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Kalff MN, Witowski V, Hoursch V, Kirsten N, Niehage L, Kramer H, Gardetto A, Sehmisch S, Ernst J. [Innovative noninvasive gait-synchronized vibrotactile feedback system : "I can feel myself walking again"]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:626-636. [PMID: 39136753 DOI: 10.1007/s00113-024-01466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 08/23/2024]
Abstract
Despite intensive research and development of systems for restoration of sensory information, these have so far only been the subject of study protocols. A new noninvasive feedback system translates pressure loads on the forefoot and hindfoot into gait-synchronized vibrotactile stimulation of a defined skin area. To increase the authenticity, this treatment can be supplemented by a surgical procedure. Targeted sensory reinnervation (TSR) describes a microsurgical procedure in which a defined skin area on the amputated stump of the residual limb is first denervated and then reinnervated by a specific, transposed sensory nerve harvested from the amputated part of the limb. This creates a sensory interface at the residual stump. This article presents the clinical and orthopedic technical treatment pathway with this innovative vibrotactile feedback system and explains in detail the surgical procedure of TSR after amputation of the lower limb.
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Affiliation(s)
- M N Kalff
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - V Witowski
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - V Hoursch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - N Kirsten
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - L Niehage
- John + Bamberg GmbH & Co. KG, Hannover, Deutschland
| | - H Kramer
- John + Bamberg GmbH & Co. KG, Hannover, Deutschland
| | - A Gardetto
- Zentrum für Plastische‑, Ästhetische- und Rekonstruktive Chirurgie mit Handchirurgie, Brixsana Private Clinic, Brixen, Italien
| | - S Sehmisch
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - J Ernst
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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Clarke L, Ridgewell E, Dillon MP. Content comparison of utility and effectiveness instruments to the Prosthetic Interventions Core Outcome Set: a step to inform the benefits measured in lower-limb prosthetic health economic evaluations. Disabil Rehabil 2024:1-11. [PMID: 39132865 DOI: 10.1080/09638288.2024.2384627] [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: 11/27/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE Health Economic Evaluations (HEEs) calculate a cost-benefit ratio using utility and effectiveness instruments. It is unknown whether existing instruments measure the items of the Prosthetic Interventions Core Outcome Set (PI-COS) that represent the benefits most important to lower-limb prosthesis users and funders. Comparing the content of existing instruments against the PI-COS will support instrument selection for future prosthetic HEEs. MATERIALS AND METHODS Utility and effectiveness instruments used to evaluate prosthetic interventions were identified and their International Classification of Functioning, Disability and Health framework (ICF) linking results were extracted. Content of each instrument was compared to the PI-COS through three metrics: content density, content diversity and bandwidth. RESULTS Of the 130 utility and effectiveness instruments, 24 had previously been linked to the ICF. The instrument with the greatest bandwidth (i.e., broadest content coverage of the PI-COS) was the SF-36 given it linked to 6 of the 14 items of the PI-COS. Combining PROMIS subscales and short-forms allow measurement of a greater range of the PI-COS items. CONCLUSIONS There is no perfect fit instrument providing coverage of the PI-COS using the metrics of content density, content diversity and bandwidth. The PROMIS instrument may provide increase coverage of the PI-COS in future HEEs.
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Affiliation(s)
- Leigh Clarke
- Discipline of Prosthetics and Orthotics, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Emily Ridgewell
- Discipline of Prosthetics and Orthotics, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Michael P Dillon
- Discipline of Prosthetics and Orthotics, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Ranker A, Greitemann B, Kohler F, Gutenbrunner C, Sturm C, Tegtbur U, Egen C. [Validated German PROMs for People with Major Amputation of the Lower Extremity - A Narrative Review Based on the Final Report of the LEAD and COMPASS Initiative of the ISPO]. DIE REHABILITATION 2024; 63:220-228. [PMID: 38917851 DOI: 10.1055/a-2291-1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Patient-reported outcome measures (PROMs) play an important role in the rehabilitation of people with major limb amputations. Patient-completed questionnaires help collect specific constructs on this patient population. The COMPASS and LEAD initiatives, carried out by the International Society for Prosthetics and Orthotics (ISPO), underscore the importance of regularly collecting high-quality PROMs. These are essential for the evaluation of rehabilitation needs, progress, and success. In the final report of ISPO's major international initiative, PROMs recommendations of the expert panel are tabulated. In Table 3.2 of the report, ISPO lists n=12 PROMs that were included in the narrow consensus process were considered to be of acceptable quality, and therefore recommended. The aim of this systematic review was to specifically search for these recommended PROMS regarding their availability in a German and validated version in order to identify potential gaps. All PROMs that were available in a German and validated version were then examined further with regard to the quality of the validation study, using the checklist of COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Through a systematic literature search, six validated German-language versions were found. Only four of these met the quality standards of the COSMIN checklist sufficiently. Overall, this review shows serious gaps in the availability in the German language of validated versions of PROMs used internationally and recommended as standard by the ISPO. This gap needs to be closed by guideline-oriented translation and subsequent validation studies in order to be able to offer and collect the PROMS recommended by the ISPO also for German-speaking patient populations.
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Affiliation(s)
- Alexander Ranker
- Klinik für Rehabilitations- und Sportmedizin, Medizinische Hochschule Hannover
| | | | | | | | - Christian Sturm
- Klinik für Rehabilitations- und Sportmedizin, Medizinische Hochschule Hannover
| | - Uwe Tegtbur
- Klinik für Rehabilitations- und Sportmedizin, Medizinische Hochschule Hannover
| | - Christoph Egen
- Klinik für Rehabilitations- und Sportmedizin, Medizinische Hochschule Hannover
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McDonald CL, Balkmann GS, Hafner BJ. How do users define success with a lower limb prosthesis? A focus group study. Disabil Rehabil 2024:1-15. [PMID: 38794954 DOI: 10.1080/09638288.2024.2356013] [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: 10/31/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE In this study, we sought to examine how lower limb prosthesis users define success, what constructs they associate with success, and what barriers and facilitators contribute to achieving success. MATERIALS AND METHODS Purposively sampled lower limb prosthesis users were recruited to participate in a focus group study. Verbatim transcripts from focus groups were analyzed using inductive thematic analysis. Identified constructs were mapped to existing outcome measures, and a conceptual framework for success with a lower limb prosthesis was proposed. RESULTS Thirty-one lower limb prosthesis users participated in one of five focus groups. Five themes were developed: keep moving forward, despite ups and downs; being able to live MY normal life and do the things I want to do with ease; learning what works for me and how to manage my prosthesis; only I can define my success; and what about my mental health? Several constructs that do not align with existing measures were identified, including prosthetic attention, grief/loss after amputation, and trust in prosthesis. Facilitators for success described by participants included peer connection, finding the right prosthetist, and mental health support. CONCLUSIONS According to lower limb prosthesis users, success must be patient-driven, individually defined, and continually reassessed.
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Affiliation(s)
| | | | - Brian J Hafner
- Rehabilitation Medicine, University of WA, Seattle, WA, USA
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Awad ME, Melton D, Shaw KG, Lev G, Gaffney BMM, Christiansen CL, Stoneback JW. How Comprehensive and Efficient Are Patient-Reported Outcome Measures for Individuals with Lower Extremity Amputation Undergoing Implantation of Osseointegrated Bone Anchored Limbs? JBJS Rev 2024; 12:01874474-202403000-00009. [PMID: 38489397 DOI: 10.2106/jbjs.rvw.23.00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
» Patient-reported outcome measures (PROMs) are essential for measuring quality and functional outcomes after implantation of osseointegrated bone anchored limbs for patients with lower extremity amputation.» Using a novel assessment criterion with 8 domains, this study assessed all commonly used PROMs for their efficiency and comprehensiveness.» Comprehensiveness was scored according to the presence or absence of PROM questions related to these 8 domains (maximum score = 60): mobility (15 items), prosthesis (14 items), pain (10 items), psychosocial status (10 items), independence/self-care (4 items), quality of life/satisfaction (4 items), osseoperception (1 item), general information (1 item), and vitality (1 item).» The efficiency scores were calculated by dividing the comprehensiveness score by the total number of questions answered by the patients with higher scores being deemed more efficient.» The most comprehensive PROMs were Orthotics and Prosthetics User's Survey-Lower Extremity Functional Status (OPUS-LEFS) (score = 36), Prosthesis Evaluation Questionnaire (PEQ) (score = 31), and Questionnaire for Persons with a Transfemoral Amputation (score = 27).» The most efficient PROMs were the OPUS-LEFS (score = 1.8) and European Quality of Life (score = 1.4).
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Affiliation(s)
- Mohamed E Awad
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Melton
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kylie G Shaw
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Guy Lev
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brecca M M Gaffney
- Department of Mechanical Engineering, University of Colorado Denver, Denver, Colorado
- Center for Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Cory L Christiansen
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Jason W Stoneback
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Secco MZ, Balbi LL, Pereira MSDC, Santos Costa W, Barros ARDSB, Registro Fonseca MDC. Convergent construct validity of the Brazilian version of the Houghton scale. Prosthet Orthot Int 2024:00006479-990000000-00220. [PMID: 38377306 DOI: 10.1097/pxr.0000000000000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/30/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND After lower limb amputations, a decrease in gait capacity, even with prostheses, is common and persistent. Functional ability involves multiple constructs; therefore, several outcome measures, such as performance tests or self-report questionnaires, should be used to evaluate people with amputation who use prostheses. OBJECTIVE To analyze the convergent construct validity of the Brazilian version of the Houghton scale in a sample of lower limb prosthesis users. METHODS Volunteers selected were older than 18 years with any level of lower limb amputation and prosthesis use for at least 6 months. In this study, evidence of construct validity of the Houghton scale was established by the Spearman rho correlation with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility and with the Physical Function (PF) and Emotional Well-being subdomains of the Medical Outcomes Study 36-Short Form Health Survey. RESULTS Seventy-one volunteers were recruited for the study. The sample consisted mainly of men (70.4%) with a mean age of 50 ± 12 years. The primary cause of amputation was traumatic (53.5%), and most participants (54.9%) had a transtibial amputation. The Houghton questionnaire correlated strongly with the Brazilian translation of the Prosthetic Limb Users Survey of Mobility questionnaire (rho: 0.74, p < 0.01) and weakly with the PF and Emotional Well-being of the 36-Short Form Health Survey (rho: 0.06 and rho: 0.22, respectively, p > 0.05). CONCLUSION This study showed evidence of convergent construct validity of the Houghton questionnaire to measure and classify functional use of lower limb prostheses, with great value to clinical practice. Additional work is needed to assess other measurement properties in different samples.
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Affiliation(s)
| | | | | | | | | | - Marisa de Cássia Registro Fonseca
- Department of Health Sciences, Rehabilitation and Performance Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Koenig KD, Hall MJ, Gormley C, Kaleta M, Munger M, Laine J, Morgan SJ. Clinical outcomes measurement in pediatric lower limb prosthetics: A scoping review. J Pediatr Rehabil Med 2024; 17:147-165. [PMID: 38427511 PMCID: PMC11307020 DOI: 10.3233/prm-230014] [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: 04/18/2023] [Accepted: 11/09/2023] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. METHODS First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP. RESULTS Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. CONCLUSIONS Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP.
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Affiliation(s)
- Kevin D. Koenig
- Orthotics, Prosthetics, Seating, and Casting Department, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
| | - Michelle J. Hall
- Orthotics, Prosthetics, Seating, and Casting Department, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
| | - Caroline Gormley
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Mary Kaleta
- Physical Therapy, Rady Children’s Hospital, San Diego, CA, USA
| | - Meghan Munger
- Outcomes Department, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
| | - Jennifer Laine
- Department of Orthopaedic Surgery, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
- Orthopedics Department, University of Minnesota, Minneapolis, MN, USA
- Research Department, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
| | - Sara J. Morgan
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Research Department, Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Raschke S. 3D Printing in Prosthetics, Orthotics and Assistive Technology: Myth and Reality. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2023; 6:42222. [PMID: 38873128 PMCID: PMC11168591 DOI: 10.33137/cpoj.v6i2.42222] [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] [Indexed: 06/15/2024] Open
Abstract
3D printing initially captured the public eye when mainstream media began writing about Enabling the Future, a volunteer network that had begun designing and 3D printing prosthetic hands. Many of the stories focused on how this technology was going to disrupt the prosthetic sector. The response from prosthetists was skepticism and concern, in particular warning that 3D printed components would not be robust enough to withstand the activities of daily living. Moreover, they emphasized that fit problems could potentially cause more harm than good. Several years on, this issue explores currant usage and experiences with the technology in prosthetics and, to a limited extent, orthotics.
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Affiliation(s)
- S.U Raschke
- British Columbia Institute of Technology, Applied Research MAKE+ (retired), 3700 Willingdon Avenue, Burnaby, Canada
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