934289 DOI: 10.1089/g4h.2023.0052] [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] [Indexed: 11/08/2023] Open
Abstract
Purpose: Virtual reality is widely used in patients with chronic musculoskeletal problems. However, the short-term effects on individuals with transtibial (TT) amputation during this process remain unclear. This study aimed at investigating the effects of virtual reality on rehabilitation outcomes in TT amputees. Methods: The study included 20 TT amputees who were using TT prostheses. The participants were divided into two groups randomly as follows: physiotherapy (PT) and virtual reality (VR). Participants were treated 3 days a week, for 4 weeks, and evaluations were made before and after treatment; a 6-minute walk test was used for performance, a single-leg balance test for balance, Trinity Amputation Prosthesis Experience Scale for prosthesis satisfaction, a 10-meter walking test for gait speed, and a wearable smart t-shirt to determine cadence. Results: It was found that there was a statistically significant difference in performance, balance, prosthesis satisfaction, cadence, and gait speed before and after PT (P < 0.05). There were differences in terms of performance, prosthesis satisfaction, balance, cadence, and gait speed before and after VR (P < 0.05). There was no statistically significant difference between PT and VR (P > 0.05). Conclusion: The 4 weeks of VR training improved performance, prosthesis satisfaction, balance, cadence, and gait speed in TT amputation rehabilitation similar to physiotherapy methods. The addition of VR training to amputation rehabilitation will bring improvements since it is a fun and safe intervention. Clinical Trial Registration: The trial is registered at Clinical Trials.gov, Trial No: NCT03872193.
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Affiliation(s)
- Tezel Yildirim Şahan
- University of Health Science Turkey, Gulhane Faculty of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Fatih Erbahçeci
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, Ankara, Turkey
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Sawers A, Fatone S. After scaling to body size hip strength of the residual limb exceeds that of the intact limb among unilateral lower limb prosthesis users. J Neuroeng Rehabil 2023; 20:50. [PMID: 37098570 PMCID: PMC10131313 DOI: 10.1186/s12984-023-01166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/30/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls. METHODS Twenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey's Honest-Difference. RESULTS A significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p < 0.001). A significant simple main effect of leg (p = 0.001) indicated peak torque differed between two or more legs per muscle group. Post-hoc comparisons revealed hip extensor, flexor, and abductor peak torque was not significantly different between the residual and control legs (p ≥ 0.067) but torques in both legs were significantly greater than in the intact leg (p < 0.001). Peak hip abductor torque was significantly greater in the control and residual legs than the intact leg (p < 0.001), and significantly greater in the residual than control leg (p < 0.001). CONCLUSIONS Our results suggest that it is the intact, rather than the residual limb, that is weaker. These findings may be due to methodological choices (e.g., normalization), or biomechanical demands placed on residual limb hip muscles. Further research is warranted to both confirm, expand upon, and elucidate possible mechanisms for the present findings; and clarify contributions of intact and residual limb hip muscles to walking and balance in LLP users. CLINICAL TRIAL REGISTRATION N/A.
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Affiliation(s)
- Andrew Sawers
- Department of Kinesiology, University of Illinois at Chicago, 1919 West Taylor Street, Rm. 646, Chicago, IL, 60612, USA.
| | - Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, 60611, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA
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5
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DeGrasse NS, Mertens JC, Brzostowski JT, Allyn KJ, Vamos AC, Krout AJ, Hafner BJ, Garbini JL, Sanders JE. Beyond step counts: Including wear time in prosthesis use assessment for lower-limb amputation. J Rehabil Assist Technol Eng 2023; 10:20556683231163337. [PMID: 36935866 PMCID: PMC10021104 DOI: 10.1177/20556683231163337] [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] [Indexed: 03/17/2023] Open
Abstract
Introduction The purpose of this study was to test a novel activity monitor that tracks the time a prosthesis is worn, and the nature of the ambulatory activity conducted with the prosthesis. These capabilities allow prosthesis users' wear and accommodation practices (e.g., temporary doffing) to be monitored, and the intensity of their activities to be assessed. Methods A portable limb-socket motion sensing system was used to monitor doffs, walk bouts (≥5 steps), low locomotion (2-4 steps), stationary positions, and weight shifts in a group of transtibial prosthesis users. The relationship between doff time and active motion time was investigated, and durations of low and high intensity active motions were compared. Results For the 14 participants tested, the median prosthesis day duration ranged from 12.8-18.8 h. Eleven participants typically doffed five or fewer times per day, and three participants typically doffed 10 or more times per day. Nine participants demonstrated a positive correlation between daily doff duration and active motion duration. Six participants spent more time in weight shifts than walk bouts, while eight participants spent more time in walk bouts than weight shifts. Conclusion Capturing don time and temporary doffs and distinguishing weight shifts from walks may provide insight relevant to patient care. Longer-term monitoring studies should be conducted, and the clinical utility of the data evaluated.
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Affiliation(s)
| | - Joseph C Mertens
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | | | - Katheryn J Allyn
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Adam J Krout
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation
Medicine, University
of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical
Engineering, University
of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering,
University
of Washington, Seattle, WA, USA
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Kline PW, Davis-Wilson HC, So NF, Fields TT, Christiansen CL. Feasibility of repeated session error-augmentation gait training for people with nontraumatic transtibial amputation. Prosthet Orthot Int 2022; 46:553-559. [PMID: 36037273 PMCID: PMC9771874 DOI: 10.1097/pxr.0000000000000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 06/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spatiotemporal gait asymmetries are a persistent problem for people with non-traumatic lower-limb amputation. To date, there is limited knowledge of multi-session gait training interventions targeting step length symmetry after non-traumatic amputation. OBJECTIVE The objective was to evaluate the feasibility and efficacy of an eight-session, treadmill-based error-augmentation gait training (EAT) protocol to improve spatiotemporal gait asymmetry in people with non-traumatic transtibial amputation (TTA). STUDY DESIGN Pre-post, single group. Methods: The EAT protocol involved eight training sessions (twice per week, four weeks) of supervised split-belt treadmill walking with asymmetrical belt speeds for five, three-minute sets each session. Step length symmetry during overground walking at a self-selected gait speed was assessed prior to, weekly, and one-week after the EAT protocol. Feasibility outcomes included protocol fidelity, safety, participant acceptability, and efficacy. RESULTS Seven of the eight participants (87.5%) completed the intervention at the prescribed dose. One participant developed a skin blister on their residual limb, which was possibly related to the intervention. No falls, musculoskeletal injuries, or increases in pain occurred. Participants rated EAT as acceptable based on scores on the Intrinsic Motivation Inventory - Interest/Enjoyment subscale (6.6 ± 0.5; mean ± SD). Average between-limb step length Normalized Symmetry Index improved (was reduced) one-week following EAT (2.41 ± 6.6) compared to baseline (5.47 ± 4.91) indicating a moderate effect size (d=0.53). CONCLUSIONS An eight session EAT program delivered over four weeks using a split-belt treadmill is feasible for people with unilateral non-traumatic TTA and may reduce step length asymmetry up to a week after intervention.
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Affiliation(s)
- Paul W Kline
- Department of Physical Therapy, High Point University, High Point, NC, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Hope C Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Noel F So
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Thomas T Fields
- Department of Physical Medicine and Rehabilitation, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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Kaizu Y, Kasuga T, Takahashi Y, Otani T, Miyata K. Sleep Should Be Focused on When Analyzing Physical Activity in Hospitalized Older Adults after Trunk and Lower Extremity Fractures-A Pilot Study. Healthcare (Basel) 2022; 10:healthcare10081429. [PMID: 36011086 PMCID: PMC9408561 DOI: 10.3390/healthcare10081429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Although the importance of resting in bed for hospitalized older adults is known, current methods of interpreting physical activity (PA) recommend the use of a broad definition of sedentary behavior (SB) that includes 0−1.5 metabolic equivalents (METs) of sleep (SL) and sitting. We investigated the characteristics of PA by conducting a cross-sectional study of 25 older adults with trunk and lower extremity fractures. The intensity of their PA was interpreted as SL (0−0.9 METs), SB (1−1.5 METs), low-intensity PA (LIPA: 1.6−2.9 METs), and moderate-to-vigorous PA (MVPA: >3.0 METs). We calculated the correlation coefficients to clarify the relationship between each PA intensity level. Our analyses revealed that the PA time (min/day) was accounted for by SB (53.5%), SL (23.2%), LIPA (22.8%), and MVPA (0.5%). We observed negative correlations between SL and SB (r = −0.837) and between SL and LIPA (r = −0.705), and positive correlations between SB and LIPA (r = 0.346) and between LIPA and MVPA (r = 0.429). SL and SB were also found to have different trends in relation to physical function. These results indicate that SL and SB are trade-offs for PA during the day. Separate interpretations of the SL and SB of older hospitalized adults are thus recommended.
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Affiliation(s)
- Yoichi Kaizu
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Takeaki Kasuga
- Department of Rehabilitation Center, Hidaka Rehabilitation Hospital, 2204 Yoshii-machi Maniwa, Takasaki, Gunma 370-2104, Japan;
| | - Yu Takahashi
- Department of Rehabilitation Center, Hidaka Hospital, 886 Nakao-machi, Takasaki, Gunma 370-0001, Japan; (Y.K.); (Y.T.)
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, 1373 Higashinagaoka-cho, Ota, Gunma 373-0812, Japan;
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, 4669-2 Ami-Machi, Inashiki-gun, Ibaraki 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
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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 2022; 22:s22062243. [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] [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;
- Correspondence:
| | - 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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Tsagkaris C, Widmer J, Wanivenhaus F, Redaelli A, Lamartina C, Farshad M. The sitting vs standing spine. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 9:100108. [PMID: 35310424 PMCID: PMC8924684 DOI: 10.1016/j.xnsj.2022.100108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
Background Planning of surgical procedures for spinal fusion is performed on standing radiographs, neglecting the fact that patients are mostly in the sitting position during daily life. The awareness about the differences in the standing and sitting configuration of the spine has increased during the last years. The purpose was to provide an overview of studies related to seated imaging for spinal fusion surgery, identify knowledge gaps and evaluate future research questions. Methods A literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews (PRISMASc) was performed to identify reports related to seated imaging for spinal deformity surgery. A summary of the finding is presented for healthy individuals as well as patients with a spinal disorder and/or surgery. Results The systematic search identified 30 original studies reporting on 1) the pre- and postoperative use of seated imaging of the spine (n=12), 2) seated imaging of the spine for non - surgical evaluation (n=7) and 3) seated imaging of the spine among healthy individuals (12). The summarized evidence illuminates that sitting leads to a straightening of the spine decreasing thoracic kyphosis (TK), lumbar lordosis (LL), the sacral slope (SS). Further, the postural change between standing and sitting is more significant on the lower segments of the spine. Also, the adjacent segment compensates the needed postural change of the lumbar spine while sitting with hyperkyphosis. Conclusions The spine has a different configuration in standing and sitting. This systematic review summarizes the current knowledge about such differences and reveals that there is minimal evidence about their consideration for surgical planning of spinal fusion surgery. Further, it identifies gaps in knowledge and areas of further research.
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Affiliation(s)
- Christos Tsagkaris
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.,Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jonas Widmer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.,Spine Biomechanics, Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Redaelli
- GSpine4 - I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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