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Abrahamsen C, Dall-Hansen D, Igelski MT, Schober TL, Jensen CM. Transitioning from hospital to home after a major lower extremity amputation: Interview study on patients' and relatives' perspectives. Int J Orthop Trauma Nurs 2024; 54:101103. [PMID: 38692131 DOI: 10.1016/j.ijotn.2024.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Patients often feel unprepared and concerned about their new life after a major lower extremity amputation (LEA). Therefore, we implemented an integrated care program, Safe Journey, to optimize the quality and continuity of care for patients with LEA due to vascular disease when transitioning from hospital to home. This study aims to illuminate and explore the experiences of patients with LEA and their relatives with the transition from hospital to home after implementing Safe Journey. MATERIAL AND METHODS This qualitative, exploratory study individually interviewed six patients with a major LEA and four relatives and jointly interviewed eight patients with their relatives. RESULTS The participants' experiences transitioning from hospital to home were centered around two major themes: (1) Going home: mixed emotions and confusion, and (2) bridging the gap. The main themes encompassed six subthemes: (1) simultaneously expectant and worried, (2) a lack of knowledge creating uncertainty, (3) an unexpressed but pending need for psychosocial support, (4) reassurance but safety comes at a price, (5) navigating the system, and (6) lack of involvement. CONCLUSION Transitioning from hospital to home after a major LEA creates mixed emotions. Knowledge, feeling involved, and being prepared and cared for were highlighted as important during the transition. The Safe Journey program made patients and relatives feel physically reassured and safe, but all the home visits strained the families. The program's benefits are consistent with existing knowledge on patients with complex needs benefitting from integrated care models. However, a more individualized and person-centered approach is needed.
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Affiliation(s)
- Charlotte Abrahamsen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Sygehusvej 20, 6000, Kolding, Denmark; Department of Regional Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Dorte Dall-Hansen
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Sygehusvej 20, 6000, Kolding, Denmark
| | - Malene Tofteng Igelski
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Sygehusvej 20, 6000, Kolding, Denmark
| | - Thea-Louise Schober
- Department of Orthopaedic Surgery and Traumatology, Hospital Lillebaelt Kolding, Sygehusvej 20, 6000, Kolding, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Manz S, Schmalz T, Ernst M, Köhler TM, Gonzalez-Vargas J, Dosen S. Using mobile eye tracking to measure cognitive load through gaze behavior during walking in lower limb prosthesis users: A preliminary assessment. Clin Biomech (Bristol, Avon) 2024; 115:106250. [PMID: 38657356 DOI: 10.1016/j.clinbiomech.2024.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Lower limb amputation does not affect only physical and psychological functioning but the use of a prosthetic device can also lead to increased cognitive demands. Measuring cognitive load objectively is challenging, and therefore, most studies use questionnaires that are easy to apply but can suffer from subjective bias. Motivated by this, the present study investigated whether a mobile eye tracker can be used to objectively measure cognitive load by monitoring gaze behavior during a set of motor tasks. METHODS Five prosthetic users and eight able-bodied controls participated in this study. Eye tracking data and kinematics were recorded during a set of motor tasks (level ground walking, walking on uneven terrain, obstacle avoidance, stairs up and ramp down, as well as ramp up and stairs down) while the participants were asked to focus their gaze on a visual target for as long as possible. Target fixation times and increase in pupil diameters were determined and correlated to subjective ratings of cognitive load. FINDINGS Overall, target fixation time and pupil diameter showed strong negative and positive correlations, respectively, to the subjective rating of cognitive load in the able-bodied controls (-0.75 and 0.80, respectively). However, the individual correlation strength, and in some cases, even the sign, was different across participants. A similar trend could be observed in prosthetic users. INTERPRETATION The results of this study showed that a mobile eye tracker may be used to estimate cognitive load in prosthesis users during locomotor tasks. This paves the way to establish a new approach to assessing cognitive load, which is objective and yet practical and simple to administer. Nevertheless, future studies should corroborate these results by comparing them to other objective measures as well as focus on translating the proposed approach outside of a laboratory.
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Affiliation(s)
- Sabina Manz
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Ottobock SE & Co. KGaA, Global Research, Duderstadt, Germany
| | - Thomas Schmalz
- Ottobock SE & Co. KGaA, Clinical Research & Services, Research Biomechanics, Göttingen, Germany
| | - Michael Ernst
- Ottobock SE & Co. KGaA, Clinical Research & Services, Research Biomechanics, Göttingen, Germany
| | | | | | - Strahinja Dosen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Bechara N, Hng TM, Gunton JE. The association between tobacco smoking and systolic toe pressures in active foot ulceration. Sci Rep 2024; 14:8550. [PMID: 38609449 PMCID: PMC11015010 DOI: 10.1038/s41598-024-59158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
Smoking may increase the risk of diabetic foot disease and ulceration. It does so by impairing glycaemic control and promoting the formation of advanced glycated end-products. Additionally, smoking is known to delay surgical wound healing and accelerate peripheral arterial disease. We aimed to determine whether toe pressures differed in smokers with a foot ulcer, when compared to non-smokers and ex-smokers, as well as ulcer outcomes at 12 months, among patients attending Blacktown Hospital High Risk Foot Service (HRFS). This study is a retrospective analysis of our prospectively collected clinic database. Eligible participants were adults attending the HRFS between June 2020 and April 2022. Participants were included if they had an ulcer, at least one systolic toe pressure reading completed at their initial visit and attended at least one follow-up visit. Participants were followed until healing, loss to follow-up or a minimum of 12 months. A total of 195 participants were included; 36 smokers, 82 ex-smokers, and 77 controls who had never smoked. Smoking status was by self-report. Current smokers were significantly younger at initial presentation (p = .002) and tended towards lower socioeconomic status (p = .067). Current smokers were significantly more likely to have ischaemic grade 3 toe pressures (< 30 mmHg) of their left foot (p = .027), suggestive of reduced perfusion. At the end of follow up period, smokers had the numerically highest rates of minor amputations. In conclusion, smokers ulcerate younger and are more likely to have grade 3 ischaemia. Collecting information about the brachial artery pressures and the time since the last cigarette may clarify any relationship between smoking and toe pressures.Trial registration: WSLHD HREC ethics approval 2111-02 and ANZCTR registration 382470. Registered on 15/09/2021.
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Affiliation(s)
- Nada Bechara
- Centre for Diabetes, Obesity and Endocrinology (CDOE) Research, The Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia
- Department of Diabetes and Endocrinology, Blacktown Mt Druitt Hospital, Blacktown, NSW, 2148, Australia
- Faculty of Medicine and Health, Westmead Hospital, Sydney Medical School, The University of Sydney, Westmead, NSW, 2145, Australia
| | - Tien-Ming Hng
- Department of Diabetes and Endocrinology, Blacktown Mt Druitt Hospital, Blacktown, NSW, 2148, Australia
- School of Medicine, Western Sydney University, Blacktown Mt Druitt Hospital, Blacktown, NSW, 2148, Australia
| | - Jenny E Gunton
- Centre for Diabetes, Obesity and Endocrinology (CDOE) Research, The Westmead Institute for Medical Research, Westmead, NSW, 2145, Australia.
- Faculty of Medicine and Health, Westmead Hospital, Sydney Medical School, The University of Sydney, Westmead, NSW, 2145, Australia.
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Bekrater-Bodmann R, Kehl I, Giordano A, Franchignoni F. Rasch validation of the German version of the Prosthesis Embodiment Scale for lower limb amputees and proposal of a revised version. Disabil Rehabil 2024; 46:1400-1407. [PMID: 37070622 DOI: 10.1080/09638288.2023.2199220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE To perform a detailed psychometric Rasch analysis of the Prosthesis Embodiment Scale (PEmbS) administered in adults with lower limb amputation (LLA). METHODS A convenience sample of German-speaking adults with LLA (n = 150), recruited from German state agencies' databases, was asked to complete the PEmbS, a 10-item patient-reported scale assessing prosthesis embodiment. RESULTS The local dependency between two items was resolved by keeping for the global score only the lower score of these two items (#9 and #10). Collapsing the seven response categories to four (two expressing disagreement and two agreement) eliminated disordered thresholds. After that, the PEmbS demonstrated unidimensionality, acceptable item fit, and good reliability indices. A keyform plot was created to transform raw scores into linear measures of prosthesis embodiment, making it possible to compare the individual's item responses with those expected by the Rasch model, and to manage missing responses. CONCLUSIONS The PEmbS is useful for assessing prosthesis embodiment in people with LLA, both for research and clinical purposes. We propose a revised version of the PEmbS for lower limb amputees; its appropriateness in other LLA contexts requires further investigation.
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Affiliation(s)
- Robin Bekrater-Bodmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH, Aachen, Germany
| | - Isabelle Kehl
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Andrea Giordano
- Bioengineering Unit, IstitutiCliniciScientifici Maugeri IRCCS, Veruno, NO, Italy
| | - Franco Franchignoni
- Physical and Rehabilitation Medicine Unit, IstitutiCliniciScientifici Maugeri IRCCS, Tradate, VA, Italy
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Norvell DC, Henderson AW, Morgenroth DC, Halsne BG, Turner AP, Biggs W, Czerniecki JM. The Effect of Prosthetic Limb Sophistication and Amputation Level on Self-reported Mobility and Satisfaction With Mobility. Arch Phys Med Rehabil 2024:S0003-9993(24)00905-5. [PMID: 38561145 DOI: 10.1016/j.apmr.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine if lower limb prosthesis (LLP) sophistication is associated with patient-reported mobility and/or mobility satisfaction, and if these associations differ by amputation level. DESIGN Cohort study that identified participants through a large national database and prospectively collected self-reported patient outcomes. SETTING The Veterans Administration (VA) Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings, and phone calls. PARTICIPANTS 347 Veterans who underwent an incident transtibial (TT) or transfemoral (TF) amputation due to diabetes and/or peripheral artery disease and received a qualifying LLP between March 1, 2018, and November 30, 2020. INTERVENTIONS Basic, intermediate, and advanced prosthesis sophistication was measured by the accurate and reliable PROClass system. MAIN OUTCOME MEASURE Patient-reported mobility using the advanced mobility subscale of the Locomotor Capabilities Index-5; mobility satisfaction using a 0-10-point Likert scale. RESULTS Lower limb amputees who received intermediate or advanced prostheses were more likely to achieve advanced mobility than those who received basic prostheses, with intermediate nearing statistical significance at nearly twice the odds (adjusted odds ratio (aOR)=1.8, 95% confidence interval (CI), .98-3.3; P=.06). The association was strongest in TF amputees with over 10 times the odds (aOR=10.2, 95% CI, 1.1-96.8; P=.04). The use of an intermediate sophistication prosthesis relative to a basic prosthesis was significantly associated with mobility satisfaction (adjusted β coefficient (aβ)=.77, 95% CI, .11-1.4; P=.02). A statistically significant association was only observed in those who underwent a TT amputation (aβ=.79, 95% CI, .09-1.5; P=.03). CONCLUSIONS Prosthesis sophistication was not associated with achieving advanced mobility in TT amputees but was associated with greater mobility satisfaction. In contrast, prosthesis sophistication was associated with achieving advanced mobility in TF amputees but was not associated with an increase in mobility satisfaction.
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Affiliation(s)
- Daniel C Norvell
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | - Alison W Henderson
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | - David C Morgenroth
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Beth G Halsne
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Wayne Biggs
- VA Puget Sound Health Care System, Seattle, WA
| | - Joseph M Czerniecki
- VA Puget Sound Health Care System, Seattle, WA; VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Bishay J, Yeap I, Wang T. The effectiveness of targeted muscle reinnervation in reducing pain and improving quality of life for patients following lower limb amputation. J Plast Reconstr Aesthet Surg 2024; 92:288-298. [PMID: 38599000 DOI: 10.1016/j.bjps.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Globally, over 1 million lower limb amputations are performed annually, with approximately 75% of patients experiencing significant pain, profoundly impacting their quality of life and functional capabilities. Targeted muscle reinnervation (TMR) has emerged as a surgical solution involving the rerouting of amputated nerves to specific muscle targets. Originally introduced to enhance signal amplification for myoelectric prosthesis control, TMR has expanded its applications to include neuroma management and pain relief. However, the literature assessing patient outcomes is lacking, specifically for lower limb amputees. This systematic review aims to assess the effectiveness of TMR in reducing pain and enhancing functional outcomes for patients who have undergone lower limb amputation. METHODS A systematic review was performed by examining relevant studies between 2010 and 2023, focusing on pain reduction, functional outcomes and patient-reported quality of life measures. RESULTS In total, 20 studies were eligible encompassing a total of 778 extremities, of which 75.06% (n = 584) were lower limb amputees. Average age was 46.66 years and patients were predominantly male (n = 70.67%). Seven studies (35%) reported functional outcomes. Patients who underwent primary TMR exhibited lower average patient-reported outcome measurement information system (PROMIS) scores for phantom limb pain (PLP) and residual limb pain (RLP). Secondary TMR led to improvements in PLP, RLP and general limb pain as indicated by average numeric rating scale and PROMIS scores. CONCLUSION The systematic review underscores TMR's potential benefits in alleviating pain, fostering post-amputation rehabilitation and enhancing overall well-being for lower limb amputees.
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Affiliation(s)
- Jeremy Bishay
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia.
| | - Isobel Yeap
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia
| | - Tim Wang
- Department of Plastic Surgery, Royal North Shore Hospital, Reserve road, St Leonards, New South Wales 2065, Australia
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Rigot SK, Maronati R, Lettenberger A, O'Brien MK, Alamdari K, Hoppe-Ludwig S, McGuire M, Looft JM, Wacek A, Cave J, Sauerbrey M, Jayaraman A. Validation of Proprietary and Novel Step-counting Algorithms for Individuals Ambulating With a Lower Limb Prosthesis. Arch Phys Med Rehabil 2024; 105:546-557. [PMID: 37907160 DOI: 10.1016/j.apmr.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To compare the accuracy and reliability of 10 different accelerometer-based step-counting algorithms for individuals with lower limb loss, accounting for different clinical characteristics and real-world activities. DESIGN Cross-sectional study. SETTING General community setting (ie, institutional research laboratory and community free-living). PARTICIPANTS Forty-eight individuals with a lower limb amputation (N=48) wore an ActiGraph (AG) wGT3x-BT accelerometer proximal to the foot of their prosthetic limb during labeled indoor/outdoor activities and community free-living. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC), absolute and root mean square error (RMSE), and Bland Altman plots were used to compare true (manual) step counts to estimated step counts from the proprietary AG Default algorithm and low frequency extension filter, as well as from 8 novel algorithms based on continuous wavelet transforms, fast Fourier transforms (FFTs), and peak detection. RESULTS All algorithms had excellent agreement with manual step counts (ICC>0.9). The AG Default and FFT algorithms had the highest overall error (RMSE=17.81 and 19.91 steps, respectively), widest limits of agreement, and highest error during outdoor and ramp ambulation. The AG Default algorithm also had among the highest error during indoor ambulation and stairs, while a FFT algorithm had the highest error during stationary tasks. Peak detection algorithms, especially those using pre-set parameters with a trial-specific component, had among the lowest error across all activities (RMSE=4.07-8.99 steps). CONCLUSIONS Because of its simplicity and accuracy across activities and clinical characteristics, we recommend the peak detection algorithm with set parameters to count steps using a prosthetic-worn AG among individuals with lower limb loss for clinical and research applications.
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Affiliation(s)
- Stephanie K Rigot
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Rachel Maronati
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Ahalya Lettenberger
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Rice University, Department of Bioengineering, Houston, TX
| | - Megan K O'Brien
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL
| | - Kayla Alamdari
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Shenan Hoppe-Ludwig
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - Matthew McGuire
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL
| | - John M Looft
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Division of Rehabilitation Science, University of Minnesota Medical School, Minneapolis, MN
| | - Amber Wacek
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Juan Cave
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Matthew Sauerbrey
- Motion Analysis Laboratory, Department of Prosthetics, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN; Minneapolis Adaptive Design & Engineering (MADE), Department of Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL; Northwestern University, Department of Physical Medicine & Rehabilitation, Chicago, IL; Northwestern University, Department of Physical Therapy & Human Movement Sciences, Chicago, IL.
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Sureshkumar A, Payne MW, Viana R, Hunter SW. The Effect of Advanced Age on Prosthetic Rehabilitation Functional Outcomes in People With Lower Limb Amputations: A Retrospective Chart Audit of Inpatient Admissions. Arch Phys Med Rehabil 2023; 104:1827-1832. [PMID: 37119956 DOI: 10.1016/j.apmr.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To evaluate the effect of age on functional outcomes at discharge from prosthetic rehabilitation. DESIGN Retrospective chart audit. SETTING Rehabilitation hospital. PARTICIPANTS Individuals ≥50 years with a transtibial level lower limb amputation (LLA) and above admitted to the inpatient prosthetic rehabilitation program from 2012 to 2019 (n=504). A secondary analysis included a subset of matched participants (n=156). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The L-Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence scale. RESULTS A total of 504 participants (66.7±10.1 years) met the inclusion criteria, 63 participants (84.9±3.7 years) were part of the oldest old group. The sample was stratified into 4 age groups (50-59, 60-69, 70-79, and 80+) for data analysis. The analysis of variances were statistically significant for all outcome measures (P<.001). Post-hoc testing for the L-Test, 2MWT, and 6MWT demonstrated that the oldest old had significantly reduced performance compared with people 50-59 years old (P<.05), but there were no significant differences between the oldest old and the 60-69 [(L-Test, P=.802), (2MWT, P=.570), (6MWT, P=.772)] and 70-79 [(L-Test, P=.148), (2MWT, P=.338), (6MWT, P=.300)] age groups. The oldest old reported significantly lower balance confidence compared with all 3 age groups (P<.05). CONCLUSION The oldest old achieved similar functional mobility outcomes as people 60-79 years, the most common age group of people with an LLA. Advanced age alone should not disqualify individuals from prosthetic rehabilitation.
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Affiliation(s)
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Canada; Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada; School of Physical Therapy, University of Western Ontario, London, Canada
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Swarnakar R, Yadav SL, Surendran D. Lower limb amputation rehabilitation status in India: A review. World J Clin Cases 2023; 11:7261-7267. [PMID: 37969465 PMCID: PMC10643056 DOI: 10.12998/wjcc.v11.i30.7261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation.
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Affiliation(s)
- Raktim Swarnakar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Shiv Lal Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Darshana Surendran
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Expósito Tirado JA, García Kirschberg P, Delgado Mendilívar JM, Rodríguez-Piñero Durán M, Gómez González AM, Fernández Torrico JM, Del Pino Algarrada R. [Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. Rehabilitacion (Madr) 2023; 57:100785. [PMID: 36739682 DOI: 10.1016/j.rh.2023.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 02/05/2023]
Abstract
The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.
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Norvell DC, Biggs WT, Bott J, Henderson AW, Moore KP, Czerniecki JM. PROClass: The Development and Validation of a Novel Prosthetic Component Sophistication Classification System. Arch Rehabil Res Clin Transl 2023; 5:100273. [PMID: 37744202 PMCID: PMC10517350 DOI: 10.1016/j.arrct.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To develop a lower limb prosthesis (LLP) sophistication classification system that categorizes prosthetic component prescriptions into "basic," "intermediate," and "advanced" and assess its content validity, reliability, and accuracy. Design Classification development and validation study. Setting The Veterans Affairs (VA) Corporate Data Warehouse database and National Prosthetics Patient Database were used to identify patients undergoing their first amputation at the transtibial or transfemoral level due to diabetes or peripheral artery disease and to identify the associated codes for each LLP. Participants An expert panel of 6 nationally recognized certified prosthetists, a national expert in VA prosthetics data and coding, a physical medicine and rehabilitation physician, and an epidemiologist developed an LLP classification system (PROClass) using 30 transfemoral and transtibial lower limb amputees. Main Outcome Measures The expert panel reviewed 20 consecutive participants meeting study criteria for the development of the PROClass system and a subsequent 30 consecutive cases for assessing the inter- and intra-rater reliability and accuracy. Results The interrater and intrarater reliability was almost perfect with Gwet's AC1 values ranging from .82 to .96 for both expert panel members and research assistants. The accuracy of the research assistant's classifications to the "criterion standard" was excellent with Gwet's AC1 values ranging between .75 and .92. Conclusions PROClass is a pragmatic, reliable, and accurate prosthetic classification system with strong face validity that will enable the classification of prosthetic components used for large data set research aimed at evaluating important clinical questions such as the effects of sophistication on patient outcomes.
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Affiliation(s)
- Daniel C. Norvell
- VA Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | | | - Jeffrey Bott
- VA in the Orthotic, Prosthetic, and Orthic Clinical Services Program Office, Washington, DC
| | - Alison W. Henderson
- VA Puget Sound Health Care System, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
| | - Kathryn P. Moore
- VA Puget Sound Health Care System, Seattle, WA
- VA Seattle Epidemiologic Research and Information Center (ERIC), Seattle, WA
| | - Joseph M. Czerniecki
- VA Puget Sound Health Care System, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
- VA Center for Limb Loss and MoBility (CLiMB), Seattle, WA
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Sureshkumar A, Payne MW, Viana R, Hunter SW. An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation: a Canadian perspective. Disabil Rehabil 2023:1-11. [PMID: 37498002 DOI: 10.1080/09638288.2023.2240231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. METHODS A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. RESULTS A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = -0.08, (95% CI: -0.13, -0.02), p = 0.011] were independently associated with admission time. CONCLUSION People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population.
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Affiliation(s)
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Parkwood Institute London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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13
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Monteiro SS, Santos TS, Pereira CA, Duarte DB, Neto H, Gomes A, Loureiro L, Martins J, Silva F, Martins LS, Ferreira L, Amaral C, Freitas C, Carvalho AC, Carvalho R, Dores J. The influence of simultaneous pancreas-kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease. J Endocrinol Invest 2023:10.1007/s40618-023-02009-3. [PMID: 36645638 DOI: 10.1007/s40618-023-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/05/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft. METHODS We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation. RESULTS Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29). CONCLUSIONS Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients.
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Affiliation(s)
- S S Monteiro
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
| | - T S Santos
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C A Pereira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - D B Duarte
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - H Neto
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - A Gomes
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L Loureiro
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Martins
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - F Silva
- Division of Nephrology and Transplant, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L S Martins
- Division of Nephrology and Transplant, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - L Ferreira
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Amaral
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - C Freitas
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - A C Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - R Carvalho
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
- Diabetic Foot Unit, Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
| | - J Dores
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Do Porto, Largo Professor Abel Salazar, 4099-001, Porto, Portugal
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Stability and Falls Evaluations in AMPutees (SAFE-AMP 2): Reduced functional mobility is associated with a history of injurious falls in lower limb prosthesis users. Ann Phys Rehabil Med 2022; 66:101679. [PMID: 35667624 DOI: 10.1016/j.rehab.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. METHODS Retrospective (2016-2018) observational study. Logistic regression applied. RESULTS A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). CONCLUSION(S) Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes.
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Affiliation(s)
- Taavy A Miller
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA; Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA
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Fadili O, Chrak A, Laffani M, El Adaoui O, El Andaloussi Y, Fadili M. A rare case and unusual localization of a poorly differentiated giant synovial sarcoma of the ankle: Case report and literature review. Int J Surg Case Rep 2022; 95:107243. [PMID: 35636215 PMCID: PMC9149195 DOI: 10.1016/j.ijscr.2022.107243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Synovial sarcoma is a rare and aggressive soft tissue tumor that affects the para-articular regions of the large joints. It originates from mesenchymal cells with synovial differentiation. Its management remains surgical with wide excision. CASE PRESENTATION We report a case of synovial sarcoma with rare localization that occurred in a 37-year-old man on the inner side of the right ankle, and we recall the clinical, radiological, and histological signs that allowed us to suggest the diagnosis as well as multidisciplinary management. DISCUSSION Synovial sarcoma is a highly aggressive soft tissue tumor with a high risk of spreading. It is a deceptive tumor in some clinical and morphological aspects that may indicate benignity. Although non-specific, MRI is critical for guiding diagnosis, identifying prognostic criteria, and ensuring post-treatment follow-up. CONCLUSION This rare case underlines the importance of evoking a synovial sarcoma in front of a mass of soft parts of the benign aspect of the ankle, as well as adapting the treatment in order to prevent possible metastases, especially in the lungs.
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Affiliation(s)
- Omar Fadili
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco.
| | - Abdellah Chrak
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Mohamed Laffani
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Oussama El Adaoui
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Yassir El Andaloussi
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
| | - Mustapha Fadili
- Department of Trauma Surgery and Orthopaedics, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy of Casablanca, Hassan II University, Morocco
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16
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Pereira PF, Silva MR, Simão RS, Negrão P, Sousa A, Neves N. Total calcanectomy in calcaneal osteomyelitis: An alternative to major amputation. Foot (Edinb) 2022; 51:101896. [PMID: 35290842 DOI: 10.1016/j.foot.2021.101896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/20/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hindfoot ulcers associated with chronic calcaneus osteomyelitis are very difficult to manage and many patients need a limb amputation for resolution. Total calcanectomy can be a salvage procedure for these patients. The purpose of this study is to present our results of total calcanectomy. METHODS Retrospective analysis of six patients undergoing total calcanectomy at our institution between 2008 and 2019. Patient data and ambulatory status were analyzed. RESULTS In 4 of the 6 patients, infection control and wound closure was achieved with total calcanectomy with follow-up ranging from 1 to 12 years. The 4 patients maintain walking ability. Two major complications: an early death caused by a respiratory infection and a below the knee amputation due to recurrence of the foot infection. CONCLUSION Total calcanectomy is an useful procedure for limb salvage in foot ulcers with chronic calcaneus osteomyelitis.
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Affiliation(s)
| | - Manuel Ribeiro Silva
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - Ricardo São Simão
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Pedro Negrão
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal
| | - António Sousa
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Neves
- Orthopedics Department, Centro Hospitalar e Universitário de São João, Porto, Portugal; Surgery and Physiology Department, Faculty of Medicine, University of Porto, Porto, Portugal; CUF Porto Hospital, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; INEB - Instituto Nacional de Engenharia Biomédica, University of Porto, Porto, Portugal
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17
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Lee LS, Hitzig SL, Mayo A, Devlin M, Dilkas S, MacKay C. Factors influencing physical activity among individuals with lower limb amputations: a qualitative study. Disabil Rehabil 2022; 45:1461-1470. [PMID: 35452590 DOI: 10.1080/09638288.2022.2065539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to explore the barriers and facilitators to physical activity from multiple stakeholder perspectives including individuals with LLA and health professionals. MATERIALS AND METHODS A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semi-structured interviews were held with individuals with LLA recruited from rehabilitation hospitals in a metropolitan city in Canada. Health professionals with experience in amputation care were recruited from across Canada. Data were analysed using codebook thematic analysis. RESULTS Thirty-three individuals with LLA and eighteen health professionals participated. Six themes were generated which represent the perceived barriers and facilitators to physical activity. Themes including Informal and Formal Supports, Availability of and Access to Community Resources, and Fit and Function of the Prosthesis were perceived by many individuals as facilitators, while acting as a barrier for others depending on an individual's circumstances. CONCLUSIONS These findings provide us with a basis of understanding from which we can begin addressing barriers to physical activity for individuals with LLA, in support of developing patient-centred interventions and physical activity programs for this population. IMPLICATIONS FOR REHABILITATIONIrrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity.Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation.A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient's motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change.The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals.
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Affiliation(s)
- Leanna S Lee
- West Park Healthcare Centre, Toronto, Canada.,University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Sander L Hitzig
- Evaluative Clinical Sciences, St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Amanda Mayo
- Sunnybrook Health Sciences Centre, Toronto, Canada
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Wei J, Li Z, Diao J, Li X, Min L, Jiang W, Yan F. [Effect of lower limb amputation level on aortic hemodynamics: a numerical study]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2022; 39:67-74. [PMID: 35231967 DOI: 10.7507/1001-5515.202108031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal individuals, but the relationship between lower limb amputation and the episodes of cardiovascular disease has not been studied from the perspective of hemodynamics. In this paper, numerical simulation was used to study the effects of amputation on aortic hemodynamics by changing peripheral impedance and capacitance. The final results showed that after amputation, the aortic blood pressure increased, the time averaged wall shear stress of the infrarenal abdominal aorta decreased and the oscillatory shear index of the left and right sides was asymmetrically distributed, while the time averaged wall shear stress of the iliac artery decreased and the oscillatory shear index increased. The changes above were more significant with the increase of amputation level, which will result in a higher incidence of atherosclerosis and abdominal aortic aneurysm. These findings preliminarily revealed the influence of lower limb amputation on the occurrence of cardiovascular diseases, and provided theoretical guidance for the design of rehabilitation training and the optimization of cardiovascular diseases treatment.
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Affiliation(s)
- Junru Wei
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Zhongyou Li
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Junjie Diao
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Xiao Li
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Lei Min
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Wentao Jiang
- Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China
- Failure Mechanics and Engineering Disaster Prevention and Mitigation Key Laboratory of Sichuan Province, Chengdu 610065, P. R. China
| | - Fei Yan
- Chongqing University Three Gorges Hospital, Chongqing 404000, P. R. China
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Spiera Z, Ilonzo N, Kaplan H, Leitman IM. Loss of independence as a metric for racial disparities in lower extremity amputation for diabetes: A National Surgery Quality Improvement Program (NSQIP) analysis. J Diabetes Complications 2022; 36:108105. [PMID: 34916145 DOI: 10.1016/j.jdiacomp.2021.108105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study assessed the association between race/ethnicity and amputation with mortality and loss of independence (LOI) for diabetic gangrene. METHODS We analyzed the American College of Surgeons National Surgery Quality Improvement Program database from 2016 to 2019. Chi-squared tests were performed to evaluate differences in baseline characteristics and complications. Multivariable logistic regression was performed to model LOI and 30-day mortality. RESULTS 5250 patients with diabetes underwent lower extremity amputation as treatment for gangrene. Hispanic patients were more likely to undergo below the knee amputation (BKA) (P = 0.006). Guillotine amputation (GA) was associated with age > 65 (P < 0.0001), independent functional status prior to admission (P < 0.0001), and mortality (OR 1.989, 95%CI 1.29-3.065), but was not associated with LOI. Mortality was less frequent in Black patients (OR 0.432, 95%CI 0.207-0.902), but loss of independence (LOI) was more frequent in Black patients (OR 1.373, 95%CI 1.017-1.853). Hispanic patients were less likely to experience LOI (OR 0.575, 95%CI 0.477-0.693). CONCLUSIONS LOI and mortality provide contrasting perspectives on outcomes following lower extremity amputation. Further assessment of risk factors may illuminate healthcare disparities.
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Affiliation(s)
- Zachary Spiera
- Icahn School of Medicine at Mount Sinai, Department of Surgery, New York, NY, USA
| | - Nicole Ilonzo
- Icahn School of Medicine at Mount Sinai, Department of Surgery, New York, NY, USA
| | - Harrison Kaplan
- Icahn School of Medicine at Mount Sinai, Department of Surgery, New York, NY, USA
| | - I Michael Leitman
- Icahn School of Medicine at Mount Sinai, Department of Surgery, New York, NY, USA.
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Shan X, Wei C, Liu S, Luo J. Altered cortical activity in patients with lower limb amputation based on EEG microstate. J Integr Neurosci 2021; 20:993-999. [PMID: 34997722 DOI: 10.31083/j.jin2004100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/03/2021] [Accepted: 10/26/2021] [Indexed: 11/06/2022] Open
Abstract
Previous studies have revealed significant changes in electroencephalogram (EEG) microstates in neuropsychiatric diseases, including schizophrenia, depression, and dementia. To explore the resting-state EEG microstate with amputation, we collected the EEG datasets from 15 patients with lower limb amputation and 20 healthy controls. Then, we analyzed the parameters of four classical EEG microstates (A-D) between the two groups. Specifically, the parameters were statistically analyzed, including duration, occurrence rate, time coverage, and transition rate. According to the results, the duration of microstate C (t = 2.95, p = 0.005) in the lower limb amputation group was significantly smaller compared with the control group, while the occurrence rate of microstate B (t = -2.22, p = 0.03) and D (t = -3.35, p = 0.002) were significantly larger in the lower limb amputation group. In addition, the transition rate of microstate differed significantly in AC, CA, DB between the two groups. Our results implied: (1) amputation has changed the resting-state EEG microstate; (2) EEG microstate analysis can be an approach to explore the alteration of cortical function.
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Affiliation(s)
- Xinying Shan
- School of Biological Science and Medical Engineering, Beihang University, 100191 Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, China
| | - Conghui Wei
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Shaowen Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Jun Luo
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
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21
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Abstract
BACKGROUND Although leg amputation is common among patients with diabetic foot ulcers, only few studies have examined the thoughts regarding leg amputation from the perspective of patients. AIM This study aims to explore the thoughts of patients with diabetic foot ulcers regarding leg amputation. METHOD A qualitative design using semi-structured interviews were used and analysed using Interpretative Phenomenological Analysis (IPA). In all five patients participated and the interview questions were focused on thoughts in relation to a possible leg amputation. FINDINGS Four significant themes were revealed: 1) "Considered-not spoken"-reflections on being alone with one's thoughts, 2) "What people think about me"-concerns about consequences on social relations, 3) "The tough ones and the ones who whine"-considerations about expected self-efficacy and 4) "Limitations and opportunities"-thoughts about physical consequences. CONCLUSION Even if an amputation is not yet planned, having a diabetic foot ulcer can result in divergent thoughts regarding leg amputation. The findings indicate that amputation is considered a taboo which makes it difficult for the patient to talk about it within either the health care context or with relatives. Health care professionals should therefore be aware of how they communicate regarding leg amputation.
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Affiliation(s)
| | | | - Ulla Riis Madsen
- Ortopedic Department, Holbaek Hospital, Denmark, Holbæk, Denmark
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22
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Saetta G, Ho JT, Bekrater-Bodmann R, Brugger P, Dijkerman CH, Lenggenhager B. Limb apparent motion perception: Modification by tDCS, and clinically or experimentally altered bodily states. Neuropsychologia 2021; 162:108032. [PMID: 34600001 DOI: 10.1016/j.neuropsychologia.2021.108032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
Limb apparent motion perception (LAMP) refers to the illusory visual perception of a moving limb upon observing two rapidly alternating photographs depicting the same limb in two different postures. Fast stimulus onset asynchronies (SOAs) induce the more visually guided perception of physically impossible movements. Slow SOAs induce the perception of physically possible movements. According to the motor theory of LAMP, the latter perception depends upon the observer's sensorimotor representations. Here, we tested this theory in two independent studies by performing a central (study 1) and peripheral (study 2) manipulation of the body's sensorimotor states during two LAMP tasks. In the first sham-controlled transcranial direct current stimulation between-subject designed study, we observed that the dampening of left sensorimotor cortex activity through cathodal stimulation biased LAMP towards the more visually guided perception of physically impossible movements for stimulus pairs at slow SOAs. In the second, online within-subject designed study, we tested three participant groups twice: (1) individuals with an acquired lower limb amputation, either while wearing or not wearing their prosthesis (2) individuals with body integrity dysphoria (i.e., with a desire for amputation of a healthy leg) while sitting in a regular position or binding up the undesired leg (to simulate the desired amputation); (3) able-bodied individuals while sitting in a normal position or sitting on one of their legs. We found that the momentary sensorimotor state crucially impacted LAMP in individuals with an amputation and able-bodied participants, but not in BID individuals. Taken together, the results of these two studies substantiate the motor theory of LAMP.
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Affiliation(s)
- Gianluca Saetta
- Department of Psychology, University of Zurich, Switzerland; Department of Experimental Psychology, Utrecht University, the Netherlands.
| | - Jasmine T Ho
- Department of Psychology, University of Zurich, Switzerland
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Brugger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry (PUK), Zurich, Switzerland; Neuropsychology Unit, Valens Rehabilitation Centre, Valens, Switzerland
| | - Chris H Dijkerman
- Department of Experimental Psychology, Utrecht University, the Netherlands
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Carse B, Scott H, Davie-Smith F, Brady L, Colvin J. Minimal clinically important difference in walking velocity, gait profile score and two minute walk test for individuals with lower limb amputation. Gait Posture 2021; 88:221-4. [PMID: 34119776 DOI: 10.1016/j.gaitpost.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with lower limb amputation are routinely assessed with a variety outcome measures, however there is a lack of published data to indicate minimal clinically important differences (MCID) for many of these outcome measures. Three such important gait-specific outcome measures include walking velocity, gait profile score (GPS) and the two minute walk test (2MWT). RESEARCH QUESTION Determine the MCIDs for walking velocity, GPS and 2MWT for individuals with lower limb amputation. METHODS Walking velocity and GPS (n = 60), and 2MWT (n = 119) data for individuals with unilateral transfemoral or knee disarticulation were identified retrospectively from a database held at the study centre. An anchor-based method was used with Medicare functional classification level (MFCL) acting as the impairment-related criterion, and a least-squares linear regression approach was used to calculate the gradient required for a change between MFCL levels. RESULTS An increase of 0.21 m/s (95 % CI: 0.13,0.29) for walking velocity, a reduction of 1.7° (95 % CI: -2.449,-1.097) for GPS and an increase of 37.2 m (95 % CI: 28.8,45.5) for 2MWT were found to correspond to an increase in MFCL of one level. Walking velocity, GPS and 2MWT correlated with MFCL with R2 values of 0.333, 0.322 and 0.398 respectively (p < 0.00001). The authors propose that 0.21 m/s for walking velocity, 1.7° for GPS and 37.2 m for 2MWT be used as MCID values for individuals with lower limb amputation. SIGNIFICANCE The results of this study can be used to help both researchers and clinicians to objectively evaluate if interventions for individuals with lower limb amputation are effective.
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Singh TP, Moxon JV, Meehan MT, Jones R, Cadet-James Y, Golledge J. Major amputation rates and outcomes for Aboriginal and Torres Strait Islander and non-Indigenous people in North Queensland Australia between 2000 and 2015. BMC Endocr Disord 2021; 21:101. [PMID: 34020627 PMCID: PMC8139111 DOI: 10.1186/s12902-021-00764-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study estimated the incidence of major amputation for people in North Queensland, Australia, examined changes in amputation rates over time and investigated survival after major amputation. METHODS This was a retrospective study of patients who underwent a major amputation above the ankle between 2000 and 2015. Major amputation rates and incidence rate ratios (IRR) were calculated using census data to define the at-risk population. Associations between risk factors and calendar year with major amputation were assessed using quasipoisson regression. Kaplan-Meier survival and Cox-proportional hazard analyses estimated the incidence of and risk factors for all-cause mortality. RESULTS The annual incidence of major amputation was estimated to be greater in Aboriginal and Torres Strait Islanders than non-Indigenous people (IRR 2.75, 95 % CI 1.92 to 3.84). After adjusting for population growth, the annual incidence of major amputations did not change significantly over time for either groups. Aboriginal and Torres Strait Islander people were at greater risk of all-cause mortality after major amputation compared to non-Indigenous people, although this association was not significant after adjusting for other risk factors (hazard ratio 1.24, 95 % CI 0.82 to 1.90). CONCLUSIONS The incidence of major amputation in North Queensland has not reduced over time, indicating the need for better preventative treatments, particularly in Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Michael T Meehan
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Rhondda Jones
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Yvonne Cadet-James
- Anton Breinl Research Centre for Health Systems Strengthening, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, 4811, Townsville, Queensland, Australia.
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia.
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
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25
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Cavedon V, Sandri M, Peluso I, Zancanaro C, Milanese C. Body composition and bone mineral density in athletes with a physical impairment. PeerJ 2021; 9:e11296. [PMID: 34026349 PMCID: PMC8117930 DOI: 10.7717/peerj.11296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background The impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI. Methods Forty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m2) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m2) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m2). Results One-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm2 and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes. Conclusions In conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.
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Affiliation(s)
- Valentina Cavedon
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Sandri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Peluso
- Council for Agricultural Research and Economics (CREA-AN), Research Centre for Food and Nutrition, Rome, Italy
| | - Carlo Zancanaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Milanese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Rosi LM, Jones AS, Topliss DJ, Bach LA. Demographics and outcomes of inpatients with diabetic foot ulcers treated conservatively and surgically in a metropolitan hospital network. Diabetes Res Clin Pract 2021; 175:108821. [PMID: 33872634 DOI: 10.1016/j.diabres.2021.108821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/06/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022]
Abstract
AIMS To describe the demographics of patients with diabetic foot ulcers (DFU) and their impact on inpatient management. Secondary outcomes identified relationships of treatment modality with mortality, length of hospital admission, readmissions and post-admission care. METHODS Retrospective cohort study including patients with DFU admitted to a hospital network in Melbourne, Australia from 2016 to 2018. Medical records were manually reviewed for acute admission with DFU as a major presenting diagnosis; incidental ulcers and traumatic amputations were excluded. Amputations distal and proximal to the ankle were labelled 'minor' and 'major' respectively. Patients were followed until October 31, 2019. RESULTS Of 338 patients, 21 and 148 had major and minor amputations, and 169 were managed conservatively. 94% had ≥1 microvascular and/or macrovascular complication. Conservative management (7 days) was associated with a shorter length of stay (major 18, minor 10 days, p < 0.001). Readmission rates were not significantly different. Mortality was greatest (38%) and survival time shortest (999 days) after major amputation than after either other treatment. Other factors associated with mortality were age and a history of coronary artery disease. CONCLUSIONS Early identification and multi-disciplinary management of DFU is essential to reduce the significant morbidity and mortality associated with amputation in these complex patients.
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Affiliation(s)
- Luisa M Rosi
- Department of Endocrinology, Alfred Hospital, Melbourne 3004, Australia
| | - Annabel S Jones
- Department of Endocrinology, Alfred Hospital, Melbourne 3004, Australia
| | - Duncan J Topliss
- Department of Endocrinology, Alfred Hospital, Melbourne 3004, Australia; Department of Medicine (Alfred), Monash University, Melbourne 3004, Australia
| | - Leon A Bach
- Department of Endocrinology, Alfred Hospital, Melbourne 3004, Australia; Department of Medicine (Alfred), Monash University, Melbourne 3004, Australia.
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Kaneko M, Fujihara K, Harada MY, Osawa T, Yamamoto M, Kitazawa M, Matsubayashi Y, Yamada T, Seida H, Kodama S, Sone H. Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database. J Foot Ankle Res 2021; 14:29. [PMID: 33836779 PMCID: PMC8034178 DOI: 10.1186/s13047-021-00474-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/03/2021] [Indexed: 01/30/2023] Open
Abstract
Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00474-8.
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Affiliation(s)
- Masanori Kaneko
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan.
| | - Mayuko Yamada Harada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Taeko Osawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masahiko Yamamoto
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Masaru Kitazawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Yasuhiro Matsubayashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Takaho Yamada
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | | | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-754 Asahimachi, Niigata, Niigata, 951-8510, Japan
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Ghaziani AO, Soheilifard R, Kowsar S. The effect of functionally graded materials on bone remodeling around osseointegrated trans-femoral prostheses. J Mech Behav Biomed Mater 2021; 118:104426. [PMID: 33740685 DOI: 10.1016/j.jmbbm.2021.104426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Abstract
Osseointegrated trans-femoral fixations have been used as alternatives for conventional sockets in recent years. Despite numerous advantages, the dissimilarity of the mechanical properties between bone and implant has led to issues in periprosthetic bone adaptation. This study aims to address these issues by proposing fixations made of functionally graded materials (FGMs). The computational study of bone remodeling was performed by linking a bone remodeling algorithm to the finite element analysis. The 3D model of the femur was created by computerized tomography (CT) scan images, and a Titanium fixture, along with nine Titanium/Hydroxyapatite FGM fixtures, were modeled. The analyses revealed evident advantages for the FGM fixtures over the conventionally used Titanium fixtures. Furthermore, it was shown that the gradation direction considerably affects the bone adaptation procedure. The results showed that using a radial FGM with low-stiffness material in the outer layer and less metal composition significantly improves the bone remodeling behavior.
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Affiliation(s)
| | - Reza Soheilifard
- Department of Mechanical Engineering, Hakim Sabzevari University, Sabzevar, Iran.
| | - Sara Kowsar
- Department of Mechanical Engineering, Hakim Sabzevari University, Sabzevar, Iran
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29
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Schafer ZA, Vanicek N. A block randomised controlled trial investigating changes in postural control following a personalised 12-week exercise programme for individuals with lower limb amputation. Gait Posture 2021; 84:198-204. [PMID: 33360642 DOI: 10.1016/j.gaitpost.2020.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with a lower limb amputation (LLA) have an increased risk of falls and often report lower balance confidence. They must compensate for altered mechanics and prosthetic limitations in order to execute appropriate motor responses to postural perturbations. Personalised exercise could be an effective strategy to enhance balance and reduce falls. RESEARCH QUESTION In this study, we investigated whether a personalised exercise programme could improve postural control and self-reported balance confidence in individuals with an LLA. METHODS Participants were block randomised into two groups (exercise, n = 7; control, n = 7) based on age and level of amputation. The exercise group completed a 12-week personalised exercise programme, including home-based exercise sessions, consisting of balance, endurance, strength, and flexibility training. The control group continued with their normal daily activities. All participants performed the Sensory Organization Test (SOT) and Motor Control Test (MCT) on the NeuroCom SMART Equitest, and completed the Activities-specific Balance Confidence-UK (ABC) self-report questionnaire, at baseline and post-intervention. RESULTS AND SIGNIFICANCE Exercise group equilibrium scores improved significantly when standing on an unstable support surface with no visual input and inaccurate somatosensory feedback (SOT condition 5, P < 0.012, d = 1.45). There were significant group*time interactions for medium (P = 0.029) and large (P = 0.048) support surface forward translations, which were associated with a trend towards increased weight-bearing on the intact limb in the control group (medium: P = 0.055; large: P = 0.087). No significant changes in ABC score were observed. These results indicate reduced reliance on visual input, and/or enhanced interpretation of somatosensory input, following an exercise programme. However, objective improvements in aspects of postural control were not associated with subjective improvements in self-reported balance confidence. More weight-bearing asymmetry in the control group suggests that a lack of targeted exercise training may have detrimental effects, with potential adverse long-term musculoskeletal consequences, that were quantifiable within a short timeframe.
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Affiliation(s)
- Zoe A Schafer
- Department of Sport, Health and Exercise Science, University of Hull, Hull, HU6 7RX, United Kingdom
| | - Natalie Vanicek
- Department of Sport, Health and Exercise Science, University of Hull, Hull, HU6 7RX, United Kingdom.
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30
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Allen APT, Bolton WS, Jalloh MB, Halpin SJ, Jayne DG, Scott JDA. Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone - a multidisciplinary patient and service provider perspective. Disabil Rehabil 2020; 44:2392-2399. [PMID: 33261506 DOI: 10.1080/09638288.2020.1836043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018. MATERIALS AND METHODS A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11). RESULTS Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services. CONCLUSIONS A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery.Implications for RehabilitationComprehensive and accessible amputee rehabilitation services can enable people with amputations to regain their independence and aid their participation in their community and workplace.There are numerous barriers to both accessing and providing amputee rehabilitation services in the Western Area, Sierra Leone, chiefly financial. We recommend a revised effort by the Sierra Leonean government to implement the progressive policies on disability they have already adopted into law, which will aid the improvement of amputee rehabilitation services. New education and training programmes for all levels of prosthetic and orthotic professions are needed to secure the future of prosthetics and orthotics in Sierra Leone.
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Affiliation(s)
- Archie P T Allen
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - William S Bolton
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Mohamed B Jalloh
- Teaching Hospitals Complex, University of Sierra Leone, Freetown, Sierra Leone
| | - Stephen J Halpin
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
| | - David G Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Julian D A Scott
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds Vascular Institute, Leeds, UK
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Bumbaširević M, Lešić A, Palibrk T, Georgescu AV, Matei IR, Tabaković D, Matić S, Glišović Jovanović I, Petrović A, Manojlović R. Lower limb replantation: 27 years follow up. Injury 2020; 51 Suppl 4:S77-S80. [PMID: 32122628 DOI: 10.1016/j.injury.2020.02.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
Replantation of lower extremity is a very complex and difficult procedure. There are still a lot of controversies about indications, even numerous scoring systems are now available that can facilitate the surgeon's decision. We present the functional results of a replanted below-knee amputation in an elderly patient, 27 years after the injury and discuss the indication for replantation.
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Affiliation(s)
- Marko Bumbaširević
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia; SANU - Serbian Academy of Sciences and Arts, Serbia.
| | - Aleksandar Lešić
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tomislav Palibrk
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alexandru Valentin Georgescu
- Department of Plastic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu Cluj Napoca, Romania; Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Recovery, Cluj Napoca, Romania
| | - Ileana Rodica Matei
- Department of Plastic Surgery and Reconstructive Microsurgery, University of Medicine Iuliu Hatieganu Cluj Napoca, Romania; Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Hospital of Recovery, Cluj Napoca, Romania
| | - Dejan Tabaković
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Slađana Matić
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Aleksandra Petrović
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Radovan Manojlović
- Orthopedic and Traumatology University Clinic, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Gandhi SK, Waschbusch M, Michael M, Zhang M, Li X, Juhaeri J, Wu C. Age- and sex-specific incidence of non-traumatic lower limb amputation in patients with type 2 diabetes mellitus in a U.S. claims database. Diabetes Res Clin Pract 2020; 169:108452. [PMID: 32949656 DOI: 10.1016/j.diabres.2020.108452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023]
Abstract
AIM To estimate age- and sex-specific incidence rates (IRs) of non-traumatic lower limb amputations (LLA) in patients with type 2 diabetes mellitus (T2DM) using a claims database from the United States (US). METHODS Patients with T2DM 18 years and older were identified using the Truven Health MarketScan database from January 1, 2007 to September 30, 2018. The overall and age- and sex-specific IRs of all non-traumatic LLA, minor LLA (amputation at or below the ankle), and major LLA (amputation above ankle) were calculated. RESULTS Among the 6,117,981 patients with T2DM, 14,627 LLA events occurred (minor LLA; 72.8%; major LLA: 27.2%). The IRs (95% CI) of all LLA, minor LLA, and major LLA per 1000 person-years or PY were 0.86 (0.85, 0.88), 0.63 (0.62, 0.64), and 0.23 (0.23, 0.24), respectively. The IR (95% CI) of all LLA per 1000 PY in males was higher compared to females [1.24 (1.22, 1.26) vs. 0.46 (0.45, 0.48)]. The incidence of all LLA increased with an increasing age (highest IR in age-group of ≥80 years). CONCLUSIONS This study identified males and older patients with T2DM at higher risk of developing LLA in the US, warranting further exploration of risk factors of LLA in these subgroups.
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Affiliation(s)
- Sampada K Gandhi
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA.
| | - Max Waschbusch
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Madlen Michael
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Meng Zhang
- Global Pharmacovigilance, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Xinyu Li
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Juhaeri Juhaeri
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
| | - Chuntao Wu
- Epidemiology and Benefit Risk, Sanofi U.S., 55 Corporate Drive, Bridgewater, NJ 08807, USA
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Seth M, Hou W, Goyarts L, Galassi J, Lamberg E. Effect Of Transtibial Prosthesis Mass On Gait Asymmetries. Can Prosthet Orthot J 2020; 3:34609. [PMID: 37621951 PMCID: PMC10445795 DOI: 10.33137/cpoj.v3i2.34609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Individuals with transtibial amputation (TTA) typically walk with an asymmetrical gait pattern, which may predispose them to secondary complications and increase risk of fall. Gait asymmetry may be influenced by prosthesis mass. OBJECTIVES To explore the effects of prosthesis mass on temporal and limb loading asymmetry in people with TTA following seven days of acclimation and community use. METHODOLOGY Eight individuals with transtibial amputation participated. A counterbalanced repeated measures study, involving three sessions (each one week apart) was conducted, during which three load conditions were examined: no load, light load and heavy load. The light load and heavy load conditions were achieved by adding 30% and 50% of the mass difference between legs, at a proximal location on the prosthesis. Kinematic and ground reaction force data was captured while walking one week after the added mass. Symmetry indices between the prosthetic and intact side were computed for temporal (Stance and Swing time) and limb loading measures (vertical ground reaction force Peak and Impulse). FINDINGS Following seven days of acclimation, no significant differences were observed between the three mass conditions (no load, light load and heavy load) for temporal (Stance time: p=0.61; Swing time: p=0.13) and limb loading asymmetry (vertical ground reaction force Peak: p=0.95; vertical ground reaction force Impulse: p=0.55). CONCLUSIONS Prosthesis mass increase at a proximal location did not increase temporal and limb loading asymmetry during walking in individuals with TTA. Hence, mass increase subsequent to replacing proximally located prosthesis components may not increase gait asymmetry, thereby allowing more flexibility to the clinician for component selection.
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Affiliation(s)
- M. Seth
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
| | - W. Hou
- School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - L.R. Goyarts
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
| | - J.P. Galassi
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
| | - E.M. Lamberg
- School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA
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Koseki K, Yozu A, Takano H, Abe A, Yoshikawa K, Maezawa T, Kohno Y, Mutsuzaki H. Gait training using the Honda Walking Assist Device® for individuals with transfemoral amputation: A report of two cases. J Back Musculoskelet Rehabil 2020; 33:339-344. [PMID: 31929139 PMCID: PMC7175943 DOI: 10.3233/bmr-191726] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. OBJECTIVE This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. METHODS This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. RESULTS SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. CONCLUSIONS Gait training using the HWA was safe and effective for improving the gait of two TF amputees.
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Affiliation(s)
- Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan,Department of Rehabilitation, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan,Corresponding author: Arito Yozu, Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan. Tel.: +81 29 888 4000; Fax: +81 29 840 2418; E-mail:
| | - Hanako Takano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Atsushi Abe
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Takayuki Maezawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan,Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan,Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
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Bateni H. Postural Sway in Lower Extremity Amputees and Older Adults May Suggest Increased Fall Risk in Amputees. Can Prosthet Orthot J 2020; 3:33804. [PMID: 37614402 PMCID: PMC10443479 DOI: 10.33137/cpoj.v3i2.33804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/05/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Falls can be detrimental to overall health and quality of life for lower extremity amputees. Most previous studies of postural steadiness focus on quantification of time series variables extracted from postural sway signals. While it has been suggested that frequency domain variables can provide more valuable information, few current studies have evaluated postural sway in amputees using frequency domain variables. METHODOLOGY Participants were assigned to 3 groups: lower extremity amputation (n=6), healthy young adults (n=10), and healthy older adults (n=10). Standing barefoot on a force platform, each individual completed 3 trials of each of 3 standing conditions: eyes open, eyes closed, and standing on a foam balance pad. Time and frequency domain variables of postural sway were computed and analyzed. RESULTS Comparison of older adults, younger adults, and amputees on the three conditions of standing eyes open, eyes closed, and on foam revealed significant differences between groups. Mean mediolateral (ML) sway distance from the center of pressure (COP), total excursions and sway velocity was significantly higher for amputees and older adults when compared to young adults (p<0.05). Furthermore, power of sway signal was substantially lower for both amputees and older adults. When compared to that of older adults, postural steadiness of amputees was more affected by the eyes closed condition, whereas older adults' was more affected when sensory and proprioceptive information was perturbed by standing on foam. CONCLUSION Our findings showed that fall risk is greater in amputees than in young adults without amputation. Additionally, amputees may rely more heavily on visual information than proprioceptive information for balance, in contrast to older and young adults without amputation.
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Affiliation(s)
- H. Bateni
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, Illinois, USA
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Blakeley N, Silver-Thorn B, Cross J. Investigation of The Effects of Prosthetic Knee Condition for Individuals with Transfemoral Amputation During Attempted Running. Can Prosthet Orthot J 2020; 3:34481. [PMID: 37614405 PMCID: PMC10443485 DOI: 10.33137/cpoj.v3i2.34481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A number of individuals with unilateral transfemoral amputation (TFA) run in a prosthesis with an unlocked prosthetic knee, while others choose to run with a locked prosthetic knee to increase stability. Research regarding running with an unlocked knee (UK) versus a locked knee (LK), with respect to energy efficiency, is limited and might be enhanced by characterization of the impact of knee condition on kinematics. OBJECTIVES To investigate the effect of an UK versus LK on hip kinematics, energy efficiency, and running speed. METHODOLOGY Five male novice runners with unilateral TFA completed one three-minute self-selected running speed (SSRS) trial and three peak speed trials per knee condition. Hip kinematics, energy efficiency, and running speed were compared between conditions. FINDINGS Four of the five subjects exhibited a fast walk, rather than a consistent run. Hip flexion increased for all subjects and hip abduction decreased for four subjects during swing phase for the UK condition. Hip kinematic asymmetry was reduced for the UK condition in the sagittal plane for four individuals; hip kinematic asymmetry was also reduced in the frontal plane for the UK condition for three of these individuals. Mean energy efficiency was better for the UK condition (UK: 0.282 mLO2/kg/m, LK: 0.328 mLO2/kg/m). Peak running speed did not differ significantly between knee conditions (UK: 1.47m/s, LK:1.32m/s). CONCLUSIONS For novice recreational runners with unilateral transfemoral amputation, the UK condition resulted in improved energy efficiency and enhanced kinematic symmetry, despite comparable peak speed relative to the LK condition. Therefore the UK condition may be advantageous for mid-range distance running.
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Affiliation(s)
- N. Blakeley
- Department of Biomedical Engineering, Marquette University, Milwaukee, USA
| | - B. Silver-Thorn
- Department of Biomedical Engineering, Marquette University, Milwaukee, USA
| | - J.A. Cross
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, USA
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Castiglia SF, Ranavolo A, Varrecchia T, De Marchis C, Tatarelli A, Magnifica F, Fiori L, Conte C, Draicchio F, Conforto S, Serrao M. Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation. Gait Posture 2020; 80:280-284. [PMID: 32563728 DOI: 10.1016/j.gaitpost.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking. RESEARCH QUESTION This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis. METHODS The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis. RESULTS Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls. SIGNIFICANCE Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Fabrizio Magnifica
- Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy; Italian Air Force Aerospace Medicine Department, Diagnostic Therapeutic and Rehabilitative Aeromedical Center, via Piero Gobetti 2, 00185, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121, Milan, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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Dakhil N, Tarrade T, Behr M, Mo F, Evin M, Thefenne L, Liu T, Llari M. Influence of the scale reduction in designing sockets for trans-tibial amputees. Proc Inst Mech Eng H 2020; 234:761-768. [PMID: 32475295 DOI: 10.1177/0954411920921648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of artificial prosthetic lower limbs aims to improve patient's mobility while avoiding secondary problems resulting from the use of the prostheses themselves. The residual limb is a pressure-sensitive area where skin injuries and pain are more likely to develop. Requirements for adequate prosthetic limbs have now become urgent to improve amputee's quality of life. This study aims to understand how socket design parameters related to geometry can influence pressure distribution in the residual limb. A finite element model was developed to simulate the mechanical loading applied on the residual limb of a below-knee amputee while walking. A sensitivity analysis to socket initial geometry, scaling the socket downward in the horizontal plane, was performed. Recordings include stress levels on the skin and in the residual limb deep soft tissues. Peak stress was reduced by up to 51% with a limited reduction of the socket size. More important scale reduction of the residual limb would lead to possible negative effects, such as stress concentrations in sensitive areas. This result confirms the interest of the prosthetist to develop a well-fitting socket, possibly a little smaller than the residual limb itself, in order to avoid residual limb mobility in the socket that could cause friction and stress concentrations. Non-homogeneous geometrical reductions of the socket should be further investigated.
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Affiliation(s)
- Nawfal Dakhil
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Technical Institute of Dewaniya, Al-Furat Al-Awsat Technical University, Kufa, Iraq
| | - Tristan Tarrade
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Michel Behr
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Fuhao Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, China
| | - Morgane Evin
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | - Laurent Thefenne
- Service de Médecine Physique et Réadaptation, Hôpital Laveran, Marseille, France
| | - Tang Liu
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Maxime Llari
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
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Fournet B, Falchetti A, Roques F, Gaillard G, Inamo J, Blanchet-Deverly A. Epidemiology of the vascular assessment and correlation of the WIfI Classification in lower limb amputee patients at Martinique university hospital in 2018. J Med Vasc 2020; 45:114-124. [PMID: 32402425 DOI: 10.1016/j.jdmv.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.
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Affiliation(s)
- B Fournet
- Vascular surgery and medicine department, CHU, Pierre Zobda-Quitman hospital, CS 90632, 97261 Fort-de-France cedex, Martinique.
| | - A Falchetti
- Vascular surgery and medicine department, CHU, Pierre Zobda-Quitman hospital, CS 90632, 97261 Fort-de-France cedex, Martinique.
| | - F Roques
- Vascular surgery and medicine department, CHU, Pierre Zobda-Quitman hospital, CS 90632, 97261 Fort-de-France cedex, Martinique.
| | - G Gaillard
- Vascular surgery and medicine department, CHU, Pierre Zobda-Quitman hospital, CS 90632, 97261 Fort-de-France cedex, Martinique.
| | - J Inamo
- Service de chirurgie et médecine vasculaire, CHU, Hôpital Pierre Zobda-Quitman, CS 90632, 97261 Fort-de-France cedex, France.
| | - A Blanchet-Deverly
- Vascular medicine department, University Hopital Center of Guadeloupe, Chauvel street, Les Abymes, Guadeloupe.
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Young M, McKay C, Williams S, Rouse P, Bilzon JLJ. Time-related changes in quality of life in persons with lower limb amputation or spinal cord injury: protocol for a systematic review. Syst Rev 2019; 8:191. [PMID: 31370881 PMCID: PMC6676595 DOI: 10.1186/s13643-019-1108-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/22/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Experiencing a lower limb amputation (LLA) or spinal cord injury (SCI) is a life-changing event, affecting physical and systemic function as well as having psychological and social impacts. However, the severity of the physical impairment and/or motor disability demonstrates a poor relationship with patient-reported quality of life, suggesting that other factors determine such outcomes. As such, holistic health-related quality of life (QoL) assessment is an important tool to monitor long-term outcomes. While there are some studies that have assessed the influence of variables such as age at time of injury occurrence and time since injury on changes in QoL, there are no systematic reviews which synthesise this evidence. METHODS/DESIGN All follow-up study designs will be included, where data from multiple time points are presented. Searches will target both SCI and LLA populations where a validated measure of QoL has been used: Medical Outcome Study Short-Form 36/12 or the World Health Organization Quality of Life instruments 100 and BREF. Studies must include adult participants (≥ 18 years at time of injury) and detail time since injury event and patient age. The primary objective is to establish the effects of participant age and time since injury on QoL scores. Secondary objectives include determining between-group effects (i.e. LLA vs. SCI). We will search PubMed, Embase and Web of Science databases, supplemented by hand-searching references within existing review articles and experimental studies. Reviewer pairs will conduct screening and quality assessment of included papers. Results will be stratified by impairment, QoL tool, age/time since injury and additional variables such as sex, race, comorbidity or disease aetiology, as appropriate. If sufficient high-quality data exist, a meta-analysis will be conducted. DISCUSSION The results of this systematic review will summarise evidence of how QoL changes across the life course, relative to both patient age and time since injury, for both LLA and SCI populations. By enabling a direct comparison of different chronic conditions, disability-specific differences in QoL changes over the life course can be identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018096633 .
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Affiliation(s)
- Matthew Young
- Department for Health, University of Bath, Bath, BA2 7AY UK
| | - Carly McKay
- Department for Health, University of Bath, Bath, BA2 7AY UK
| | - Sean Williams
- Department for Health, University of Bath, Bath, BA2 7AY UK
| | - Peter Rouse
- Department for Health, University of Bath, Bath, BA2 7AY UK
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Beausoleil S, Miramand L, Turcot K. Evolution of gait parameters in individuals with a lower-limb amputation during a six-minute walk test. Gait Posture 2019; 72:40-45. [PMID: 31136941 DOI: 10.1016/j.gaitpost.2019.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A recent amputation leads to decreased functional capacities in the lower limb amputees (LLA), especially during walking. Assessments of LLA's gait in clinical settings are used to provide feedback on their evolution without quantifying gait parameters distinctly, unlike new technologies, such as inertial sensors (IMUs), which have demonstrated their effectiveness in different environments and populations. RESEARCH QUESTION How do the spatial-temporal gait parameters and kinematics of the LLA evolve quantitatively over a six-minute walk test (6MWT) and is the use of inertial sensors relevant in clinical practice to quantify those parameters? METHODS Fifteen LLA from a study cohort performed a 6MWT post-rehabilitation, wearing inertial sensors on both feet to provide gait parameters (i.e., minimum toe clearance (minTC), speed, cadence, stance time and foot flat ratio (FFr)) over this test. A non-parametric ANOVA was conducted comparing the evolution of each parameter over the 6MWT (12 intervals of 30 s). Significance level was set at P ≤ 0.05. Post-hoc Wilcoxon signed-rank tests were performed if a main effect was detected. RESULTS MinTC and stance phase variability along the 6MWT were significantly different over time. Cadence variability and speed variation were significantly different between both feet (amputated and non-amputated leg). SIGNIFICANCE The increased variability in gait parameters along the 6MWT suggests a greater risk of future mobility problems following a return in community. The data provided by the IMUs reflect the potential of the clinical rehabilitation programme and could, therefore, help clinicians to refine their interventions.
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Affiliation(s)
- Sarah Beausoleil
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Ludovic Miramand
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada
| | - Katia Turcot
- Faculty of medicine, Department of Kinesiology, Laval University, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada.
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Potier L, Roussel R, Velho G, Saulnier PJ, Bumbu A, Matar O, Schneider F, Ragot S, Marre M, Mohammedi K, Hadjadj S. Lower limb events in individuals with type 2 diabetes: evidence for an increased risk associated with diuretic use. Diabetologia 2019; 62:939-947. [PMID: 30809716 DOI: 10.1007/s00125-019-4835-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/29/2019] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS Recently, safety data signalled an increased risk of amputations in people taking canagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor. If this side effect is due to drug-induced hypovolaemia, diuretics should also increase that risk. The aim of this study was to analyse the association between diuretic use and the risk of lower limb events (LLEs) in people with type 2 diabetes. METHODS SURDIAGENE (SUivi Rénal, DIAbète de type 2 et GENEtique) is a prospective observational cohort that includes people with type 2 diabetes enrolled from 2002 to 2012 and followed-up until onset of LLE, death or 31 December 2015, whichever came first. Primary outcome was the first occurrence of LLE, a composite of lower limb amputation (LLA) and lower limb revascularisation (LLR). The rates of primary outcome were compared between participants taking and not taking diuretics at baseline in a Cox-adjusted model. RESULTS At baseline, of the 1459 participants included, 670 were taking diuretics. In participants with and without diuretics, the mean ages were 67.1 and 62.9 years and 55.8% and 59.8% were men, respectively. During a median follow-up of 7.1 years, the incidence of LLE was 1.80 per 100 patient-years in diuretic users vs 1.00 in non-users (p < 0.001). The HR for LLE in users vs non-users was 2.08 (95% CI 1.49, 2.93), p < 0.001. This association remained significant in a multivariable-adjusted model (1.49 [1.01, 2.19]; p = 0.04) and similar after considering death as a competing risk (subhazard ratio 1.89 [1.35, 2.64]; p < 0.001). When separated, LLA but not LLR, was associated with the use of diuretics: 2.01 (1.14, 3.54), p = 0.02 and 1.05 (0.67, 1.64), p = 0.84, respectively, in the multivariable-adjusted model. CONCLUSIONS/INTERPRETATION Among people with type 2 diabetes treated with diuretics, there was a significant increase in the risk of LLE, predominantly in the risk of LLA.
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Affiliation(s)
- Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, DHU FIRE, 46 rue Henri Huchard 75877, Paris Cedex 18, France.
- UFR de Médecine, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France.
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, DHU FIRE, 46 rue Henri Huchard 75877, Paris Cedex 18, France
- UFR de Médecine, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
| | - Pierre-Jean Saulnier
- CIC1402, INSERM, Poitiers, France
- UFR de Médecine et Pharmacie, Poitiers University, Poitiers, France
- Clinical Investigation Centre, CHU de Poitiers, Poitiers, France
| | - Anisoara Bumbu
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, DHU FIRE, 46 rue Henri Huchard 75877, Paris Cedex 18, France
| | - Odette Matar
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, DHU FIRE, 46 rue Henri Huchard 75877, Paris Cedex 18, France
| | - Fabrice Schneider
- CIC1402, INSERM, Poitiers, France
- UFR de Médecine et Pharmacie, Poitiers University, Poitiers, France
- Clinical Investigation Centre, CHU de Poitiers, Poitiers, France
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Stéphanie Ragot
- CIC1402, INSERM, Poitiers, France
- UFR de Médecine et Pharmacie, Poitiers University, Poitiers, France
- Clinical Investigation Centre, CHU de Poitiers, Poitiers, France
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, DHU FIRE, 46 rue Henri Huchard 75877, Paris Cedex 18, France
- UFR de Médecine, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, Paris, France
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Kamel Mohammedi
- Department of Diabetology, Endocrinology and Nutrition, Hôpital Haut-Lévêque, Bordeaux, France
- Bordeaux University, Bordeaux, France
- Inserm U1219 'Bordeaux Population Health', Bordeaux, France
| | - Samy Hadjadj
- Institut du Thorax, Inserm, CNRS, CHU Nantes, Nantes, France
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Sarfo-Kantanka O, Sarfo FS, Kyei I, Agyemang C, Mbanya JC. Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010-2015- a retrospective cohort study. BMC Endocr Disord 2019; 19:27. [PMID: 30823912 PMCID: PMC6397489 DOI: 10.1186/s12902-019-0353-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 02/21/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana. METHODS This was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA. RESULTS The mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84-5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21-2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22-12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06-1.22, p < 0.001), male gender (HR: 3.50, CI:2.88-5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58-10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51-7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05-1.25, p = 0.03), hypertension (HR:1.14, CI:1.12-3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21-8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39-9.53, p < 0.001). CONCLUSION The study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O Box 1934, Kumasi, Ghana
| | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O Box 1934, Kumasi, Ghana
- Department of Medicine, Komfo Anokye Teaching Hospital/ School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ishmael Kyei
- Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O Box 1934, Kumasi, Ghana
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jean Claude Mbanya
- Faculty of Medicine and Department of Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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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: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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 19.8% in 2005 to 17.4% 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. Electronic supplementary material The online version of this article (10.1186/s12913-018-3759-5) contains supplementary material, which is available to authorized users.
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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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Chigblo P, Tidjani IF, Alagnidé E, Lawson E, Madougou S, Agbessi O, Hans-Moevi Akué A. Outcomes of lower limb amputees at Cotonou. J Clin Orthop Trauma 2019; 10:191-4. [PMID: 30705558 DOI: 10.1016/j.jcot.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice. METHODS This prospective analytical study over 7 years (January 2009-December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation. Statistical analysis was performed with Chi2 and Mann-Whitney tests; a p-value ≤ 0.05 was considered statistically significant. RESULTS The average Timed Up and Go Test was 18.5 s. Class II of Pohjolainen subjects were the most recovered (37%). The mean Houghton score in the 17 fitted patients was 6.2 ± 2.0. Socially, 90% of the patients no longer practiced leisure activities, and 4/53 patients were no longer in a couple. At the economic level, 87% of patients had a decreased monthly income. Factors that bear direct correlation to functional outcome of patients were the level of amputation, and the prosthesis fitting. CONCLUSION Lower limbs amputations entail adverse consequences at the functional and socio-economic level. Our country must review its policy on prosthetic fittings for amputees, and vote laws that involve private firms and government in socio-economic reintegration, and empowerment of these subjects.
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Fujishita H, Urabe Y, Maeda N, Komiya M, Sakai S, Hirata K, Sakamitsu T, Kimura H. Biomechanics of single-leg running using lofstrand crutches in amputee soccer. J Phys Ther Sci 2018; 30:1483-1487. [PMID: 30568340 PMCID: PMC6279695 DOI: 10.1589/jpts.30.1483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/27/2018] [Indexed: 11/25/2022] Open
Abstract
[Purpose] Amputee soccer is a game for individuals with amputations. Players use
lofstrand crutches to move around the field and kick the ball. Scoring quick goals during
a match requires players to have maximum running skills. Notably, a few parameters affect
the running speed in players; however, no study has reported the biomechanical analysis of
running in amputee soccer. Thus study aimed to analyze the biomechanics of single-leg
running using lofstrand crutches in 12 healthy adult males (6 with prior amputee soccer
experience and 6 without such experience). [Participants and Methods] The kinematics of
the lower limb and the pelvis, the ground reaction force, and skill in using the crutches
were evaluated using 3 dimensional motion analysis combined with 8 force plates. Lower leg
amputation was simulated in all participants by maintaining the non-dominant knee in a
position of maximum flexion using an elastic band. [Results] Significant differences were
observed between experienced and non-experienced participants with regard to the angle of
the pelvis and the crutch stance phase. Specifically, higher running speed was associated
with an increased forward tilt of the pelvis and a shorter crutch stance phase.
[Conclusion] These findings will be useful to improve the running speed of amputee soccer
players.
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Affiliation(s)
- Hironori Fujishita
- Graduated School of Biomedicine and Health Sciences, Hiroshima University: 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8527, Japan.,Sports Medical Center, Hiroshima University Hospital, Japan
| | - Yukio Urabe
- Graduated School of Biomedicine and Health Sciences, Hiroshima University: 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8527, Japan
| | - Noriaki Maeda
- Graduated School of Biomedicine and Health Sciences, Hiroshima University: 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8527, Japan
| | - Makoto Komiya
- Graduated School of Biomedicine and Health Sciences, Hiroshima University: 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8527, Japan
| | - Shogo Sakai
- Graduated School of Biomedicine and Health Sciences, Hiroshima University: 1-4-1 Kagamiyama, Higashi-hiroshima, Hiroshima 739-8527, Japan
| | | | | | - Hiroaki Kimura
- Division of Rehabilitation Medicine, Hiroshima University Hospital, Japan
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Clemens SM, Klute GK, Kirk-Sanchez NJ, Raya MA, Kim KJ, Gaunaurd IA, Gailey RS. Temporal-Spatial Values During a 180° Step Turn in People with Unilateral Lower Limb Amputation. Gait Posture 2018; 63:276-281. [PMID: 29803146 DOI: 10.1016/j.gaitpost.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Daily ambulation with a prosthesis often involves turning to negotiate within the home and community environments, however how people with lower limb loss perform turns is infrequently studied. Administering a common clinical outcome measure to capture turn performance data provides a convenient means of assessing this ubiquitous activity. RESEARCH QUESTION What temporal-spatial parameters are exhibited by people with unilateral lower limb amputation while performing a 180˚ turn task? METHODS Forty community-ambulating subjects with unilateral lower limb amputation (20 transtibial amputees, 20 transfemoral amputees) performed the Component Timed-Up-and-Go (cTUG) test turning once in each direction, both toward the intact and toward the prosthetic limb. An instrumented walkway captured temporal-spatial parameters during performance of the 180˚ turn task of the cTUG, while a custom iPad application recorded time and number of steps to perform the turn. Comparisons between turn direction and level of amputation during the cTUG and temporal-spatial results were assessed. RESULTS People with lower limb amputation spent more time on their intact limb while turning than their prosthetic limb regardless of the position of the intact limb, and those with transfemoral amputation spent significantly more time over the intact limb than those with transtibial amputation. Additionally, subjects with transfemoral amputation performed the turn significantly faster when turning with an inner intact limb. SIGNIFICANCE Amputees use different movement strategies with altered temporal-spatial characteristics to turn depending on the direction of the turn and the level of amputation. Clinical use of the cTUG could provide evidence supporting prosthetic prescription practice and introduction of novel physical therapy interventions for individuals with lower limb amputation.
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Affiliation(s)
- Sheila M Clemens
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States; Research Department, Miami VA Healthcare System, Miami, FL, United States.
| | - Glenn K Klute
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States; Rehabilitation Research and Development, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Neva J Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Michele A Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Kyoung Jae Kim
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Ignacio A Gaunaurd
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States; Research Department, Miami VA Healthcare System, Miami, FL, United States
| | - Robert S Gailey
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL, United States; Research Department, Miami VA Healthcare System, Miami, FL, United States
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Davie-Smith F, Coulter E, Kennon B, Wyke S, Paul L. Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: A systematic review of the literature. Prosthet Orthot Int 2017; 41:537-547. [PMID: 28147898 DOI: 10.1177/0309364617690394] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The majority of lower limb amputations are undertaken in people with peripheral arterial occlusive disease, and approximately 50% have diabetes. Quality of life is an important outcome in lower limb amputations; little is known about what influences it, and therefore how to improve it. OBJECTIVES The aim of this systematic review was to identify the factors that influence quality of life after lower limb amputation for peripheral arterial occlusive disease. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science and Cochrane databases were searched to identify articles that quantitatively measured quality of life in those with a lower limb amputation for peripheral arterial occlusive disease. Articles were quality assessed by two assessors, evidence tables summarised each article and a narrative synthesis was performed. STUDY DESIGN Systematic review. RESULTS Twelve articles were included. Study designs and outcome measures used varied. Quality assessment scores ranged from 36% to 92%. The ability to walk successfully with a prosthesis had the greatest positive impact on quality of life. A trans-femoral amputation was negatively associated with quality of life due to increased difficulty in walking with a prosthesis. Other factors such as older age, being male, longer time since amputation, level of social support and presence of diabetes also negatively affected quality of life. CONCLUSION Being able to walk with a prosthesis is of primary importance to improve quality of life for people with lower limb amputation due to peripheral arterial occlusive disease. To further understand and improve the quality of life of this population, there is a need for more prospective longitudinal studies, with a standardised outcome measure. Clinical relevance This is of clinical relevance to those who are involved in the rehabilitation of persons with lower limb amputations. Improved quality of life is associated with successful prosthetic use and focus should be directed toward achieving this.
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Affiliation(s)
| | | | - Brian Kennon
- 2 Queen Elizabeth University Hospital, Diabetes Centre, NHSGGC, Glasgow, UK
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Abstract
BACKGROUND In all, 68% of all lower limb amputees experience residual limb pain. More than 95% of all lower limb amputations in developed countries are due to peripheral artery occlusive disease in combination with diabetes mellitus. Therefore, claudication, which is one of the most common manifestations of peripheral artery occlusive disease, should be taken into consideration in making a differential diagnosis of residual limb pain. Case description and methods: We present a case study of a 60-year-old diabetic patient who underwent a transfemoral amputation due to peripheral artery occlusive disease and who experiences residual limb pain. A computed tomography angiography was performed, and we searched for relevant literature on claudication pain after lower limb amputation. CONCLUSION Little research has explored claudication as a cause of residual limb pain. More research will lead to a decrease in unnecessary prosthetic fittings and adjustments give more insight into the treatment and management of residual limb pain and prevent a decrease in mobility in amputees. Clinical relevance Claudication due to peripheral artery occlusive disease should be included as a possible cause of residual limb pain to prevent unnecessary prosthetic fittings and adjustments and to minimize psychological effects and limitations in activities and participation.
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Affiliation(s)
| | | | - Bert Kap
- 2 Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands
| | - Jan Hb Geertzen
- 3 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Adamczyk PG, Roland M, Hahn ME. Sensitivity of biomechanical outcomes to independent variations of hindfoot and forefoot stiffness in foot prostheses. Hum Mov Sci 2017; 54:154-171. [PMID: 28499159 PMCID: PMC6284521 DOI: 10.1016/j.humov.2017.04.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Many studies have reported the effects of different foot prostheses on gait, but most results cannot be generalized because the prostheses' properties are seldom reported. We varied hindfoot and forefoot stiffness in an experimental foot prosthesis, in increments of 15N/mm, and tested the parametric effects of these variations on treadmill walking in unilateral transtibial amputees, at speeds from 0.7 to 1.5m/s. We computed outcomes such as prosthesis energy return, center of mass (COM) mechanics, ground reaction forces, and joint mechanics, and computed their sensitivity to component stiffness. A stiffer hindfoot led to reduced prosthesis energy return, increased ground reaction force (GRF) loading rate, and greater stance-phase knee flexion and knee extensor moment. A stiffer forefoot resulted in reduced prosthetic-side ankle push-off and COM push-off work, and increased knee extension and knee flexor moment in late stance. The sensitivity parameters obtained from these tests may be useful in clinical prescription and further research into compensatory mechanisms of joint function.
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Affiliation(s)
- Peter Gabriel Adamczyk
- Intelligent Prosthetic Systems, LLC, Madison, WI, USA; The University of Michigan, Ann Arbor, MI, USA.
| | - Michelle Roland
- The University of Oregon, Eugene, OR, USA; Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, U.S. Dept. of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Michael E Hahn
- The University of Oregon, Eugene, OR, USA; Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, U.S. Dept. of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
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