Comprehensive Treatment Strategy for Chronic Low Back Pain in a Patient with Bilateral Transfemoral Amputations Integrating Changes in Prosthetic Socket Design

Comparison of Ischial Containment and Subischial Sockets on Comfort, Function, Quality of Life, and Satisfaction With Device in Persons With Unilateral Transfemoral Amputation: A Randomized Crossover Trial

OBJECTIVE

To compare comfort and functional performance of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket with the ischial containment (IC) socket in persons with unilateral transfemoral amputation.

DESIGN

Randomized crossover trial with two 7-week periods.

SETTING

Private prosthetic clinics and university research laboratory.

PARTICIPANTS

A total of 30 enrolled (N=30); 25 participants completed the study with full (n=18) or partial data (n=7).

INTERVENTIONS

Two custom-fabricated sockets (IC and NU-FlexSIV), worn full-time for 7 weeks, with testing at 1, 4, and 7 weeks after socket delivery.

MAIN OUTCOME MEASURES

The primary outcome was change in Socket Comfort Score (SCS) at 7 weeks. Secondary outcomes at 7 weeks included the Orthotic and Prosthetic Users' Survey (OPUS) to assess lower extremity functional status, health-related quality of life, and satisfaction with device, as well as the 5-Times Rapid Sit-to-Stand Test, Four Square Step Test, and T-Test of Agility to assess functional performance.

RESULTS

At 7 weeks, the mean SCS for IC (7.0±1.7) and NU-FlexSIV (8.4±1.1) Sockets were significantly different (P<.001; 95% confidence interval, 0.8-2.3). Results from a linear mixed-effects model, accounting for data from all time points, indicated that the SCS was 1.7 (SE=0.45) points higher for the NU-FlexSIV Socket (P<.001). For the secondary outcomes, only OPUS satisfaction with device was significantly better in the NU-FlexSIV Socket after accounting for all data points.

CONCLUSIONS

The results suggest that after 7 weeks' accommodation, the NU-FlexSIV Socket was more comfortable and led to greater satisfaction with device than the IC socket in persons with unilateral transfemoral amputation and K3/K4 mobility. Other patient-reported outcomes and function were no different between sockets.

Health Outcomes Used to Determine Facets of Health-related Quality of Life for Post-9/11 Veterans Using Assistive Technology for A Combat-related Mobility Impairment: A Literature Review

INTRODUCTION

Novel rehabilitation methods, including distribution and adoption of assistive technology for lower extremity impairments, are becoming crucial to ensure positive quality of life in all individuals. The quality of life of post-9/11 combat veterans is not well understood, in comparison to research on other populations. The following essay describes a review on health outcomes used to determine health-related quality of life (HR-QoL) among combat-injured service members who require mobility-related assistive technology.

MATERIALS AND METHODS

Reviews pooled data from research on PubMed, EMBASE, CINAHL, and PsycINFO published after September 11, 2001, and included service members who sustained a mobility impairment because of involvement in a post-9/11 combat operation. Basic descriptors were extracted in addition to health outcomes used, which were then categorized and summarized by six domains for HR-QoL as defined by the World Health Organization.

RESULTS

This review found health outcomes that fit in the pain and discomfort, negative emotions, mobility, social relations, access to and quality of healthcare services, and religious/spiritual/personal beliefs subdomains. The categorized results detailed their application to track and model HR-QoL health states in those with mobility impairments using mobility-based assistive technology.

CONCLUSIONS

The research on combat-induced mobility impairments indicates assistive technology improves otherwise poor health states. The results model these domains and subdomains to determine overall HR-QoL and the quality of a healthcare intervention, though additional research is needed as only one study was identified to be experimental in design.

Technique modifications for a suction suspension version of the Northwestern University Flexible Sub-Ischial Vacuum socket: The Northwestern University Flexible Sub-Ischial Suction socket

BACKGROUND AND AIM:

Development of a passive suction version of the Northwestern University Flexible Sub-Ischial Vacuum socket would expand application of sub-ischial sockets to a larger proportion of persons with transfemoral amputation. While active vacuum suspension provides more positive coupling of the residual limb to the prosthetic socket, there are circumstances when use of active vacuum is not appropriate or feasible. Therefore, this technical note describes the technique modifications required to cast, fabricate, and fit a passive suction version of the Northwestern University Flexible Sub-Ischial Vacuum socket (i.e. the Northwestern University Flexible Sub-Ischial Suction socket).

TECHNIQUE:

Most technique modifications stem from the use of an internal seal with the Northwestern University Flexible Sub-Ischial Suction socket and the need to account for the greater relative motion occurring between the residual limb and socket with passive suction compared to active vacuum suspension.

DISCUSSION:

Between January 2015 and March 2018, 266 Northwestern University Flexible Sub-Ischial Suction sockets were fit successfully using the described technique modifications.

CLINICAL RELEVANCE

A passive suction version of the Northwestern University Flexible Sub-Ischial Vacuum socket-the Northwestern University Flexible Sub-Ischial Suction socket-broadens the application of sub-ischial sockets to a larger proportion of the population with transfemoral amputation.