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Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PM R 2024; 16:462-473. [PMID: 37632836 PMCID: PMC10895070 DOI: 10.1002/pmrj.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Limited available data suggest that fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self-imposed declines in activity. There is a need to identify the validity of fear-of-falling-related activity avoidance scales in LLPUs. OBJECTIVE To evaluate the convergent, discriminant, and known-group construct validity of the modified Survey of Activities and FoF in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity. DESIGN Online survey. SETTING Not applicable. PARTICIPANTS Fifty-nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers. INTERVENTION Participants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear-of-falling-related activity avoidance (yes/no), as well as previously validated scales capturing related and unrelated constructs. T-tests were used to compare mSAFE score between yes/no respondents for known-group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis. MAIN OUTCOME MEASURES Not applicable. RESULTS Significant correlation coefficients of |0.440-0.825| were found for convergent validity with evidence of known-group construct validity (p < .021 for all comparisons). There was evidence for discriminant validity, with non-significant associations for two-of-three correlations. Results from validity analyses for a shortened 6-item mSAFE were similar to that for the full scale. CONCLUSION This study provided initial evidence regarding validity of the mSAFE as a measure to assess fear-of-falling-related activity avoidance in LLPUs. A 6-item scale may be appropriate if the full scale would be taxing or time-consuming.
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Affiliation(s)
- Noah J Rosenblatt
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Bobak Manesh
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Kristin Schneider
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Steven A Miller
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Tobaigy M, Hafner BJ, Hsieh K, Sawers A. Falls perceived as significant by lower limb prosthesis users are generally associated with fall consequences rather than circumstances. Disabil Rehabil 2024:1-7. [PMID: 38505985 DOI: 10.1080/09638288.2024.2328313] [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: 10/11/2023] [Accepted: 03/02/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To determine if falls perceived as significant by lower limb prosthesis (LLP) users were associated with fall circumstances and/or consequences. MATERIALS AND METHODS The circumstances and consequences of LLP users' most significant fall in the past 12-months were collected using the Lower Limb Prosthesis User Fall Event Survey. Participants rated fall significance from 0 (not significant) to 10 (extremely significant), which was then dichotomized into "low" and "high". Binary logistic regression was used to assess associations between fall significance and fall circumstances and consequences. RESULTS Ninety-eight participants were included in the analysis. Five fall consequences were associated with greater significance: major injury (OR = 26.7, 95% CI: 1.6-459.6, p = 0.024), need to seek medical treatment (OR = 19.0, 95% CI: 1.1-329.8, p = 0.043), or allied-health treatment (OR = 18.2, 95% CI: 2.3-142.4, p = 0.006), decreased balance confidence (OR = 10.9, 95% CI: 2.4-49.3, p = 0.002), and increased fear of falling (OR = 7.5, 95% CI: 2.4-23.8, p = 0.001), compared to two fall circumstances: impact to the arm (OR = 5.0, 95% CI: 2.0-12.1, p = 0.001), and impact to the face, head, or neck (OR = 9.7, 95% CI: 1.2-77.4, p = 0.032). CONCLUSIONS Significant falls were generally more associated with fall consequence than fall circumstances.
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Affiliation(s)
- Moaz Tobaigy
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
- Faculty of Medical Rehabilitation Science, King Abdulaziz University, Jeddah, KSA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Kelly Hsieh
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
- Department of Disability and Human Development, University of Illinois Chicago, Chicago, IL, USA
| | - Andrew Sawers
- Department of Kinesiology, University of Illinois Chicago, Chicago, IL, USA
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Smolderen KG, Samaan Z, Decker C, Collins T, Lazar RM, Itoga NK, Mena-Hurtado C. Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1511-1528. [PMID: 37781785 DOI: 10.1161/cir.0000000000001178] [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] [Indexed: 10/03/2023]
Abstract
Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.
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Omaña H, Frengopoulos C, Montero-Odasso M, Payne MW, Viana R, Hunter SW. Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study. Prosthet Orthot Int 2023; 47:505-510. [PMID: 36705570 DOI: 10.1097/pxr.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/21/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis. METHODS Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test. RESULTS Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST ( P < 0.001, R 2 = 0.56) and DT ( P = 0.008, R 2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35-0.14) and 0.23 (95% confidence interval, 0.39-0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed. CONCLUSIONS Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.
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Affiliation(s)
- Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Courtney Frengopoulos
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manuel Montero-Odasso
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Michael W Payne
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Wijekoon A, Jayawardana S, Milton-Cole R, Chandrathilaka M, Jones A, Cook S, Morrison E, Sheehan KJ. Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review. Arch Phys Med Rehabil 2023; 104:1484-1497. [PMID: 36893877 DOI: 10.1016/j.apmr.2023.02.009] [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: 08/01/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial amputation on pain, physical function, and quality of life and (2) the extent of inequities (unfair, avoidable differences in health) in access to identified interventions. DATA SOURCES Embase, MEDLINE, PEDro, Cinahl, Global Health, PsycINFO, OpenGrey, and ClinicalTrials.gov were systematically searched from inception to August 12, 2021, for published, unpublished, and registered ongoing randomized controlled trials. STUDY SELECTION Three review authors completed screening and quality appraisal in Covidence using the Cochrane Risk of Bias Tool. Included were randomized controlled trials of exercise-based rehabilitation interventions based in the community or at home for adults with transfemoral or transtibial amputation that assessed effectiveness on pain, physical function, or quality of life. DATA EXTRACTION Effectiveness data were extracted to templates defined a priori and the PROGRESS-Plus framework was used for equity factors. DATA SYNTHESIS Eight completed trials of low to moderate quality, 2 trial protocols, and 3 registered ongoing trials (351 participants across trials) were identified. Interventions included cognitive behavioral therapy, education, and video games, combined with exercise. There was heterogeneity in the mode of exercise as well as outcome measures employed. Intervention effects on pain, physical function, and quality of life were inconsistent. Intervention intensity, time of delivery, and degree of supervision influenced reported effectiveness. Overall, 423 potential participants were inequitably excluded from identified trials (65%), limiting the generalizability of interventions to the underlying population. CONCLUSIONS Interventions that were tailored, supervised, of higher intensity, and not in the immediate postacute phase showed greater promise for improving specific physical function outcomes. Future trials should explore these effects further and employ more inclusive eligibility to optimize any future implementation.
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Affiliation(s)
- Ashan Wijekoon
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Subashini Jayawardana
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Rhian Milton-Cole
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Amy Jones
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Sophie Cook
- Amputee Rehabilitation Unit, Lambeth Community Care Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Ed Morrison
- Bowley Close Rehabilitation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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B Aledi L, Flumignan CD, Trevisani VF, Miranda F. Interventions for motor rehabilitation in people with transtibial amputation due to peripheral arterial disease or diabetes. Cochrane Database Syst Rev 2023; 6:CD013711. [PMID: 37276273 PMCID: PMC10240563 DOI: 10.1002/14651858.cd013711.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Amputation is described as the removal of an external part of the body by trauma, medical illness or surgery. Amputations caused by vascular diseases (dysvascular amputations) are increasingly frequent, commonly due to peripheral arterial disease (PAD), associated with an ageing population, and increased incidence of diabetes and atherosclerotic disease. Interventions for motor rehabilitation might work as a precursor to enhance the rehabilitation process and prosthetic use. Effective rehabilitation can improve mobility, allow people to take up activities again with minimum functional loss and may enhance the quality of life (QoL). Strength training is a commonly used technique for motor rehabilitation following transtibial (below-knee) amputation, aiming to increase muscular strength. Other interventions such as motor imaging (MI), virtual environments (VEs) and proprioceptive neuromuscular facilitation (PNF) may improve the rehabilitation process and, if these interventions can be performed at home, the overall expense of the rehabilitation process may decrease. Due to the increased prevalence, economic impact and long-term rehabilitation process in people with dysvascular amputations, a review investigating the effectiveness of motor rehabilitation interventions in people with dysvascular transtibial amputations is warranted. OBJECTIVES To evaluate the benefits and harms of interventions for motor rehabilitation in people with transtibial (below-knee) amputations resulting from peripheral arterial disease or diabetes (dysvascular causes). SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 9 January 2023. SELECTION CRITERIA We included randomised controlled trials (RCT) in people with transtibial amputations resulting from PAD or diabetes (dysvascular causes) comparing interventions for motor rehabilitation such as strength training (including gait training), MI, VEs and PNF against each other. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. prosthesis use, and 2. ADVERSE EVENTS Our secondary outcomes were 3. mortality, 4. QoL, 5. mobility assessment and 6. phantom limb pain. We use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included two RCTs with a combined total of 30 participants. One study evaluated MI combined with physical practice of walking versus physical practice of walking alone. One study compared two different gait training protocols. The two studies recruited people who already used prosthesis; therefore, we could not assess prosthesis use. The studies did not report mortality, QoL or phantom limb pain. There was a lack of blinding of participants and imprecision as a result of the small number of participants, which downgraded the certainty of the evidence. We identified no studies that compared VE or PNF with usual care or with each other. MI combined with physical practice of walking versus physical practice of walking (one RCT, eight participants) showed very low-certainty evidence of no difference in mobility assessment assessed using walking speed, step length, asymmetry of step length, asymmetry of the mean amount of support on the prosthetic side and on the non-amputee side and Timed Up-and-Go test. The study did not assess adverse events. One study compared two different gait training protocols (one RCT, 22 participants). The study used change scores to evaluate if the different gait training strategies led to a difference in improvement between baseline (day three) and post-intervention (day 10). There were no clear differences using velocity, Berg Balance Scale (BBS) or Amputee Mobility Predictor with PROsthesis (AMPPRO) in training approaches in functional outcome (very low-certainty evidence). There was very low-certainty evidence of little or no difference in adverse events comparing the two different gait training protocols. AUTHORS' CONCLUSIONS Overall, there is a paucity of research in the field of motor rehabilitation in dysvascular amputation. We identified very low-certainty evidence that gait training protocols showed little or no difference between the groups in mobility assessments and adverse events. MI combined with physical practice of walking versus physical practice of walking alone showed no clear difference in mobility assessment (very low-certainty evidence). The included studies did not report mortality, QoL, and phantom limb pain, and evaluated participants already using prosthesis, precluding the evaluation of prosthesis use. Due to the very low-certainty evidence available based on only two small trials, it remains unclear whether these interventions have an effect on the prosthesis use, adverse events, mobility assessment, mortality, QoL and phantom limb pain. Further well-designed studies that address interventions for motor rehabilitation in dysvascular transtibial amputation may be important to clarify this uncertainty.
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Affiliation(s)
- Luciane B Aledi
- Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carolina Dq Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virginia Fm Trevisani
- Medicina de Urgência and Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo and Universidade de Santo Amaro, São Paulo, Brazil
| | - Fausto Miranda
- Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Sun M, Zhuang L. Effect of Cognitive Behavioral Therapy on Stress Disorder, Cognitive Function, Motor Function, and Daily Living Ability of Patients with a Traumatic Brain Injury. Emerg Med Int 2022; 2022:2375344. [PMID: 36065223 PMCID: PMC9440628 DOI: 10.1155/2022/2375344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/06/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of the study is to observe the effects of cognitive behavioral therapy on stress disorder, cognitive function, motor function, and daily living ability of traumatic brain injury (TBI) patients. Methods 84 patients with TBI admitted to our hospital from June 2019 to May 2021 were selected as the research subjects. They were divided into a control group (from June 2019 to May 2020) and an observation group (from June 2020 to May 2021), with 42 cases in each group. The control group received routine intervention; the observation group received cognitive behavioral therapy on the basis of the control group. Before and after intervention, the posttraumatic stress disorder (PTSD), cognitive function, motor function, and daily living ability of the two groups were observed. Results After intervention, the PTSD-self-rating scale (PTSD-SS) scores of both groups were lower than those before intervention, and the PTSD-SS scores of the observation group were lower than those of the control group (P < 0.05). After intervention, the scores of the Montreal cognitive assessment (MoCA) scale, Fugl-Meyer assessment (FMA), and modified Barthel index (MBI) in both groups were higher than those before intervention, and the scores of MoCA, FMA, and MBI in the observation group were higher than those in the control group (P < 0.05). Conclusion The application of cognitive behavioral therapy to TBI patients is beneficial to reduce the degree of PTSD and improve cognitive function, motor function, and daily living ability, which is worthy of clinical application.
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Affiliation(s)
- Meng Sun
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
| | - Li Zhuang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
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Impact of Kinesiotherapy and Hydrokinetic Therapy on the Rehabilitation of Balance, Gait and Functional Capacity in Patients with Lower Limb Amputation: A Pilot Study. J Clin Med 2022; 11:jcm11144108. [PMID: 35887872 PMCID: PMC9316740 DOI: 10.3390/jcm11144108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 12/10/2022] Open
Abstract
The purpose of this pilot study was to identify impact differences in the rehabilitation of balance, gait and functional capacity in patients with lower limb amputation performing hydrokinetic therapy and kinesiotherapy programs during the pre-prosthetic and prosthetic phases. The study included 16 male patients aged 40–60 years with amputated lower limbs for 6 to 12 months, which involved transfemoral amputation (TFA), transtibial amputation (TTA), traumatic and vascular amputation, who were divided into the following two groups: the hydrokinetic therapy (HKT) group and the kinesiotherapy (KT) group, named after the content of the rehabilitation programs that were implemented for 2 weeks in the pre-prosthetic and prosthetic periods. The initial and final evaluation of the participants included the following tests: the Berg Scale and the four square test for the evaluation of the balance; the PodoSmart device for gait assessment; through the walking test over 6 min, we evaluated the functional capacity. The results were processed in SPSS 24. Analysis of the results on balance rehabilitation through the Berg Scale highlighted that the progress related to the mean of the total score was 7.62 points, p = 0.00 for the HKT group and 7.50 points, p = 0.00 for the KT group, while in the four square step test, the mean of progress was 6.125 s, p = 0.00 for the HKT group and 6 s, p = 0.000 for the KT group. The PodoSmart gait analysis revealed that the HKT group showed a progress mean of 4.875%, p = 0.00, for the foot symmetry parameter, which was 1.875% less than the score achieved by the KT group whose symmetry progress mean was 6.75%, p = 0.00, while the average progress mean for the cadence parameter was 2.75 steps/min higher for the KT group than the HKT group. The comparative analysis of the impact of these two programs on the patients’ functional capacity indicated that the score recorded by the KT group was a progress mean of 15.12 m, p = 0.00 better than the HKT group for the travelled distance parameter; the implementation of the hydrokinetic therapy program led to better exercise adaptation for the HKT group compared to the KT group at an average HR (HRavg) with 0.50 BPM, p = 0.00. After analyzing the results, it has been found that hydrokinetic therapy programs have a greater impact on balance rehabilitation and exercise adaptation, while kinesiotherapy programs have a greater impact on gait rehabilitation and functional capacity optimization for the travelled distance parameter.
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Rosenblatt NJ, Stachowiak A, Reddin C. Prosthetic Disuse Leads to Lower Balance Confidence in a Long-Term User of a Transtibial Prosthesis. Adv Wound Care (New Rochelle) 2021; 10:529-533. [PMID: 34232743 PMCID: PMC8260888 DOI: 10.1089/wound.2019.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022] Open
Abstract
Residual limb wounds or ulcers are one of the most frequent skin problems reported by lower extremity prosthesis users. Healing often requires prosthesis disuse, which can logically impair physical functioning. However, there are limited data available to support this idea. We report the impact of prosthesis disuse by presenting assessments of balance, gait, physical activity, and balance confidence obtained on a case subject before experiencing a wound and following reintroduction to a well-fit prosthesis after wound-related prosthesis disuse. The case subject was a 76-year-old male who suffered a unilateral, transtibial amputation due to synovial sarcoma 13 years before. After presenting with a history of pain in the area of a chronic skin plaque, he received a punch biopsy, which resulted in 4 weeks of prosthesis disuse followed by 12 weeks of limited use before a final well-fitting socket was received. The following data were collected 24 weeks before the biopsy and 4 weeks after receiving the final well-fitting socket: Berg Balance Scale, L-test of walking, quantitative gait analysis, Activity-specific Balance Confidence Scale, and 1 week of community-based activity. Balance confidence decreased nearly 19%, walking speed decreased by 12%, and steps/day decreased by 19% following ∼4 months of prosthesis disuse/limited use; functional measures were not impacted. Lower balance confidence is not trivial as it can lead to activity avoidance and increased fall risk. Interventions to target balance confidence changes following prosthesis disuses may be important to minimize the impact of disuse on physical and mental well-being.
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Affiliation(s)
- Noah J. Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Aaron Stachowiak
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
| | - Christopher Reddin
- Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois
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Selecting, Administering, and Interpreting Outcome Measures among Adults with Lower-Limb Loss: An Update for Clinicians. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:92-109. [PMID: 33767921 DOI: 10.1007/s40141-020-00274-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose of review To summarize outcome measurement research among adults with lower-limb loss (LLL) for clinicians. Recent findings Houghton Scale, Prosthetic Evaluation Questionnaire-mobility subscale (PEQ-m), Prosthetic Limb Users Survey of Mobility (PLUS-M™), Activities-Specific Balance Confidence Scale (ABC), Amputee Mobility Predictor (AMP), Comprehensive High-Level Activity Mobility Predictor, Four Square Step Test (FSST), Narrowing Beam Walking Test (NBWT), L Test, 10 Meter Walk Test (10MWT), and 6 Minute Walk Test (6MWT) are appropriate for evaluating individual patient changes post-LLL. Post-LLL, Socket Comfort Score, Patient-Specific Functional Scale, Patient-Reported Outcomes Measurement Information System 29-Item Profile, Timed Up and Go, and 2 Minute Walk Test may be more appropriate for evaluating groups. Minimal detectable change is available for 15/20 reviewed measures. Many measures differ between mobility levels. Summary Quick, reliable measures for evaluating patient functional change include ABC, PEQ-m, PLUS-M™, FSST, and L Test; when resources allow, NBWT, 10MWT, 6WMT and AMP may be considered.
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Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
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Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
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