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Ghai S, Hitzig SL, Eberlin L, Melo J, Mayo AL, Blanchette V, Habra N, Zucker-Levin A, Zidarov D. Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1158-1170. [PMID: 37708929 DOI: 10.1016/j.apmr.2023.08.028] [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: 03/09/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA). DATA SOURCES The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022. STUDY SELECTION To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting. DATA EXTRACTION The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer. DATA SYNTHESIS Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported. CONCLUSION The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstads Universitet, Karlstad, Sweden; Centre for Societal Risk Research, Karlstads Universitet, Karlstad, Sweden; Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Sander L Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lindsay Eberlin
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Melo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Québec, Canada; Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Natalie Habra
- Faculté de Médecine, Université de Montréal, Montréal, Canada; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Diana Zidarov
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada; École de readaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
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McMenemy L, Behan FP, Kaufmann J, Cain D, Bennett AN, Boos CJ, Fear NT, Cullinan P, Bull AMJ, Phillips ATM, McGregor AH. Association Between Combat-Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study. J Bone Miner Res 2023; 38:1227-1233. [PMID: 37194399 DOI: 10.1002/jbmr.4794] [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: 10/28/2022] [Revised: 02/08/2023] [Accepted: 02/22/2023] [Indexed: 05/18/2023]
Abstract
The association between combat-related traumatic injury (CRTI) and bone health is uncertain. A disproportionate number of lower limb amputees from the Iraq and Afghanistan conflicts are diagnosed with osteopenia/osteoporosis, increasing lifetime risk of fragility fracture and challenging traditional osteoporosis treatment paradigms. The aim of this study is to test the hypotheses that CRTI results in a systemic reduction in bone mineral density (BMD) and that active traumatic lower limb amputees have localized BMD reduction, which is more prominent with higher level amputations. This is a cross-sectional analysis of the first phase of a cohort study comprising 575 male adult UK military personnel with CRTI (UK-Afghanistan War 2003 to 2014; including 153 lower limb amputees) who were frequency-matched to 562 uninjured men by age, service, rank, regiment, deployment period, and role-in-theatre. BMD was assessed using dual-energy X-ray absorptiometry (DXA) scanning of the hips and lumbar spine. Femoral neck BMD was lower in the CRTI than the uninjured group (T-score -0.08 versus -0.42 p = .000). Subgroup analysis revealed this reduction was significant only at the femoral neck of the amputated limb of amputees (p = 0.000), where the reduction was greater for above knee amputees than below knee amputees (p < 0.001). There were no differences in spine BMD or activity levels between amputees and controls. Changes in bone health in CRTI appear to be mechanically driven rather than systemic and are only evident in those with lower limb amputation. This may arise from altered joint and muscle loading creating a reduced mechanical stimulus to the femur resulting in localized unloading osteopenia. This suggests that interventions to stimulate bone may provide an effective management strategy. © 2023 Crown copyright and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.
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Affiliation(s)
- Louise McMenemy
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Institute of Naval Medicine, Gosport, UK
| | - Fearghal P Behan
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Josh Kaufmann
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, London, UK
- Musculoskeletal Biodynamics, Imperial College London, London, UK
| | - David Cain
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Christopher J Boos
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Academic Department of Military Mental Health, King's College London, London, UK
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
- Cardiology, University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Andrew T M Phillips
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, London, UK
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3
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Edwards NA, Talarico MK, Chaudhari A, Mansfield CJ, Oñate J. Use of accelerometers and inertial measurement units to quantify movement of tactical athletes: A systematic review. APPLIED ERGONOMICS 2023; 109:103991. [PMID: 36841096 DOI: 10.1016/j.apergo.2023.103991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
The dynamic work environments of tactical athletes are difficult to replicate in a laboratory. Accelerometers and inertial measurement units provide a way to characterize movement in the field. This systematic review identified how accelerometers and inertial measurement units are currently being used to quantify movement patterns of tactical athletes. Seven research and military databases were searched, producing 26,228 potential articles with 78 articles included in this review. The articles studied military personnel (73.1%), firefighters (19.2%), paramedics (3.8%), and law enforcement officers (3.8%). Accelerometers were the most used type of sensor, and physical activity was the primarily reported outcome variable. Seventy of the studies had fair or poor quality. Research on firefighters, emergency medical services, and law enforcement officers was limited. Future research should strive to make quantified movement data more accessible and user-friendly for non-research personnel, thereby prompting increased use in tactical athlete groups, especially first responder agencies.
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Affiliation(s)
- Nathan A Edwards
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Human Performance Collaborative, The Ohio State University, 1961 Tuttle Park Place, Columbus, OH, 43210, USA; Sports Medicine Research Institute, The Ohio State University, 4835 Fred Taylor Drive, Columbus, OH, 43210, USA.
| | - Maria K Talarico
- Human Systems Integration Division, DEVCOM Analysis Center, U.S. Army Futures Command, 7188 Sustainment Rd, Aberdeen Proving Ground, MD, 21005, USA.
| | - Ajit Chaudhari
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Sports Medicine Research Institute, The Ohio State University, 4835 Fred Taylor Drive, Columbus, OH, 43210, USA; Department of Mechanical and Aerospace Engineering, The Ohio State University, 201 W. 19th Avenue, Columbus, OH, 43210, USA; Department of Biomedical Engineering, The Ohio State University, 140 W. 19th Avenue, Columbus, OH, 43210, USA.
| | - Cody J Mansfield
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Sports Medicine Research Institute, The Ohio State University, 4835 Fred Taylor Drive, Columbus, OH, 43210, USA.
| | - James Oñate
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Human Performance Collaborative, The Ohio State University, 1961 Tuttle Park Place, Columbus, OH, 43210, USA; Division of Athletic Training, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH, 43210, USA; Sports Medicine Research Institute, The Ohio State University, 4835 Fred Taylor Drive, Columbus, OH, 43210, USA.
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Ladlow P, Nightingale TE, McGuigan MP, Bennett AN, Koumanov F, Phillip R, Bilzon JLJ. Influence of traumatic lower-limb amputation on physical activity, body composition, and cardiometabolic risks: A descriptive preliminary study. PM R 2023; 15:413-425. [PMID: 36655403 DOI: 10.1002/pmrj.12944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/30/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Following traumatic lower-limb amputation (LLA), humans are predisposed to numerous unfavorable changes in health, including the development of secondary chronic health conditions such as metabolic disorders and cardiovascular disease. OBJECTIVE To determine within and between group differences in cardiometabolic component risks, body composition, and physical activity (PA) in individuals with traumatic unilateral and bilateral LLA, compared to noninjured controls. DESIGN Prospective observational cohort study. SETTING A military complex trauma rehabilitation center. PARTICIPANTS Sixteen males with traumatic LLA (8 unilateral, mean age 30 ± 5 years and 8 bilateral, mean age 29 ± 3 years). Thirteen active age-matched males with no LLA (28 ± 5 years) acted as controls and performed habitual activities of daily living. INTERVENTION Participants with LLA attended two 4-week periods of inpatient rehabilitation, separated by two 6-week periods of home-based recovery. MAIN OUTCOME MEASURES Venous blood samples were taken prior to and following a 75 g oral glucose load, for determination of biomarkers, including insulin and glucose, at baseline and 20 weeks. Body composition (dual X-ray absorptiometry) was measured at baseline, 10 weeks, and 20 weeks. Daily PA was recorded using a triaxial accelerometer for 7 days during inpatient rehabilitation and while at home. Energy expenditure was estimated using population-specific equations. RESULTS Individuals with bilateral LLA demonstrated more unfavorable mean body composition values, lower PA, and increased cardiometabolic health risk compared to controls. Cardiometabolic syndrome was identified in 63% of individuals with bilateral LLA. No statistically significant differences in cardiometabolic component risk factors, body composition, and estimated daily PA were reported between unilateral LLA and control groups (p > .05). While at home, mean PA counts.day-1 reduced by 17% (p = .018) and 42% (p = .001) in the unilateral and bilateral LLA groups, respectively. CONCLUSIONS Despite extensive inpatient rehabilitation, cardiometabolic component risks are elevated in individuals with bilateral LLA but are comparable between unilateral LLA and active noninjured control groups. Innovative strategies that improve/support the long-term PA and cardiometabolic health of severely injured individuals with bilateral LLA are warranted.
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Affiliation(s)
- Peter Ladlow
- Department for Health, University of Bath, Bath, UK.,Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, UK
| | - Thomas E Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | | | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Loughborough, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, UK
| | | | - Rhodri Phillip
- Complex Trauma Rehabilitation Department, Defence Medical Rehabilitation Centre (DMRC), Loughborough, UK
| | - James L J Bilzon
- Department for Health, University of Bath, Bath, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Department for Health, University of Bath, Bath, UK
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Mertens JC, Brzostowski JT, Vamos A, Allyn KJ, Hafner BJ, Friedly JL, DeGrasse NS, Ballesteros D, Krout A, Larsen BG, Garbini JL, Sanders JE. A novel portable sensor to monitor bodily positions and activities in transtibial prosthesis users. Clin Biomech (Bristol, Avon) 2022; 99:105741. [PMID: 36041309 PMCID: PMC10545288 DOI: 10.1016/j.clinbiomech.2022.105741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/22/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Step activity monitors provide insight into the amount of physical activity prosthesis users conduct but not how they use their prosthesis. The purpose of this research was to help fill this void by developing and testing a technology to monitor bodily position and type of activity. METHODS Thin inductive distance sensors were adhered to the insides of sockets of a small group of transtibial prosthesis users, two at proximal locations and two at distal locations. An in-lab structured protocol and a semi-structured out-of-lab protocol were video recorded, and then participants wore the sensing system for up to 7 days. A data processing algorithm was developed to identify sit, seated shift, stand, standing weight-shift, walk, partial doff, and non-use. Sensed distance data from the structured and semi-structured protocols were compared against the video data to characterize accuracy. Bodily positions and activities during take-home testing were tabulated to characterize participants' use of the prosthesis. FINDINGS Sit and walk detection accuracies were above 95% for all four participants tested. Stand detection accuracy was above 90% for three participants and 62.5% for one participant. The reduced accuracy may have been due to limited stand data from that participant. Step count was not proportional to active use time (sum of stand, walk, and standing weight-shift times). INTERPRETATION Step count may provide an incomplete picture of prosthesis use. Larger studies should be pursued to investigate how bodily position and type of activity may facilitate clinical decision-making and improve the lives of people with lower limb amputation.
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Affiliation(s)
- Joseph C Mertens
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Jacob T Brzostowski
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Andrew Vamos
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Adam Krout
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joan E Sanders
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
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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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Wong CK, Rissland MS, Madagan DM, Jones KN. A Scoping Review of Physical Activity in People With Lower-Limb Loss: 10,000 Steps Per Day? Phys Ther 2021; 101:6254127. [PMID: 33909881 DOI: 10.1093/ptj/pzab115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/08/2021] [Accepted: 03/31/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE After amputation, people with lower-limb loss (PLL) face challenges to regain their previous physical activity level. Assessing the scope of evidence regarding physical activity in PLL can identify sources of evidence and gaps within the literature that can influence amputation-related research, outcome assessment choices, and wellness activities. The purpose of this scoping review was to map the evidence regarding steps per day as a physical activity measure for PLL. Specific aims were to (1) identify research designs, (2) catalog population subgroups, (3) document steps per day measurement methods, and (4) provide descriptive data for steps per day in PLL. METHODS The MEDLINE, CINAHL, Embase, Web of Science, and AMED databases; and the Journal of Prosthetics and Orthotics archive were searched without language or time limits. Exclusion criteria included no PLL subjects, not peer-reviewed, and no direct step count measure. Inclusion criteria allowed any sample size, nonprosthetic use, and self-reported step count. As a scoping review, only descriptive statistics were compiled, and no methodologic quality assessment was performed. RESULTS Twenty-one articles using crossover (8), cohort (4), cross-section (8), and case-study (1) designs were included that reported accelerometer (19) or pedometer (2) data. Studies often mixed amputation etiologies (15/21) and most (13/21) excluded transfemoral amputations. Studies primarily examined people with transtibial amputations (81.2%) and people at independent community walking levels (Medicare functional classifications: K3 = 49.2%, K4 = 36.3%). All 21 studies had fewer than 100 participants, and overall included 515 subjects (343, 66.6% male), mean (SD) age 53.2 (22.1) years. Mean (SD) number of pooled steps per day for PLL was 5087 (2998): 5929 (3047) for transtibial amputations and 3553 (2030) for transfemoral amputations. CONCLUSIONS Most PLL have low activity levels compared with the 10,000 steps per day generally recommended or 6000 common in people with diabetes. Research with larger samples, defined subgroups, and data along the recovery continuum would enhance knowledge of physical activity level in PLL. IMPACT This scoping review has identified gaps in the research related to steps per day as a measure of physical activity in people with lower-limb loss to guide future research. LAY SUMMARY People with lower-limb loss take fewer steps per day than suggested for general health. Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.
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Affiliation(s)
- Christopher K Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Maia S Rissland
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deanna M Madagan
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kameron N Jones
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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8
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Srisuwan B, Klute GK. Locomotor activities of individuals with lower-limb amputation. Prosthet Orthot Int 2021; 45:191-197. [PMID: 33856151 PMCID: PMC8494105 DOI: 10.1097/pxr.0000000000000009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 11/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ambulatory individuals with lower-limb amputation perform a variety of locomotor activities, but the step count distribution of these activities is unknown. OBJECTIVE To describe a novel method for activity monitoring and to use it to count steps taken while walking straight ahead on level ground, turning right and left, up and down stairs, and up and down ramps. STUDY DESIGN This is an observational study. METHODS A portable instrument to record leg motion was placed on or inside the prosthetic pylon of 10 individuals with unilateral transtibial amputations. Participants first walked a defined course in a hospital environment to train and validate a machine learning algorithm for classifying locomotor activity. Participants were then free to pursue their usual activities while data were continuously collected over 1-2 d. RESULTS Overall classification accuracy was 97.5% ± 1.5%. When participants were free to walk about their home, work, and community environments, 82.8% of all steps were in a straight line, 9.0% were turning steps, 4.8% were steps on stairs, and 3.6% were steps on ramps. CONCLUSION A novel activity monitoring method accurately classified the locomotion activities of individuals with lower-limb amputation. Nearly 1 in 5 of all steps taken involved turning or walking on stairs and ramps.
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Affiliation(s)
- Bantoon Srisuwan
- University of Washington, Seattle, WA, USA
- Institute of Field Robotics, Bangkok, Thailand
| | - Glenn K. Klute
- University of Washington, Seattle, WA, USA
- Department of Veterans Affairs Medical Center, Seattle, WA, USA
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9
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Greenhalgh M, Kulich H, Blaauw E, Turner R, Peterson S, Cooper RA, Songer T. 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. Mil Med 2021; 186:1106-1114. [PMID: 33538791 DOI: 10.1093/milmed/usab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Mark Greenhalgh
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Hailee Kulich
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Eline Blaauw
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA
| | - Rose Turner
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Health Sciences Library, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Sara Peterson
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Prosthetics and Orthotics, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Thomas Songer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Chadwell A, Diment L, Micó-Amigo M, Morgado Ramírez DZ, Dickinson A, Granat M, Kenney L, Kheng S, Sobuh M, Ssekitoleko R, Worsley P. Technology for monitoring everyday prosthesis use: a systematic review. J Neuroeng Rehabil 2020; 17:93. [PMID: 32665020 PMCID: PMC7362458 DOI: 10.1186/s12984-020-00711-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring, with particular focus on low-resource settings. METHODS A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis users during daily-living. RESULTS Sixty lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. CONCLUSIONS Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user's requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.
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Affiliation(s)
| | - Laura Diment
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
| | - M Micó-Amigo
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
| | | | - Alex Dickinson
- People Powered Prosthetics Group, University of Southampton, Southampton, UK.
- Exceed Research Network, Exceed Worldwide, Lisburn, UK.
| | - Malcolm Granat
- University of Salford, Salford, UK
- Exceed Research Network, Exceed Worldwide, Lisburn, UK
| | - Laurence Kenney
- University of Salford, Salford, UK
- Exceed Research Network, Exceed Worldwide, Lisburn, UK
| | - Sisary Kheng
- University of Salford, Salford, UK
- Exceed Worldwide, Phnom Penh, Cambodia
| | | | | | - Peter Worsley
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
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