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Butowicz CM, Golyski PR, Acasio JC, Hendershot BD. Comparing spinal loads in individuals with unilateral transtibial amputation with and without chronic low back pain: An EMG-informed approach. J Biomech 2024; 166:111966. [PMID: 38373872 DOI: 10.1016/j.jbiomech.2024.111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 02/21/2024]
Abstract
Chronic low back pain (cLBP) is highly prevalent after lower limb amputation (LLA), likely due in part to biomechanical factors. Here, three-dimensional full-body kinematics and kinetics during level-ground walking, at a self-selected and three controlled speeds (1.0, 1.3, and 1.6 m/s), were collected from twenty-one persons with unilateral transtibial LLA, with (n = 9) and without cLBP (n = 12). Peak compressive, mediolateral, and anteroposterior L5-S1 spinal loads were estimated from a full-body, transtibial amputation-specific OpenSim model and compared between groups. Predicted lumbar joint torques from muscle activations were compared to inverse dynamics and predicted and measured electromyographic muscle activations were compared for model evaluation and verification. There were no group differences in compressive or anterior shear forces (p > 0.466). During intact stance, peak ipsilateral loads increased with speed to a greater extent in the cLBP group vs. no cLBP group (p=0.023), while during prosthetic stance, peak contralateral loads were larger in the no cLBP group (p=0.047) and increased to a greater extent with walking speed compared to the cLBP group (p=0.008). During intact stance, intact side external obliques had higher activations in the no cLBP group (p=0.039), and internal obliques had higher activations in the cLBP group at faster walking speeds compared to the no cLBP group. Predicted muscle activations demonstrated similar activation patterns to electromyographic-measured activations (r = 0.56-0.96), and error between inverse dynamics and simulated spinal moments was low (0.08 Nm RMS error). Persons with transtibial LLA and cLBP may adopt movement strategies during walking to reduce mediolateral shear forces at the L5-S1 joint, particularly as walking speed increases. However, future work is needed to understand the time course from pain onset to chronification and the cumulative influence of increased spinal loads over time.
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Affiliation(s)
- Courtney M Butowicz
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
| | - Pawel R Golyski
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Julian C Acasio
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States
| | - Brad D Hendershot
- Research & Surveillance Section, Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, United States; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States; Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States
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Exercise Therapy in Nonspecific Low Back Pain among Individuals with Lower-Limb Amputation: A Systematic Review. Life (Basel) 2023; 13:life13030772. [PMID: 36983927 PMCID: PMC10059211 DOI: 10.3390/life13030772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Low back pain is very common condition that often becomes a long-lasting problem in prostheses users after lower limb amputation. The presented study aims to decide the potential benefits of exercise therapy on low back pain among lower limb amputees by using a systematic review. The PICO technique was used to answer the primary issue of this review: Does exercise treatment lessen the prevalence of low back pain in the population of lower limb amputees? Systematic review was conducted in the following databases: Medline-PubMed, EMBASE, Scopus, and Web of Science. Studies up to September 2010 published in English are included. Aim, target population, development and execution strategies, and treatment suggestions were among the data gathered. The primary outcomes of interest were exercise interventions as a therapy for low back pain but only two articles met including criteria. The search was broadened and 21 studies describing biomechanical changes in gait and pelvic-spine posture were analysed. This review indicates that movement therapy is a potential treatment strategy in low back pain among amputees. The major limitation of the study is the very heterogenous group of subjects in terms of amputation level, baseline activity level and comorbidities. We used a procedure that was registered in PROSPERO (CRD42022345556) to perform this systematic review of systematic reviews. There is a necessity of good quality research for concluding a consensus of exercise intervention.
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Lee SP, Farrokhi S, Kent JA, Ciccotelli J, Chien LC, Smith JA. Comparison of clinical and biomechanical characteristics between individuals with lower limb amputation with and without lower back pain: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 101:105860. [PMID: 36549051 PMCID: PMC9892268 DOI: 10.1016/j.clinbiomech.2022.105860] [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: 09/28/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lower back pain is a debilitating condition common to individuals with lower limb amputation. It is unclear what risk factors contribute to the development of back pain. This study systematically reviewed and analyzed the available evidence regarding the clinical and biomechanical differences between individuals with amputation, with and without lower back pain. METHODS A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL databases in November 2020 and repeated in June 2021 and June 2022. Studies were included if they reported comparisons of demographic, anthropometric, biomechanical, and other clinical variables between participants with and without LBP. Study quality and potential for reporting bias were assessed. Meta-analyses were conducted to compare the two groups. FINDINGS Thirteen studies were included, with aggregated data from 436 participants (239 with LBP; 197 pain free). The median reporting quality score was 37.5%. The included studies enrolled participants who were predominantly male (mean = 91.4%, range = 77.8-100%) and with trauma-related amputation. Meta-analyses showed that individuals with LBP exhibited moderate (3.4 out of 10) but significantly greater pain than those without LBP. We found no between-group differences in age, height, weight, BMI, and time since amputation (p = 0.121-0.682). No significant differences in trunk/pelvic kinematics during gait were detected (p = 0.07-0.446) between the groups. INTERPRETATION Demographic, anthropometric, biomechanical, and simple clinical outcome variables may be insufficient for differentiating the risk of developing back pain after amputation. Investigators should be aware of the existing gender bias in sampling and methodological limitations, as well as to consider incorporating psychosocial measures when studying LBP in this clinical population.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA.
| | - Shawn Farrokhi
- Research and Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence (EACE), San Antonio, TX, USA; Department of Physical and Occupational Therapy, Chiropractic Services and Sports Medicine, Naval Medical Center San Diego, San Diego, CA, USA
| | - Jenny A Kent
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Jason Ciccotelli
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, NV, USA
| | - Jo Armour Smith
- Department of Physical Therapy, Chapman University, Irvine, CA, USA
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Sadowski PK, Battista S, Leuzzi G, Sansone LG, Testa M. Low Back Pain in People With Lower Limb Amputation: A Cross-Sectional Study. Spine (Phila Pa 1976) 2022; 47:1599-1606. [PMID: 35920468 PMCID: PMC9612722 DOI: 10.1097/brs.0000000000004422] [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: 04/14/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study based on an online questionnaire. OBJECTIVE The aim was to investigate the prevalence and intensity of low back pain (LBP) in people with lower limb amputation (LLA) and to analyze the association factors that can influence the genesis of LBP. SUMMARY OF BACKGROUND DATA It is still unclear whether LBP is more prevalent in the amputated population than in its nonamputated counterpart. Given the multifactorial nature of LBP, it is necessary to explore possible factors that can influence its presence and intensity, to build a solid background to define a better rehabilitation pathway for the management of these people. METHODS The online questionnaire included six sections: informed consent of the study, demographic information, comorbid conditions, history of LLA, history of LBP, and acceptance of the amputation. RESULTS Between March and June 2021, 239 participants [mean age (SD): 49.2 (11.5); female 11%] completed the survey (response rate: 32%). From the results of this study, LBP in LLA showed a prevalence of 82% postamputation and 70% in the last year. A logistic regression with a backward method showed that participants who had problems in the not affected leg presented 1.58 (95% confidence interval: 0.70; 2.45) times higher odds to have LBP after the amputation. CONCLUSION This study shows that the prevalence of LBP in lower limb amputees appears to be higher than in the general population, with similar levels of pain intensity and frequency. The highest percentage of people with a sedentary lifestyle not practicing any kind of sports emphasizes the importance of educating this population on the importance of physical activity. New strategies to invest in the education of this population in terms of physical activity are needed. LEVEL OF EVIDENCE Level 4.
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Acasio JC, Butowicz CM, Dearth CL, Bazrgari B, Hendershot BD. Trunk Muscle Forces and Spinal Loads while Walking in Persons with Lower Limb Amputation: Influences of Chronic Low Back Pain. J Biomech 2022; 135:111028. [DOI: 10.1016/j.jbiomech.2022.111028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 10/19/2022]
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Acasio JC, Shojaei I, Banerjee R, Dearth CL, Bazrgari B, Hendershot BD. Trunk-Pelvis motions and spinal loads during upslope and downslope walking among persons with transfemoral amputation. J Biomech 2019; 95:109316. [PMID: 31471112 DOI: 10.1016/j.jbiomech.2019.109316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/28/2019] [Accepted: 08/14/2019] [Indexed: 11/27/2022]
Abstract
Larger trunk and pelvic motions in persons with (vs. without) lower limb amputation during activities of daily living (ADLs) adversely affect the mechanical demands on the lower back. Building on evidence that such altered motions result in larger spinal loads during level-ground walking, here we characterize trunk-pelvic motions, trunk muscle forces, and resultant spinal loads among sixteen males with unilateral, transfemoral amputation (TFA) walking at a self-selected speed both up ("upslope"; 1.06 ± 0.14 m/s) and down ("downslope"; 0.98 ± 0.20 m/s) a 10-degree ramp. Tri-planar trunk and pelvic motions were obtained (and ranges-of-motion [ROM] computed) as inputs for a non-linear finite element model of the spine to estimate global and local muscle (i.e., trunk movers and stabilizers, respectively) forces, and resultant spinal loads. Sagittal- (p = 0.001), frontal- (p = 0.004), and transverse-plane (p < 0.001) trunk ROM, and peak mediolateral shear (p = 0.011) and local muscle forces (p = 0.010) were larger (respectively 45, 35, 98, 70, and 11%) in upslope vs. downslope walking. Peak anteroposterior shear (p = 0.33), compression (p = 0.28), and global muscle (p = 0.35) forces were similar between inclinations. Compared to previous reports of persons with TFA walking on level ground, 5-60% larger anteroposterior and mediolateral shear observed here (despite ∼0.25 m/s slower walking speeds) suggest greater mechanical demands on the low back in sloped walking, particularly upslope. Continued characterization of trunk motions and spinal loads during ADLs support the notion that repeated exposures to these larger-than-normal (i.e., vs. level-ground walking in TFA and uninjured cohorts) spinal loads contribute to an increased risk for low back injury following lower limb amputation.
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Affiliation(s)
- Julian C Acasio
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Iman Shojaei
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Rajit Banerjee
- University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Christopher L Dearth
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma & Amputation Center of Excellence, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Babak Bazrgari
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Brad D Hendershot
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; DoD-VA Extremity Trauma & Amputation Center of Excellence, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss. Gait Posture 2019; 74:236-241. [PMID: 31563825 DOI: 10.1016/j.gaitpost.2019.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/16/2019] [Accepted: 09/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Persons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population. RESEARCH QUESTION Is there a potential role of impaired trunk postural control among persons with lower limb loss and chronic low back pain? METHODS Two groups of males with unilateral lower-limb loss (n = 18 with chronic low back pain; n = 13 without pain) performed an unstable sitting task. Trunk postural control was characterized using traditional and non-linear measures derived from center-of-pressure time series, as well as trunk kinematics and the ratio of lumbar to thoracic erector spinae muscle activations. RESULTS Traditional and non-linear center-of-pressure measures and trunk muscle activation ratios were similar between groups, while participants with chronic low back pain demonstrated greater trunk motion and reduced local dynamic stability. SIGNIFICANCE Our results suggest that persons with both lower-limb loss and chronic low back pain exhibit impaired trunk postural control compared to those with limb loss but without pain. Aberrant trunk motor behavior may be a response to altered functional requirements of walking with a prosthesis. An inability to adequately control the trunk could lead to spinal instability and pain in the presence of repetitive exposure to aberrant motor behavior of these proximal structures during everyday activities.
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Changes in Trunk and Pelvis Motion Among Persons With Unilateral Lower Limb Loss During the First Year of Ambulation. Arch Phys Med Rehabil 2019; 101:426-433. [PMID: 31542398 DOI: 10.1016/j.apmr.2019.08.476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized. DESIGN Inception cohort with up to 5 repeated evaluations, including both biomechanical and subjective outcomes, during a 1-year period (0, 2, 4, 6, 12 months) after initial ambulation with a prosthesis. SETTING Biomechanics laboratory within military treatment facility. PARTICIPANTS Twenty-two men with unilateral transtibial limb loss and 10 men with unilateral transfemoral limb loss (N=32). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Triplanar trunk-pelvis range of motion and intersegmental coordination (continuous relative phase) obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking velocities. Self-reported presence and intensity of low back pain. RESULTS An interaction effect between time and group existed for sagittal (P=.039) and transverse (P=.009) continuous relative phase at self-selected walking velocity and transverse trunk range of motion (P=.013) and sagittal continuous relative phase (P=.005) at controlled walking velocity. Trunk range of motion generally decreased, and trunk-pelvis coordination generally increased with increasing time after initial ambulation. Sagittal trunk and pelvis range of motion were always less and frontal trunk-pelvis coordination was always greater for persons with more distal limb loss. Low back pain increased for persons with transtibial limb loss and decreased for persons with transfemoral limb loss following the 4-month time point. CONCLUSIONS Temporal changes (or lack thereof) in features of trunk-pelvis motions within the first year of ambulation help elucidate relationships between (biomechanical) risk factors for low back pain after limb loss.
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Sivapuratharasu B, Bull AMJ, McGregor AH. Understanding Low Back Pain in Traumatic Lower Limb Amputees: A Systematic Review. Arch Rehabil Res Clin Transl 2019; 1:100007. [PMID: 33543047 PMCID: PMC7853329 DOI: 10.1016/j.arrct.2019.100007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective This systematic review aims to evaluate current literature for the prevalence, causes, and effect of low back pain (LBP) in traumatic lower limb amputees, specifically its association with the kinematics and kinetics of the lumbar spine and lower extremities. Data Sources Databases (EMBASE, MEDLINE, Scopus, CINAHL, PsycINFO) were searched systematically for eligible studies from inception to January 2018. Study Selection The inclusion terms were synonyms of low back pain, lower limb amputation, and trauma, whereas studies involving nontraumatic amputee populations, single cases, or reviews were excluded. 1822 studies were initially identified, of which 44 progressed to full-text reading, and 11 studies were included in the review. Data Extraction Two independent reviewers reviewed the included studies, which were evaluated using a quality assessment tool and the Grades of Recommendation, Assessment, Development and Evaluation system for risk of bias, prior to analyzing results and conclusions. Data Synthesis There was an LBP prevalence of 52%-64% in traumatic amputees, compared to 48%-77% in the general amputee population (predominantly vascular, tumor, trauma), attributed to a mixture of biomechanical, psychosocial, and personal factors. These factors determined the presence, frequency, and severity of the pain in the amputees, significantly affecting their quality of life. However, little evidence was available on causality. Conclusion The high prevalence of LBP in traumatic amputees highlights the necessity to advance research into the underlying mechanics behind LBP, specifically the spinal kinematics and kinetics. This may facilitate improvements in rehabilitation, with the potential to improve quality of life in traumatic amputees.
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Affiliation(s)
- Biranavan Sivapuratharasu
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Alison H McGregor
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Highsmith MJ, Goff LM, Lewandowski AL, Farrokhi S, Hendershot BD, Hill OT, Rábago CA, Russell-Esposito E, Orriola JJ, Mayer JM. Low back pain in persons with lower extremity amputation: a systematic review of the literature. Spine J 2019; 19:552-563. [PMID: 30149083 DOI: 10.1016/j.spinee.2018.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lower extremity amputation (LEA) is associated with an elevated risk for development and progression of secondary health conditions. Low back pain (LBP) is one such condition adversely affecting function, independence, and quality of life. PURPOSE The purpose of this study was to systematically review the literature to determine the strength of evidence relating the presence and severity of LBP secondary to LEA, thereby supporting the formulation of empirical evidence statements (EESs) to guide practice and future research. STUDY DESIGN/SETTING Systematic review of the literature. METHODS A systematic review of five databases was conducted followed by evaluation of evidence and synthesis of EESs. RESULTS Seventeen manuscripts were included. From these, eight EESs were synthesized within the following categories: epidemiology, amputation level, function, disability, leg length, posture, spinal kinematics, and osseointegrated prostheses. Only the EES on epidemiology was supported by evidence at the moderate confidence level given support by eight moderate quality studies. The four EESs for amputation level, leg length, posture, and spinal kinematics were supported by evidence at the low confidence level given that each of these statements had some evidence not supporting the statement but ultimately more evidence (and of higher quality) currently supporting the statement. The remaining three EESs that addressed function, disability and osseointegrated prosthetic use were all supported by single studies or had comparable evidence that disagreed with study findings rendering insufficient evidence to support the respective EES. CONCLUSIONS Based on the state of the current evidence, appropriate preventative and, particularly, treatment strategies to manage LBP in persons with LEA remain a knowledge gap and an area of future study.
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Affiliation(s)
- M Jason Highsmith
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, 13000 Bruce B. Downs Blvd., Tampa, FL, 33612, USA; School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave. Tampa, FL, 33612, USA; 319th Minimal Care Detachment, U.S. Army Reserves, Pinellas Park, 2801 Grand Ave. Pinellas Park, FL, USA, 33782.
| | - Lisa M Goff
- Center of Innovation on Disability & Rehabilitation Research, James A. Haley Veterans' Administration Hospital, 8900 Grand Oak Ci, Tampa, FL, 33637, USA
| | | | - Shawn Farrokhi
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, 34800 Bob Wilson Dr. San Diego, CA, 92134, USA; The Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, 34800 Bob Wilson Dr. San Diego, CA, 92134, USA
| | - Brad D Hendershot
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Bethesda, 4494 North Palmer Rd, Bethesda, MD, 20889, USA; Department of Rehabilitation, Research and Development Section, Walter Reed National Military Medical Center, Bethesda, 4494 North Palmer Rd, Bethesda, MD, 20889, USA
| | - Owen T Hill
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - Christopher A Rábago
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA; Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - Elizabeth Russell-Esposito
- Extremity Trauma & Amputation Center of Excellence (EACE), US Department of Veterans' Affairs, US Department of Defense, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA; Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA, Ft. Sam Houston, 3851 Roger Brooke Dr, San Antonio, TX, 78234, USA
| | - John J Orriola
- Shimberg Health Sciences Library, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Tampa, FL, 33612
| | - John M Mayer
- U.S. Spine & Sport Foundation, 3760 Convoy St #101. San Diego, CA, 92111, USA
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Haddas R, Belanger T. Clinical Gait Analysis on a Patient Undergoing Surgical Correction of Kyphosis from Severe Ankylosing Spondylitis. Int J Spine Surg 2017; 11:18. [PMID: 28765802 DOI: 10.14444/4018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic inflammatory disease primarily affecting the axial skeleton, including the sacroiliac joints, costovertebral joints, and the spine. Patients with AS found to have an alter gait pattern. The purpose of this study was to investigate biomechanical alterations in gait after surgical correction in a patient with severe kyphosis from AS. METHODS A case report in controlled laboratory study, a pretest-posttest design. A 20 year-old male presented with severe sagittal imbalance and inability to stand erect due to AS. He presented with thoracic kyphosis of 70°, lumbar kyphosis of 25°, and pelvic incidence of 43°. The patient had a complex spinal reconstruction with 84° of sagittal correction, normalizing his sagittal alignment. Gait analysis was performed the day before surgery and one month post surgery, including three-dimensional kinematics, ground reaction forces, and electromyography outcomes. RESULTS Normalization of spinal alignment minimally increased walking speed and cadence. Lower extremity ranges of motion angles increased, but were not symmetrical even one month post surgery. Postoperatively, trunk flexion, neck extension and head orientation angles decreased compared with preoperative values, but was not symmetrical even one month post surgery. The trunk muscles were activated earlier in the post surgery condition compared to the pre surgery condition while lower extremity muscles presented later muscle activation. CONCLUSIONS Surgical correction of spinal alignment improved spine function and efficiency. Changes in gait abnormality parameters observed imply that the patient used less energy to ambulate after surgery than before surgery. Although pre-surgery data showed compensation in the spine kinematics, post-surgery data supported significant changes in the spine and the lower extremity values. CLINICAL RELEVANCE Formal gait and motion analysis can provide a method to assess the impact of severe spinal deformity on function and changes after treatment.
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Affiliation(s)
- Ram Haddas
- Texas Back Institute Research Foundation, Plano, TX, USA
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