Maximal Walking Distance in Persons with a Lower Limb Amputation

A DEDICATED AMPUTEE SPORTS PROGRAMME IMPROVES PHYSICAL FUNCTIONING AND SPORTS PARTICIPATION

Objective

People with a lower-limb amputation often have a sedentary lifestyle and increasing physical activity is important to optimize their health and quality of life. To achieve this the Amputee Parateam programme was developed. Amputee Parateam is a sports programme that addresses important physical, environmental, and social barriers for sports participation. This programme was evaluated in terms of various aspects of physical functioning and health.

Design

Repeated measures design.

Patients

Thirteen participants with a lower-limb amputation, with a median age of 51 (interquartile range (IQR) 40-63).

Methods

Measurements were performed at T0 (baseline), T1 (after 6 weeks) and T2 (follow-up after 12 months). Outcome measures were walking ability, functional mobility, daily activity, health-related quality of life, and adherence to sports at follow-up.

Results

Walking ability and functional ability significantly improved between T0 and T1. Adherence to sports at follow-up was high, with 11/13 participants still practicing sports weekly. There were no significant changes in daily activity or health-related quality of life.

Conclusions

The Amputee Parateam programme successfully improved walking ability and functional mobility and resulted in a high adherence to sports among the participants. However, these improvements in physical capacity did not lead to less sedentary behaviour in daily life.

Using Sensor Technology to Measure Gait Capacity and Gait Performance in Rehabilitation Inpatients with Neurological Disorders

The aim of this study was to objectively assess and compare gait capacity and gait performance in rehabilitation inpatients with stroke or incomplete spinal cord injury (iSCI) using inertial measurement units (IMUs). We investigated how gait capacity (what someone can do) is related to gait performance (what someone does). Twenty-two inpatients (11 strokes, 11 iSCI) wore ankle positioned IMUs during the daytime to assess gait. Participants completed two circuits to assess gait capacity. These were videotaped to certify the validity of the IMU algorithm. Regression analyses were used to investigate if gait capacity was associated with gait performance (i.e., walking activity and spontaneous gait characteristics beyond therapy time). The ankle positioned IMUs validly assessed the number of steps, walking time, gait speed, and stride length (r ≥ 0.81). The walking activity was strongly (r ≥ 0.76) related to capacity-based gait speed. Maximum spontaneous gait speed and stride length were similar to gait capacity. However, the average spontaneous gait speed was half the capacity-based gait speed. Gait capacity can validly be assessed using IMUs and is strongly related to gait performance in rehabilitation inpatients with neurological disorders. Measuring gait performance with IMUs provides valuable additional information about walking activity and spontaneous gait characteristics to inform about functional recovery.

Elective transfemoral amputation and simultaneous implantation of a transcutaneous osseointegrated prosthesis stem as salvage treatment after knee joint arthrodesis with poor function: A case report

Background

Surgical reconstruction of anterior cruciate ligament ruptures is a well-established procedure, and although it is for the vast majority of patients without severe complications, total knee joint arthroplasty, arthrodesis of the knee, and finally transfemoral amputation have to be considered in the worst-case scenario.

The case

We report a case of a patient with a 13-year history of recurrent failure after anterior cruciate ligament reconstruction. She claimed she had severely impaired mobility secondary to a knee joint arthrodesis via an Ilizarov circular frame 2 years ago and chronic immobilizing pain, making a permanent medication with opioids necessary. She was aware of the therapeutic options and asked for transfemoral amputation and concomitant supply with a transcutaneous osseointegrated prosthesis system (TOPS).

Procedures

After careful evaluation and clinical work-up, the indication for transfemoral amputation and concomitant implantation of the prosthetic stem into the femoral cavity was secured. Six weeks after the creation of the stoma for coupling of the artificial limb and onset of physiotherapy, balance and gait training were scheduled. Full weight-bearing and walking without crutches were allowed 12 weeks after the index procedure. This sequence of events was paralleled by a series of pre-defined examinations, that is, questionnaires and mobility scores addressing the situation of transfemoral amputees, as well as standardized clinical gait analysis. The latter was performed before surgery and 6, 9, and 18 months after the index procedure.

Outcome

At the time of the index procedure, opioids could be tapered to zero, and the patient quickly regained her walking abilities during the rehabilitation period. Clinical gait analysis confirmed the restoration of bilateral symmetry by mutual approximation of kinematics and kinetics to a standard gait pattern.

Conclusion

The outcome of our patient strengthens the therapeutic potential of a unilateral transfemoral amputation in combination with TOPS. Nevertheless, long-term follow-up is necessary to detect future complications of this approach.

Adults with unilateral lower-limb amputation: greater spatial extent of pain is associated with worse adjustment, greater activity restrictions, and less prosthesis satisfaction

OBJECTIVES

This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation.

METHODS

Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability.

RESULTS

Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC)3,1 = 0.84].

CONCLUSIONS

A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated- and secondary-site pain prevention.

ETHICAL COMMITTEE NUMBER

IRB #1611862.

Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review

Background: The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. Methods: The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. Results and conclusions: 98 articles met the inclusion criteria. According to the included studies’ main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.

Clinical Outcomes Comparing Two Prosthetic Knee Designs in Individuals with Unilateral Transfemoral Amputation in Turkey

BACKGROUND

Clinical outcome assessments provide important input for the rehabilitation of individuals with transfemoral amputation. Differences in prosthetic knee designs may influence clinical outcomes.

OBJECTIVES

The aim of this study was to compare functional mobility, balance, prosthetic satisfaction and quality of life in individuals with unilateral transfemoral amputation with microprocessor-controlled (MPK) and non-microprocessor knee designs (Non-MPK).

METHODOLOGY

The study included ten experienced MPK (Rheo Knee) users (Group 1) and ten experienced Non-MPK (Total Knee® 2000) users (Group 2). For mobility; the 6 Minute Walk Test (6MWT), for balance; the Berg Balance Scale (BBS), Single Leg Stand Test (SLST) and Four Square Step Test (FSST), for quality of life; the Nottingham Health Profile (NHP) and for prosthetic satisfaction; the Satisfaction with Prosthesis Questionnaire (SATPRO) were administered.

FINDINGS

6MWT results of the MPK group were significantly higher than Non-MPK group (p<0.05). In the MPK group a strong negative correlation was found between the FSST and the 6MWT (r=-0.661, p=0.038). No statistically significant differences were found between the groups (p>0.05) comparing balance, prosthesis satisfaction and quality of life values.

CONCLUSION

The findings will inform about the patient's prognosis and the expected clinical outcomes when prescribing an MPK or an Non-MPK. Individuals with unilateral transfemoral amputation covered longer distances using an MPK compared to Non-MPK.