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Schnadthorst PG, Hoffmeister M, Grunwald M, Wagner CM, Schulze C. Intraindividual Correlation and Comparison of Maximal Aerobic Capacity and Maximum Power in Hand-Crank and Bicycle Spiroergometry. J Sport Rehabil 2024; 33:582-589. [PMID: 39084616 DOI: 10.1123/jsr.2023-0366] [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: 10/29/2023] [Revised: 03/14/2024] [Accepted: 05/26/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Spiroergometry is important for modern performance diagnostics, and reference values have been evaluated for bicycle and treadmill ergometers. The aim of this study is to assess the comparability of bicycle and hand-crank spiroergometry and its associated parameters, as hand-crank spiroergometry can be used during rehabilitation in patients with definitive or temporally impairment of the lower extremity. METHODS Thirty-seven healthy volunteers completed 2 exhausting performance diagnostics on hand-crank and bicycle spiroergometry. Participants' anthropometric characteristics, maximum power, multiple exertion criteria, maximum aerobic capacity, and maximum heart rate were detected, and ventilatory and metabolic thresholds were determined. RESULTS The maximum power, maximum heart rate, maximum aerobic capacity, and ventilatory thresholds were significant higher on the bicycle ergometer (P < .001). The metabolic thresholds occurred on higher lactate values on the hand-crank ergometer. Equations for calculating maximum aerobic capacity from the maximum power measured in either hand-crank or bicycle ergometer could be found through regression analysis. CONCLUSIONS Although there are problems in interpreting results of different ergometries due to severe physiology differences, the equations can be used for patients who are temporally unable to complete the established ergometry due to a deficit in the lower extremity. This could improve training recommendations for patients and para-athletes in particular.
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Affiliation(s)
| | - Meike Hoffmeister
- Deutschen Hochschule für Gesundheit und Sport, Fakultät Sportwissenschaft, Berlin, Germany
| | | | - Carl-Maximilian Wagner
- Deutschen Hochschule für Gesundheit und Sport, Fakultät Sportwissenschaft, Berlin, Germany
| | - Christoph Schulze
- Zentrum für Sportmedizin der Bundeswehr, Warendorf, Germany
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Arcobelli VA, Moscato S, Palumbo P, Marfoglia A, Nardini F, Randi P, Davalli A, Carbonaro A, Chiari L, Mellone S. FHIR-standardized data collection on the clinical rehabilitation pathway of trans-femoral amputation patients. Sci Data 2024; 11:806. [PMID: 39033239 PMCID: PMC11271302 DOI: 10.1038/s41597-024-03593-6] [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: 03/11/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024] Open
Abstract
Lower limb amputation is a medical intervention which causes motor disability and may compromise quality of life. Several factors determine patients' health outcomes, including an appropriate prosthetic provision and an effective rehabilitation program, necessitating a thorough quantitative observation through different data sources. In this context, the role of interoperability becomes essential, facilitating the reuse of real-world data through the provision of structured and easily accessible databases. This study introduces a comprehensive 10-year dataset encompassing clinical features, mobility measurements, and prosthetic knees of 1006 trans-femoral amputees during 1962 hospital stays for rehabilitation. The dataset is made available in both comma-separated values (CSV) format and HL7 Fast Healthcare Interoperability Resources (FHIR)-based representation, ensuring broad utility and compatibility for researchers and healthcare practitioners. This initiative contributes to advancing community understanding of post-amputation rehabilitation and underscores the significance of interoperability in promoting seamless data sharing for meaningful insights into healthcare outcomes.
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Affiliation(s)
- Valerio Antonio Arcobelli
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy.
| | - Serena Moscato
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy.
| | - Pierpaolo Palumbo
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy.
| | - Alberto Marfoglia
- Department of Computer Science and Engineering - DISI, University of Bologna, Bologna, Italy
| | - Filippo Nardini
- Department of Industrial Engineering - DIN, University of Bologna, Bologna, Italy
| | - Pericle Randi
- Unità operativa di medicina fisica e riabilitazione, INAIL Centro Protesi, Vigorso di Budrio, Italy
| | - Angelo Davalli
- Area ricerca e formazione, INAIL Centro Protesi, Vigorso di Budrio, Italy
| | - Antonella Carbonaro
- Department of Computer Science and Engineering - DISI, University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" - DEI, University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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Heitzmann DWW, Block J, Trinler U, Wolf SI, Alimusaj M. [Motion analysis in lower limb exoprosthetics-possibilities and limitations]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04408-z. [PMID: 37458809 DOI: 10.1007/s00132-023-04408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Gait analysis is of high relevance in prosthetics as it is an essential part of the fitting process. The documentation of movement by means of videos and instrumented methods is becoming increasingly important in prosthetics as benefits of a complex prosthesis can best be shown by structured observation. PROCEDURE A movement analysis should always be preceded by an anamnesis and clinical examination in order to detect functional limitations of the examined person and thus to establish correlations to gait deviations. Additionally, the orthopaedic aid should be evaluated as well. In addition to walking on level ground, walking on everyday obstacles such as stairs and ramps is also of interest when observing people using prosthetic limbs. Functional tests can be used to determine the functional status more comprehensively. An instrumental-3D gait analysis is indicated for specific questions, especially regarding kinetic parameters.
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Affiliation(s)
- Daniel Walter Werner Heitzmann
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| | - Julia Block
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Sebastian I Wolf
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Merkur Alimusaj
- Abteilungen Technische Orthopädie und Bewegungsanalytik, Klinik für Orthopädie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
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Berli MC, Rancic Z, Schöni M, Götschi T, Schenk P, Kabelitz M, Böni T, Waibel FWA. Salami-Tactics: when is it time for a major cut after multiple minor amputations? Arch Orthop Trauma Surg 2023; 143:645-656. [PMID: 34370043 PMCID: PMC9925494 DOI: 10.1007/s00402-021-04106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. MATERIALS AND METHODS A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. RESULTS 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 - 275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) to lead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor for major amputation if at least one re-amputation had to be performed. CONCLUSIONS There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. LEVEL OF EVIDENCE Retrospective comparative study (Level III).
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Affiliation(s)
- Martin C Berli
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Zoran Rancic
- Clinic for Vascular Surgery, University Hospital Zurich, and Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Madlaina Schöni
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, University of Zurich, Institute for Biomechanics, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Pascal Schenk
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Method Kabelitz
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Thomas Böni
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Felix W A Waibel
- Division of "Prosthetics and Orthotics", Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland.
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Coman H, Stancu B, Gâvan NA, Bowling FL, Podariu L, Bondor CI, Radulian G. Diabetes-Related Lower Extremity Amputations in Romania: Patterns and Changes between 2015 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:557. [PMID: 36612876 PMCID: PMC9819762 DOI: 10.3390/ijerph20010557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Lower extremity amputations (LEAs) are a feared complication of diabetes mellitus (DM). Here we evaluated the recent trends in DM-related LEAs in Romania. We collected data from a national database regarding minor and major LEAs performed between 2015 and 2019 in patients with DM admitted to a public hospital. Absolute numbers of LEAs were presented by year, diabetes type, sex and age; incidence rates of LEAs in the general population were also calculated. Over the study period, 40,499 LEAs were recorded nationwide (83.16% in persons with type 2 DM [T2DM]); on average, the number of LEAs increased by 5.7%/year. This trend was driven by an increased number of LEAs in patients with T2DM; in patients with type 1 DM (T1DM), LEAs decreased over the study period. In patients with T2DM, the increase in minor LEAs was more pronounced than that in major LEAs. The overall number of LEAs showed an increasing trend with age (r = 0.72), which was most pronounced in patients aged ≥70 years. Men had a higher frequency of LEAs than women, regardless of DM type. These data support renewed efforts to prevent and decrease the burden of amputations among patients with DM.
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Affiliation(s)
- Horaţiu Coman
- Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania
| | - Bogdan Stancu
- Second Department of Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | | | - Frank L. Bowling
- Developmental Biomedicine Research Group, The University of Manchester, Manchester M13 9PL, UK
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Laura Podariu
- Vascular Surgery Clinic, Cluj County Emergency Hospital, 400347 Cluj-Napoca, Romania
- “Nicolae Stăncioiu” Heart Institute, 400001 Cluj-Napoca, Romania
| | - Cosmina I. Bondor
- Department of Medical Informatics and Biostatistics, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Gabriela Radulian
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucureşti, Romania
- “Prof. Dr. Nicolae Paulescu” National Institute for Diabetes, Nutrition and Metabolic Diseases, 030167 Bucuresti, Romania
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Einfeldt AK, Brinck AK, Schiller S, Borgetto BM. [Gait Training for Lower Limb Amputees - A Systematic Review Based on the Research Pyramid]. DIE REHABILITATION 2022; 61:373-382. [PMID: 35172351 DOI: 10.1055/a-1719-3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lower extremity amputation patients have gait asymmetries which can lead to further complaints in other joints of the body. METHOD Five relevant databases were systematically searched for studies about gait training methods among people with transtibial and transfemoral amputations, followed by an evaluation of the methodical power of the eight references. Subsequently, the studies were categorized into the evidence classes of the research pyramid. The aim was to give treatment recommendations for this patient group. RESULTS All training methods show an improvement in gait parameters of the patients. In seven studies at least four different training forms are used within one training intervention. Therefore, a combination of different forms seems promising. A long-term statement among these methods could not be made. Due to the high variability in intervention methods and outcome parameters, an aggregation of data and meta-analyses were not possible. CONCLUSION The Evidence-Based Amputee Rehabilitation Program provides a good basis for a standardized training method. It should be supplemented with functional dual-task training and education. In further research a specific duration and intensity of such a program needs to be investigated. On top of that further qualitative and observational research is needed to generate statements which optimize the gait training in the physiotherapeutic routine practice.
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Affiliation(s)
- Ann-Kathrin Einfeldt
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen.,Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover
| | - Ann-Kathrina Brinck
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
| | - Sandra Schiller
- Hochschule für angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen
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Wandrey JD, Schäfer M, Erlenwein J, Tafelski S. [Practice of perioperative phantom limb pain prevention in Germany: a nationwide survey]. DIE ANAESTHESIOLOGIE 2022; 71:834-845. [PMID: 36036261 PMCID: PMC9636281 DOI: 10.1007/s00101-022-01188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The prevalence of phantom limb pain after major amputation remains high and affected patients suffer from relevant impairments in the quality of life. Perioperative treatment strategies may prevent phantom limb pain. This study aims to assess the state of the perioperative anesthesiological pain management for major amputations. Furthermore, it analyzes potentials for optimization and barriers towards a better treatment of patients with amputations. MATERIAL AND METHODS This online survey was distributed by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) mailing list of anesthesiological consultants. It was approved by the Charité ethics board. RESULTS Overall, 402 persons participated in this survey. Mostly, general anesthesia (85%), regional anesthesia (63%) and neuraxial anesthesia (49%) were performed in different combinations. Furthermore, 72% of participants reported using i.v. opioids postoperatively, mostly applied via patient-controlled analgesia (PCA). In contrast, preoperative regional anesthesia (74%) and gabapentinoids (67%) were seen as potential methods to improve treatment; however, barrier analysis revealed that treatment options are limited especially by organizational aspects and intrinsic patient factors. CONCLUSION This survey describes the current practice of phantom limb pain prevention in Germany. It shows an unmet need for specialized perioperative pain treatment. As the evidence regarding treatment recommendations is limited, further research questions can be deduced from this study.
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Affiliation(s)
- Jan D Wandrey
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland.
| | - Michael Schäfer
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - Joachim Erlenwein
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Sascha Tafelski
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité-Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Gliedkörperschaft der Freien Universität Berlin, der Humboldt Universität zu Berlin und des Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Wissenschaftlicher Arbeitskreis Schmerzmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
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Temporal Trends in Patients with Peripheral Artery Disease Influenced by COVID-19 Pandemic. J Clin Med 2022; 11:jcm11216433. [PMID: 36362660 PMCID: PMC9655378 DOI: 10.3390/jcm11216433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background: The COVID-19 pandemic influences the health care management of acute and chronic diseases. Data concerning the influence of the pandemic on hospitalizations of patients with peripheral artery disease (PAD) are sparse. Methods: We analysed all patients hospitalized due to PAD between 1 January 2019 and 31 December 2020 in Germany. Hospitalizations of PAD patients during the pre-pandemic year 2019 were compared to the pandemic year 2020. Results: Overall, 361,029 hospitalizations of PAD patients in the years 2019 and 2020 (55.4% aged ≥70 years; 36.6% females) were included in this study. In the pre-pandemic year of 2019, a total of 25,501 (13.2%) more hospitalizations due to PAD were detected compared to the COVID-19 pandemic year of 2020 (2019: 192,765 [53.4%] vs. 2020: 168,264 [46.6%], p = 0.065). Overall, in 610 (0.4%) of the hospitalization cases, a COVID-19 infection was diagnosed. Regarding interventional/surgical treatments, total numbers of peripheral endovascular intervention of the lower extremity decreased by 9.9% (83,845 vs. 75,519, p < 0.001), surgical peripheral artery revascularization of the lower extremity by 11.4% (32,447 vs. 28,754, p = 0.041) and amputations by 4.0% (20,612 vs. 19,784, p < 0.001) in 2020 compared to 2019. The case fatality rate (2.6% vs. 2.4%, p < 0.001), as well as MACCE rate (3.4% vs. 3.2%, p < 0.001), were slightly higher during the pandemic year 2020 compared to the pre-pandemic year 2019. Conclusions: The COVID-19 pandemic influenced the number of hospitalizations of PAD patients with a 13.2% reduction in hospital admissions and decreased total numbers of revascularization and amputation treatments.
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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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Ruemenapf G, Morbach S, Sigl M. Therapeutic Alternatives in Diabetic Foot Patients without an Option for Revascularization: A Narrative Review. J Clin Med 2022; 11:2155. [PMID: 35456247 PMCID: PMC9032488 DOI: 10.3390/jcm11082155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The healing of foot wounds in patients with diabetes mellitus is frequently complicated by critical limb threatening ischemia (neuro-ischemic diabetic foot syndrome, DFS). In this situation, imminent arterial revascularization is imperative in order to avoid amputation. However, in many patients this is no longer possible ("too late", "too sick", "no technical option"). Besides conservative treatment or major amputation, many alternative methods supposed to decrease pain, promote wound healing, and avoid amputations are employed. We performed a narrative review in order to stress their efficiency and evidence. METHODS The literature research for the 2014 revision of the German evidenced-based S3-PAD-guidelines was extended to 2020. RESULTS If revascularization is impossible, there is not enough evidence for gene- and stem-cell therapy, hyperbaric oxygen, sympathectomy, spinal cord stimulation, prostanoids etc. to be able to recommend them. Risk factor management is recommended for all CLTI patients. With appropriate wound care and strict offloading, conservative treatment may be an effective alternative. Timely amputation can accelerate mobilization and improve the quality of life. CONCLUSIONS Alternative treatments said to decrease the amputation rate by improving arterial perfusion and wound healing in case revascularization is impossible and lack both efficiency and evidence. Conservative therapy can yield acceptable results, but early amputation may be a beneficial alternative. Patients unfit for revascularization or major amputation should receive palliative wound care and pain therapy. New treatment strategies for no-option CLTI are urgently needed.
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Affiliation(s)
- Gerhard Ruemenapf
- Vascular Center Oberrhein Speyer-Mannheim, Department of Vascular Surgery, Diakonissen-Stiftungs-Krankenhaus, 67346 Speyer, Germany
| | - Stephan Morbach
- Department of Diabetology und Angiology, Marienkrankenhaus, 59494 Soest, Germany;
| | - Martin Sigl
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site, 68199 Mannheim, Germany;
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Lower Limb Amputation Rates in Germany. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010101. [PMID: 35056409 PMCID: PMC8780615 DOI: 10.3390/medicina58010101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: The current epidemiology of lower limb amputations is unknown. Therefore, the purpose of this study was to determine (1) lower extremity amputation rates as a function of age, gender, and amputation level between 2015 and 2019, (2) main diagnoses indicating amputation, (3) revision rates after lower extremity amputation. Materials and Methods: Lower extremity amputation rates were quantified based on annual Operation and Procedure Classification System (OPS) and International Classifications of Disease (ICD)-10 codes from all German medical institutions between 2015 through 2019, provided by the Federal Statistical Office of Germany (Destatis). Results: In 2019, 62,016 performed amputations were registered in Germany. Out of these 16,452 procedures (26.5%) were major amputations and 45,564 patients (73.5%) underwent minor amputations. Compared to 2015, the incidence of major amputations decreased by 7.3% to 24.2/100,000 inhabitants, whereas the incidence of minor amputation increased by 11.8% to 67.1/100,000 inhabitants. Highest incidence was found for male patients aged 80-89 years. Patients were mainly diagnosed with peripheral arterial disease (50.7% for major and 35.7% for minor amputations) and diabetes mellitus (18.5% for major and 44.2% for minor amputations). Conclusions: Lower limb amputations remain a serious problem. Further efforts in terms of multidisciplinary team approaches and patient optimization strategies are required to reduce lower limb amputation rates.
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Liu R, Li L, Shao C, Cai H, Wang Z. The Impact of Diabetes on Vascular Disease: Progress from the Perspective of Epidemics and Treatments. J Diabetes Res 2022; 2022:1531289. [PMID: 35434140 PMCID: PMC9012631 DOI: 10.1155/2022/1531289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 12/23/2022] Open
Abstract
At present, the global incidence of diabetes has increased in countries with large populations, and the changes in developing regions are particularly worthy of attention. In the past 40 years or so, the income situation in China, India, and other countries has exploded, leading to changes in the way of life and work as well as an increase in the prevalence of diabetes. Metabolic disorders caused by diabetes can lead to secondary vascular complications, which have long-term malignant effects on the heart, kidneys, brain, and other vital organs of patients. Adequate primary prevention measures are needed to reduce the incidence of diabetic vascular complications, and more attention should be given to treatment after the disease. To this end, it is necessary to determine a standardized drug and physical therapy system and to build a more efficient and low-cost chronic disease management system.
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Affiliation(s)
- Runyang Liu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Honghua Cai
- Department of Burn Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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von Falck C, Orgel M, Wacker F, Aschoff HH, Krettek C, Ringe KI. Icing the Pain-Ultrasound-Guided Cryoablation of Symptomatic Post-Amputation Stump Neuroma. Cardiovasc Intervent Radiol 2021; 45:223-227. [PMID: 34820693 PMCID: PMC8807464 DOI: 10.1007/s00270-021-02998-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
Purpose To assess the feasibility and outcome of ultrasound-guided cryoablation in patients with a sensitized stump neuroma after limb amputation. Material and Methods Seven patients (3 females, 4 males; mean age 42 years) were included in this retrospective study. Ultrasound-guided cryoablation of a previously identified painful stump neuroma was performed. Pain was assessed on the visual analogue scale (VAS) and compared before and after cryoablation (Wilcoxon Test). The degree of pain alleviation was correlated with patient age, duration of pain before ablation and time interval between amputation and ablation (Spearman correlation). A p-value less than 0.05 was deemed statistically significant. Results Nine cryoablations were performed for 8 neuromas. Technical success was 100%, there were no major complications. Mean follow-up was 27 months. There was a statistically significant decrease of pain from mean 8.3 / 10 (baseline) to 4 /10 (on day one), 2.1 / 10 (at one week) and 3 / 10 (at last follow-up) (p < 0.05). Patient satisfaction with cryoablation treatment was very high (median score 70 / 100). Conclusion In our small population observational study, ultrasound-guided cryoablation of a sensitized stump neuroma was effective and safe for pain alleviation with very good long-term results. Level of Evidence Level 2, Observational study with dramatic effect
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Affiliation(s)
- C von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - M Orgel
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - H H Aschoff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - C Krettek
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
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Keller K, Schmitt VH, Vosseler M, Brochhausen C, Münzel T, Hobohm L, Espinola-Klein C. Diabetes Mellitus and Its Impact on Patient-Profile and In-Hospital Outcomes in Peripheral Artery Disease. J Clin Med 2021; 10:jcm10215033. [PMID: 34768552 PMCID: PMC8585025 DOI: 10.3390/jcm10215033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In patients with peripheral artery disease (PAD), the impact of diabetes mellitus (DM) on patient-profile and adverse in-hospital events is not well investigated. METHODS The German nationwide inpatient sample 2005-2019 was used for this analysis. Hospitalized PAD patients were stratified for DM and the influence of DM on patient-profile and adverse in-hospital events was investigated. RESULTS Our study comprised 2,654,871 hospitalizations (54.3% aged ≥70 years, 36.7% females) of patients with PAD in Germany 2005-2019. Among these, 864,691 (32.6%) patients had DM and 76,716 (2.9%) died during hospitalization. Diabetic PAD patients revealed an aggravated cardiovascular profile (Charlson Comorbidity Index: 6.0 (5.0-8.0) vs. 4.0 (3.0-5.0), p < 0.001). PAD patients with DM showed a higher rate of in-hospital mortality (3.5% vs. 2.6%, p < 0.001), as well as major adverse cardiovascular and cerebrovascular events (MACCE, 4.7% vs. 3.3%, p < 0.001) and had more often operated with amputation surgery (16.4% vs. 9.1%, p < 0.001). DM was an independent predictor of in-hospital mortality (OR 1.077 (95%CI 1.060-1.093), p < 0.001) and MACCE (OR 1.118 (95%CI 1.103-1.133), p < 0.001). In addition, amputations were also associated with DM (OR 1.804 (95%CI 1.790-1.818)), p < 0.001). CONCLUSIONS DM is associated with an unfavorable clinical patient-profile and higher risk for adverse events in PAD patients, including substantially increased in-hospital mortality as well as MACCE rate, and were more often associated with amputation surgeries.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +0049-6131-17-8380; Fax: +0049-6131-17-8461
| | - Volker H. Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Markus Vosseler
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
| | | | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), 55131 Mainz, Germany; (V.H.S.); (M.V.); (T.M.); (L.H.); (C.E.-K.)
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Decker JA, Varga-Szemes A, Schoepf UJ, Emrich T, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. In-patient care trends in peripheral artery disease in the German healthcare system over the past decade. Eur Radiol 2021; 32:1697-1708. [PMID: 34647176 DOI: 10.1007/s00330-021-08285-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome. METHODS Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed. RESULTS A total of 1.8 million hospitalizations resulting in €10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from €5,261 to €6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%). CONCLUSIONS This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee. KEY POINTS • The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs. • Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing. • Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee. • Major amputations are decreasing while the number of minor amputations is increasing.
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Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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Meffen A, Houghton JSM, Nickinson ATO, Pepper CJ, Sayers RD, Gray LJ. Understanding variations in reported epidemiology of major lower extremity amputation in the UK: a systematic review. BMJ Open 2021; 11:e053599. [PMID: 34615685 PMCID: PMC8496376 DOI: 10.1136/bmjopen-2021-053599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Estimate the prevalence/incidence/number of major lower extremity amputations (MLEAs) in the UK; identify sources of routinely collected electronic health data used; assess time trends and regional variation; and identify reasons for variation in reported incidence/prevalence of MLEA. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, EMcare, CINAHL, The Cochrane Library, AMED, Scopus and grey literature sources searched from 1 January 2009 to 1 August 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Reports that provided population-based statistics, used routinely collected electronic health data, gave a measure of MLEA in adults in the general population or those with diabetes in the UK or constituent countries were included. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Instruments were performed by two reviewers independently. Due to considerable differences in study populations and methodology, data pooling was not possible; data were tabulated and narratively synthesised, and study differences were discussed. RESULTS Twenty-seven reports were included. Incidence proportion for the general population ranged from 8.2 to 51.1 per 100 000 and from 70 to 291 per 100 000 for the population with diabetes. Evidence for trends over time was mixed, but there was no evidence of increasing incidence. Reports consistently found regional variation in England with incidence higher in the north. No studies reported prevalence. Differences in database use, MLEA definition, calculation methods and multiple procedure inclusion which, together with identified inaccuracies, may account for the variation in incidence. CONCLUSIONS UK incidence and trends in MLEA remain unclear; estimates vary widely due to differences in methodology and inaccuracies. Reasons for regional variation also remain unexplained and prevalence uninvestigated. International consensus on the definition of MLEA and medical code list is needed. Future research should recommend standards for the reporting of such outcomes and investigate further the potential to use primary care data in MLEA epidemiology. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020165592.
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Affiliation(s)
- Anna Meffen
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - John S M Houghton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Coral J Pepper
- Department of Library and Information Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Robert D Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
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Kamitani F, Nishioka Y, Noda T, Myojin T, Kubo S, Higashino T, Okada S, Akai Y, Ishii H, Takahashi Y, Imamura T. Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan. BMJ Open 2021; 11:e048436. [PMID: 34404707 PMCID: PMC8372805 DOI: 10.1136/bmjopen-2020-048436] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/05/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION This study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes. RESEARCH DESIGN AND METHODS This retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted. RESULTS In the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables. CONCLUSIONS This is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.
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Affiliation(s)
- Fumika Kamitani
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuichi Nishioka
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, Tokyo, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasuhiro Akai
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Center for Postgraduate Training, Nara Medical University, Kashihara, Nara, Japan
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
| | - Hitoshi Ishii
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
- Department of Doctor-Patient Relationships, Nara Medical University, Kashihara, Nara, Japan
| | - Yutaka Takahashi
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Huang J, Li Y, He C. Melatonin as a Trigger of Therapeutic Bone Regenerating Capacity in Biomaterials. Curr Pharm Biotechnol 2021; 23:707-718. [PMID: 34250874 DOI: 10.2174/1389201022666210709145347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Abstract
Bone defects are usually treated with bone grafting. Several synthetic biomaterials have emerged to replace autologous and allogeneic bone grafts, but there are still shortcomings in bone regeneration. Melatonin has demonstrated a beneficial effect on bone metabolism with the potential to treat fractures, bone defects, and osteoporosis. The hormone promoted osteogenesis, inhibited osteoclastogenesis, stimulated angiogenesis, and reduced peri-implantitis around the graft. Recently, a growing number of studies showed beneficial effects of melatonin to treat bone defects. However, cellular and molecular mechanisms involved in bone healing are still poorly understood. In this review, we recapitulate the potential mechanisms of melatonin, providing a new horizon to the clinical treatment of bone defects.
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Affiliation(s)
- Jinming Huang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
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Investigation of Orthopedic Prosthesis Socket Management after Transfemoral Amputation by Expert Survey. PROSTHESIS 2021. [DOI: 10.3390/prosthesis3020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prosthesis treatment requires the close interaction of different actors. In fitting prostheses to patients, special attention is given to the manufacturing of the socket. The continuous development of the technologies involved in the fitting and optimization of prostheses is shown in the literature. The assessment of orthopedic technicians and their influence in the process is thus far largely unexplored. Ten orthopedic technicians were interviewed about the socket fitting process after transfemoral amputation. The research goal was to clarify the socket treatment process with regards to the German context. The results showed that the orthopedic technicians focussing on the patient during the fitting process. This study underlines the importance of interaction and empathy. Volume fluctuations are decisive within the treatment process and are interactively influenced by various factors. Furthermore, the research emphasizes the need for appropriate assistive technologies and the potential for the further development of existing systems.
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Hohneck A, Sigl M. [Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. Chirurg 2021; 92:173-186. [PMID: 33237367 PMCID: PMC7875854 DOI: 10.1007/s00104-020-01313-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Diakonissen-Stiftungs-Krankenhaus Speyer, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich , Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - A Hohneck
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
| | - M Sigl
- Abteilung für Angiologie, 1. Medizinische Klinik, Universitätsklinik Mannheim, Mannheim, Deutschland
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21
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Rümenapf G, Morbach S, Rother U, Uhl C, Görtz H, Böckler D, Behrendt CA, Hochlenert D, Engels G, Sigl M. [Diabetic foot syndrome-Part 1 : Definition, pathophysiology, diagnostics and classification]. Chirurg 2021; 92:81-94. [PMID: 33170315 PMCID: PMC7819949 DOI: 10.1007/s00104-020-01301-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced.
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Affiliation(s)
- G Rümenapf
- Oberrheinisches Gefäßzentrum Speyer, Klinik für Gefäßchirurgie, Diakonissen-Stiftungs-Krankenhaus, Paul-Egell-Straße 33, 67346, Speyer, Deutschland.
| | - S Morbach
- Abteilung Diabetologie und Angiologie, Fachbereich Innere Medizin, Marienkrankenhaus gGmbH Soest, Soest, Deutschland
| | - U Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H Görtz
- Klinik für Gefäßchirurgie, Bonifatius Hospital Lingen, Lingen, Deutschland
| | - D Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C-A Behrendt
- Klinik und Poliklinik für Gefäßmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - D Hochlenert
- Centrum für Diabetologie, Endoskopie und Wundheilung Köln, Köln, Deutschland
| | - G Engels
- Chirurgische Praxis am Bayenthalgürtel, Köln, Deutschland
| | - M Sigl
- 1. Medizinische Klinik, Abteilung für Angiologie, Universitätsklinik Mannheim, Mannheim, Deutschland
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Hobusch GM, Döring K, Brånemark R, Windhager R. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev 2020; 5:724-741. [PMID: 33204516 PMCID: PMC7608512 DOI: 10.1302/2058-5241.5.190070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.
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Affiliation(s)
- Gerhard M Hobusch
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Kevin Döring
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Rickard Brånemark
- Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Reinhard Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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23
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Stratmann B, Costea TC, Nolte C, Hiller J, Schmidt J, Reindel J, Masur K, Motz W, Timm J, Kerner W, Tschoepe D. Effect of Cold Atmospheric Plasma Therapy vs Standard Therapy Placebo on Wound Healing in Patients With Diabetic Foot Ulcers: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2010411. [PMID: 32672829 PMCID: PMC7366186 DOI: 10.1001/jamanetworkopen.2020.10411] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Diabetic foot ulcers are a common complication of diabetes and require specialized treatment. Cold atmospheric plasma (CAP) has been associated with benefits in wound infection and healing in previous smaller series of case reports. Yet the effect of CAP compared with standard care therapy in wound healing in diabetic foot ulcers remains to be studied. OBJECTIVE To determine whether the application of CAP accelerates wound healing in diabetic foot ulcers compared with standard care therapy. DESIGN, SETTING, AND PARTICIPANTS A prospective, randomized, placebo-controlled, patient-blinded clinical trial was conducted at 2 clinics with recruitment from August 17, 2016, to April 20, 2019. Patients were scheduled to remain in follow-up until April 30, 2024. Patients with diabetes and diabetic foot ulcers described using the combined Wagner-Armstrong classification of 1B or 2B (superficial or infected diabetic foot ulcers extending to tendon) were eligible. A patient could participate with 1 or more wounds in both groups in both intervention and control groups. Wounds were randomized separately, allowing a participant to be treated several times within the study following a 2 × 2 × 2 randomization strata considering sex, smoking status, and age (≤68 years and >68 years). INTERVENTIONS Standard care treatment with 8 applications of either CAP generated from argon gas in an atmospheric pressure plasma jet or 8 applications of placebo treatment in a patient-blinded manner. MAIN OUTCOMES AND MEASURES Primary end points were reduction in wound size, clinical infection, and microbial load compared with treatment start. Secondary end points were time to relevant wound reduction (>10%), reduction of infection, parameters of patient's well-being, and treatment-associated adverse events. RESULTS Of 65 diabetic foot ulcer wounds from 45 patients assessed for study, 33 wounds from 29 patients were randomized to CAP and 32 wounds from 28 to placebo, with 62 wounds from 43 patients (31 wounds per group) included for final evaluation (mean [SD] age, 68.5 [9.1] years for full sample). Four patients with 5 wounds of 31 (16.1%) wounds in the CAP group and 3 patients with 4 wounds of 31 (13%) wounds in the placebo group were active smokers. CAP therapy yielded a significant increase in wound healing, both in total mean (SD) area reduction (CAP vs placebo relative units, -26.31 [11.72]; P = .03) and mean (SD) time to relevant wound area reduction (CAP vs placebo relative units, 10% from baseline, 1.60 [0.58]; P = .009). Reduction of infection and microbial load was not significantly different between CAP and placebo. No therapy-related adverse events occurred during therapy; patient's perceptions during therapy were comparable. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, CAP therapy resulted in beneficial effects in chronic wound treatment in terms of wound surface reduction and time to wound closure independent from background infection. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04205942.
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Affiliation(s)
- Bernd Stratmann
- Diabeteszentrum, Herz- und Diabeteszentrum Nordrhein Westfalen (NRW), Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Tania-Cristina Costea
- Diabeteszentrum, Herz- und Diabeteszentrum Nordrhein Westfalen (NRW), Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Catharina Nolte
- Diabeteszentrum, Herz- und Diabeteszentrum Nordrhein Westfalen (NRW), Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Jonas Hiller
- Diabeteszentrum, Herz- und Diabeteszentrum Nordrhein Westfalen (NRW), Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Jörn Schmidt
- Klinikum Karlsburg der Klinikgruppe Dr Guth GmbH & Co KG, Karlsburg, Germany
| | - Jörg Reindel
- Klinikum Karlsburg der Klinikgruppe Dr Guth GmbH & Co KG, Karlsburg, Germany
| | - Kai Masur
- Leibniz-Institut für Plasmaforschung und Technologie, Greifswald, Germany
- Kompetenzzentrum Diabetes Karlsburg, Karlsburg, Germany
| | - Wolfgang Motz
- Klinikum Karlsburg der Klinikgruppe Dr Guth GmbH & Co KG, Karlsburg, Germany
| | - Jürgen Timm
- Competence Center for Clinical Studies Bremen, Bremen, Germany
| | - Wolfgang Kerner
- Klinikum Karlsburg der Klinikgruppe Dr Guth GmbH & Co KG, Karlsburg, Germany
| | - Diethelm Tschoepe
- Diabeteszentrum, Herz- und Diabeteszentrum Nordrhein Westfalen (NRW), Ruhr Universität Bochum, Bad Oeynhausen, Germany
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24
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Kuhlmann A, Krüger H, Seidinger S, Hahn A. Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:437-449. [PMID: 31897813 PMCID: PMC7188726 DOI: 10.1007/s10198-019-01138-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The safe use of a prosthesis in activities of daily living is key for transfemoral amputees. However, the number of falls varies significantly between different prosthetic device types. This study aims to compare medical and economic consequences of falls in transfemoral amputees who use the microprocessor-controlled knee joint C-Leg with patients who use non-microprocessor-controlled (mechanical) knee joints (NMPK). The main objectives of the analysis are to investigate the cost-effectiveness and budget impact of C-Legs in transfemoral amputees with diabetes mellitus (DM) and without DM in Germany. METHODS A decision-analytic model was developed that took into account the effects of prosthesis type on the risk of falling and fall-related medical events. Cost-effectiveness and budget impact analyses were performed separately for transfemoral amputees with and without DM. The study took the perspective of the statutory health insurance (SHI). Input parameters were derived from the published literature. Univariate and probabilistic sensitivity analyses (PSA) were performed to investigate the impact of changes in individual input parameter values on model outcomes and to explore parameter uncertainty. RESULTS C-Legs reduced the rate of fall-related hospitalizations from 134 to 20 per 1000 person years (PY) in amputees without DM and from 146 to 23 per 1000 PY in amputees with DM. In addition, the C-Leg prevented 15 or 14 fall-related death per 1000 PY. Over a time horizon of 25 years, the incremental cost-effectiveness ratio (ICER) was 16,123 Euro per quality-adjusted life years gained (QALY) for amputees without DM and 20,332 Euro per QALY gained for amputees with DM. For the period of 2020-2024, the model predicted an increase in SHI expenditures of 98 Mio Euro (53 Mio Euro in prosthesis users without DM and 45 Mio Euro in prosthesis users with DM) when all new prosthesis users received C-Legs instead of NMPKs and 50% of NMPK user whose prosthesis wore out switched to C-Legs. Results of the PSA showed moderate uncertainty and a probability of 97-99% that C-Legs are cost-effective at an ICER threshold of 40,000 Euro (≈ German GDP per capita in 2018) per QALY gained. CONCLUSION Results of the study suggest that the C-Leg provides substantial additional health benefits compared with NMPKs and is likely to be cost-effective in transfemoral amputees with DM as well as in amputees without DM at an ICER threshold of 40,000 Euro per QALY gained.
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Affiliation(s)
- Alexander Kuhlmann
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany.
| | - Henning Krüger
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany
| | | | - Andreas Hahn
- Otto Bock HealthCare Products GmbH, Vienna, Austria
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25
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Bumbaširević M, Lesic A, Palibrk T, Milovanovic D, Zoka M, Kravić-Stevović T, Raspopovic S. The current state of bionic limbs from the surgeon's viewpoint. EFORT Open Rev 2020; 5:65-72. [PMID: 32175092 PMCID: PMC7047902 DOI: 10.1302/2058-5241.5.180038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Amputations have a devastating impact on patients' health with consequent psychological distress, economic loss, difficult reintegration into society, and often low embodiment of standard prosthetic replacement.The main characteristic of bionic limbs is that they establish an interface between the biological residuum and an electronic device, providing not only motor control of prosthesis but also sensitive feedback.Bionic limbs can be classified into three main groups, according to the type of the tissue interfaced: nerve-transferred muscle interfacing (targeted muscular reinnervation), direct muscle interfacing and direct nerve interfacing.Targeted muscular reinnervation (TMR) involves the transfer of the remaining nerves of the amputated stump to the available muscles.With direct muscle interfacing, direct intramuscular implants record muscular contractions which are then wirelessly captured through a coil integrated in the socket to actuate prosthesis movement.The third group is the direct interfacing of the residual nerves using implantable electrodes that enable reception of electric signals from the prosthetic sensors. This can improve sensation in the phantom limb.The surgical procedure for electrode implantation consists of targeting the proximal nerve area, competently introducing, placing, and fixing the electrodes and cables, while retaining movement of the arm/leg and nerve, and avoiding excessive neural damage.Advantages of bionic limbs are: the improvement of sensation, improved reintegration/embodiment of the artificial limb, and better controllability. Cite this article: EFORT Open Rev 2020;5:65-72. DOI: 10.1302/2058-5241.5.180038.
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Affiliation(s)
- Marko Bumbaširević
- School of Medicine, University of Belgrade, Serbia
- University Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Serbia
| | - Aleksandar Lesic
- School of Medicine, University of Belgrade, Serbia
- University Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Serbia
| | - Tomislav Palibrk
- School of Medicine, University of Belgrade, Serbia
- University Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Serbia
| | - Darko Milovanovic
- School of Medicine, University of Belgrade, Serbia
- University Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, Serbia
| | | | | | - Stanisa Raspopovic
- ETH Zürich, Department of Health Sciences and Technology, Institute for Robotics and Intelligent System, Zurich, Switzerland
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Dey S, Eslamy M, Yoshida T, Ernst M, Schmalz T, Schilling A. A Support Vector Regression Approach for Continuous Prediction of Ankle Angle and Moment During Walking: An Implication for Developing a Control Strategy for Active Ankle Prostheses. IEEE Int Conf Rehabil Robot 2019; 2019:727-733. [PMID: 31374717 DOI: 10.1109/icorr.2019.8779445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lower limb amputations impair normal locomotion. This calls for the use of prosthetic devices to restore the lost or disabled functionality. Most of the commercially available prostheses offer only passive assistance with limited capacity. On the other hand, active prostheses may better restore movement, by supporting missing muscle function with additional motor power. The control algorithms of such embedded motors must understand the users locomotive intention to produce the required locomotion similar to that of an able-bodied individual. For individuals with transtibial amputation, the control algorithm should produce the desired locomotion by controlling an active ankle joint to generate appropriate ankle angle and ankle moment. In this paper, a strategy is proposed for the continuous estimation of ankle angle and ankle moment during walking using a support vector regression approach. Experimentally obtained hip and knee joint motion data were provided as the inputs to the support vector regression model. It is shown that, for level ground walking at self-selected speed, the proposed method could predict the ankle angle and moment with high accuracy (mean R2 value of 0.98 for ankle angle and 0.97 for ankle moment).
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27
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Schellong SM. [The conspicuous leg]. Internist (Berl) 2019; 59:227-233. [PMID: 29387895 DOI: 10.1007/s00108-018-0386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Symptoms of the leg or of both legs, may indicate a need for evaluation and/or treatment, which must be clarified urgently or even as an emergency situation. Among the diseases which must be considered from a vascular viewpoint are critical limb ischemia, suspicion of deep leg vein thrombosis and special forms of venous insufficiency. With respect to infections erysipelas and the syndrome of infected diabetic foot must be considered as well as peripheral and central leg paresis as orthopedic and neurological disorders, respectively. The current review summarizes the main clinical features of these diseases. Criteria are discussed as to which require the particular capabilities of a hospital and which patients can be managed in an outpatient setting.
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Affiliation(s)
- S M Schellong
- Medizinische Klinik 2, Städtisches Klinikum Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland.
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28
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Schwarze M, Alimusaj M, Heitzmann DWW, Block J, Putz C, Wolf SI, Schiltenwolf M. [Expert assessment of lower extremity prosthetics]. DER ORTHOPADE 2019; 49:238-247. [PMID: 31089773 DOI: 10.1007/s00132-019-03750-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the number of major amputations is declining throughout Germany, more than 57,000 surgical procedures for amputation still take place. As a consequence of high prosthetic care costs, these often lead to disputes before the social court in which expert medical opinions are required. With knowledge of the legal norms, the remit of the expert opinion can be fulfilled. The expert begins with evaluation of the patient's file and a search of the contested parts. The investigation includes a medical history, in addition to a physical examination, in order to be able to comment on the disputed beneficial use of the therapeutic appliance and respond to questions of proof. Questionnaires may be helpful.
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Affiliation(s)
- M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - M Alimusaj
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - D W W Heitzmann
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - J Block
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - C Putz
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - S I Wolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Spoden M, Nimptsch U, Mansky T. Amputation rates of the lower limb by amputation level - observational study using German national hospital discharge data from 2005 to 2015. BMC Health Serv Res 2019; 19:8. [PMID: 30612550 PMCID: PMC6322244 DOI: 10.1186/s12913-018-3759-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In international comparisons, rates of amputations of the lower limb are relatively high in Germany. This study aims to analyze trends in lower limb amputations over time, as well as outcomes of care concerning in-hospital mortality and reamputation rates during the same hospital stay which might indicate the quality of surgical and perioperative health care processes. METHODS This work is an observational population-based study using complete national hospital discharge data (Diagnosis-Related Group Statistics (DRG Statistics)) from 2005 to 2015. All inpatient cases with lower limb amputation were identified and stratified by eight amputation levels. Time trends of case numbers and in-hospital mortality were studied age-sex standardized. For inpatient cases with reamputation during the same hospital stay, first and last amputation levels were cross tabulated. RESULTS A total of 55,595 amputations of the lower limb in 2015 (52,096 in 2005) were identified. After age-sex standardization to the demographic structure of 2005, a relative decrease of - 11.1% was revealed (men - 2.6%, women - 25.0%). The stratified analysis by amputation levels showed that the decreases were induced by higher amputation levels, whereas the amputation levels of toe/foot ray after standardization still showed a relative increase of + 12.8%. In-hospital mortality of all cases with lower limb amputation fell from 11.2% in 2005 to 7.7% in 2015 (SMR 0.89 [95% CI 0.86; 0.92]). The percentage of reamputations during the same hospital stay declined from 13.2 to 10.2%. CONCLUSIONS The number of lower limb amputations declined in Germany, however distinctly stronger in women than in men. The observed decreases of in-hospital mortality as well as of reamputation rates point to improvements in perioperative health care. Despite these indications of improvements, the distinct increase in case numbers at the level of toe/foot ray calls for additional targeted prevention efforts, especially for patients with diabetes.
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Affiliation(s)
- Melissa Spoden
- Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Berlin, Germany
- Department of Health Care Management, Technische Universität Berlin, H80, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Ulrike Nimptsch
- Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Berlin, Germany
- Department of Health Care Management, Technische Universität Berlin, H80, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Thomas Mansky
- Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin, Berlin, Germany
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Fard B, Dijkstra PU, Stewart RE, Geertzen JHB. Incidence rates of dysvascular lower extremity amputation changes in Northern Netherlands: A comparison of three cohorts of 1991-1992, 2003-2004 and 2012-2013. PLoS One 2018; 13:e0204623. [PMID: 30248158 PMCID: PMC6152988 DOI: 10.1371/journal.pone.0204623] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/11/2018] [Indexed: 11/18/2022] Open
Abstract
Objective To analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012–2013 compared to previous cohorts in 1991–1992 and 2003–2004. Design Retrospective cohort study. Participants Adults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5–81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM). Main outcome measures Crude and age-standardized incidence rates of major LEA per 100.000 person-years. Results Crude incidence rate (IR) of first ever major LEA in 2012–2013 was 9.9 per 100.000 person-years, while the age-standardized IR was 7.7 per 100.000 person-years. A Poisson regression analysis showed that amputation rates among men were 2.3 times higher compared to women (95%CI 1.9–2.6), while in 2012–2013 the population aged >63 years had decreased amputation rates compared to 1991–1992. In the DM population the crude IR decreased from 142.6 per 100.000 person-years in 2003–2004 to 89.2 per 100.000 person-years in 2012–2013 (p<0.001). Conclusions In 2012–2013 a decrease in age-standardized IR for the general population and a decrease in crude IR for the DM population were observed compared to cohorts from the previous two decades, despite considerable shifts in the age distribution of the Dutch population towards more elderly people and increased prevalence of DM. These findings might suggest that improved treatment of patients at risk of dysvascular amputations is associated with reduced incidence rates of major LEA at the population level.
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Affiliation(s)
- Behrouz Fard
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Roessingh Center for Rehabilitation, Enschede, the Netherlands
- * E-mail:
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roy E. Stewart
- Department of Public Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Gabrys L, Heidemann C, Schmidt C, Baumert J, Teti A, Du Y, Paprott R, Ziese T, Banzer W, Böhme M, Borrmann B, Busse R, Freitag M, Hagen B, Holl R, Icks A, Kaltheuner M, Koch K, Kümmel S, Kuhn J, Kuß O, Laux G, Schubert I, Szecsenyi J, Uebel T, Zahn D, Scheidt-Nave C. Selecting and defining indicators for diabetes surveillance in Germany. JOURNAL OF HEALTH MONITORING 2018; 3:3-21. [PMID: 35586543 PMCID: PMC8852787 DOI: 10.17886/rki-gbe-2018-063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mainly because of the large number of people affected and associated significant health policy implications, the Robert Koch Institute (RKI) is developing a public health surveillance system using diabetes as an example. In a first step to ensure long-term and comparable data collection and establish efficient surveillance structures, the RKI has defined a set of relevant indicators for diabetes surveillance. An extensive review of the available literature followed by a structured process of consensus provided the basis for a harmonised set of 30 core and 10 supplementary indicators. They correspond to the following four fields of activity: (1) reducing diabetes risk, (2) improving diabetes early detection and treatment, (3) reducing diabetes complications, (4) reducing the disease burden and overall costs of the disease. In future, in addition to the primary data provided by RKI health monitoring diabetes surveillance needs to also consider the results from secondary data sources. Currently, barriers to accessing this data remain, which will have to be overcome, and gaps in the data closed. The RKI intentends to continuously update this set of indicators and at some point apply it also to further chronic diseases with high public health relevance.
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Affiliation(s)
| | | | | | | | | | - Yong Du
- Robert Koch Institute, Berlin
| | | | | | | | | | | | | | | | - Bernd Hagen
- Central Research Institute of Ambulatory Health Care in Germany, Cologne
| | | | - Andrea Icks
- Heinrich Heine University Düsseldorf
- German Diabetes Center Düsseldorf
- German Center for Diabetes Research, Neuherberg
| | | | - Klaus Koch
- Institute of Quality and Efficiency in Health Care, Cologne
| | - Stefanie Kümmel
- Institute for Applied Quality Improvement and Research in Health Care, Göttingen
| | - Joseph Kuhn
- Bavarian Health and Food Safety Authority, Oberschleißheim
| | - Oliver Kuß
- Institute for Biometrics and Epidemiology at the German Diabetes Center, Düsseldorf
| | | | | | | | - Til Uebel
- German College of General Practitioners and Family Physicians, Berlin
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Rümenapf G, Morbach S. Amputation Statistics-How to Interpret Them? DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:128-129. [PMID: 28302262 DOI: 10.3238/arztebl.2017.0128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gerhard Rümenapf
- Clinic for Vascular Surgery, Deaconess Foundation Hospital, Upper Rhine Vascular Center Speyer-Mannheim; Department of Diabetology and Angiology, Virgin Mary Hospital Soest and Institute for Health Services Research and Health Economics, Research Center for Health and Society, Heinrich Heine University Düsseldorf
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Kröger K, Berg C, Santosa F, Malyar N, Reinecke H. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:400. [PMID: 28655379 PMCID: PMC5504515 DOI: 10.3238/arztebl.2017.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Knut Kröger
- *Klinik für Gefäßmedizin HELIOS Klinikum Krefeld GmbH, Krefeld
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Tanudjaja T. Treat Foot Ulcers Conservatively. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:399. [PMID: 28655376 PMCID: PMC5504512 DOI: 10.3238/arztebl.2017.0399a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Tony Tanudjaja
- *Diabetologische Schwerpunktpraxis, Fußambulanz, Hausärztliche Versorgung, Düsseldorf
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Schirmer S, Fansa H. Interdisciplinary collaboration is important in peripheral arterial disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:399-400. [PMID: 28655378 PMCID: PMC5504514 DOI: 10.3238/arztebl.2017.0399c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Steffen Schirmer
- *Department für Plastische und Ästhetische Chirurgie Helios Klinikum Berlin Buch
| | - Hisham Fansa
- **Gemeinschaftspraxis Prof. Heitmann & Prof. Fansa, München
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Chantelau EA. Podological Treatment Has a Protective Effect. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:399. [PMID: 28655377 PMCID: PMC5504513 DOI: 10.3238/arztebl.2017.0399b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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