Prosthetics and Orthotics International最新文献

Background: Current processes for identifying the best microprocessor-controlled prosthetic knee (MPK) for individuals with transfemoral amputations are subjective, nonscientific, and sometimes fail to consider unique patient needs. Inaccurate prescriptions may hinder a patient's ability to make a speedy rehab.

Objectives: We developed a clinical decision equation that outputs MPK recommendation scores for 3 commercially available MPKs (Power Knee, C-Leg 4.0, Rheo Knee) based on easily acquirable user evaluation data.

Study design: Participants wore each of the study MPKs at home for a 1-week acclimation period. On the experiment day, participants completed a set of functional tasks including a 10-m walk test, stair and ramp ambulation tasks, a 2-minute walk test, and a narrow beam walking test. Performance outcome measures were collected.

Methods: Microprocessor-controlled prosthetic knees were scored relatively to the best performing knee based on their performance in 5 areas of interest: agility, community ambulation, energy, stability, and gait quality. The relative importance of each of these areas was computed based on a quantitative prediction of a user's functional needs from features including age, body mass index (BMI), AMPnoPRO score, and likelihood of stairs/ramps. We describe the algorithm-suggested optimal patient profiles for each device.

Results: We developed an application that allows clinicians to obtain instant recommendations. Clinicians can further adjust the relative importance of each area of interest based on patient needs.

Conclusions: This algorithm represents a transparent, experimentally backed clinical decision-making aid with the potential to streamline the prosthesis fitting process. Future studies are required to evaluate the effectiveness of the algorithm.

Background: Successful prosthetic socket fitting contributes to prosthesis user satisfaction and facilitates rehabilitation, but is often challenging to achieve and maintain. There is a lack of information available that explores firsthand experiences of prosthetic users throughout socket fitting sessions and, in particular, their preferences regarding information exchange between them and their prosthetist.

Objectives: Assess satisfaction with prosthetic service, confidence in clinical judgement, and confidence providing feedback to prosthetists, examine experiences of prosthesis users in providing feedback to prosthetists and identify the types of information that prosthesis users want to communicate to their prosthetist, as well receive before, during, and after the socket fitting process.

Study design: Mixed-method (quantitative and qualitative) survey.

Methods: A questionnaire was designed and administered in consultation with Amputees NSW (an amputee community support group) and distributed through their membership database. Quantitative items with discrete or scale-based responses were analyzed using descriptive, nonparametric methods and described satisfaction and confidence during prosthetic fitting. A thematic analysis was performed on qualitative responses to explore prosthesis user experiences of information exchange before, during, and after socket fitting.

Results: There were 24 survey responses. Ninety-six percentage of respondents were satisfied with their prosthetic service and were confident in their prosthetists' clinical judgement as well as ensuring socket comfort for their client. Most prosthesis users felt comfortable to provide feedback to their prosthetist (median =100 [interquartile range = 20], where 0 = not at all confident and 100 = completely confident). Experiences in providing input on comfort and fitting fell under 4 interrelated themes: collaboration, frustrations with process, impacts of poor fit, and prosthetic fit. Experiences with exchanging information with their prosthetist before, during, and after socket fitting fell under a further 4 themes: process-based information and provision options, taking history and treatment planning, collaboration and communication, and functional concerns.

Conclusions: Prosthesis users' confidence to provide feedback and satisfaction with prosthetic services could be helped by ensuring a responsive working relationship, facilitating information exchange between the prosthetist and prosthesis user, as well as improved prosthesis user education on the socket fit process.

Objectives: The aim of the current study is to translate the original prosthetic limb users survey of mobility (PLUS-M) instrument to Norwegian, investigate its psychometric properties, and conduct a survey on mobility in Norwegian lower limb prosthetic users (LLPU).

Methods: The Functional Assessment of Chronic Illness Therapy methodology was followed for translation and cross-cultural validation. After translation, invitations to participate in a survey was sent from prosthetic and orthotic clinics in Norway to registered LLPU. Of 1279 invitations, 454 people with unilateral lower limb amputation (age, 62.6 ± 14.4 years) were included in the study. Known-groups construct validity was investigated by comparing the T-scores of men vs. women, transtibial vs. transfemoral amputation, vascular vs. nonvascular etiology, and younger vs. older persons.

Results: The overall PLUS-M T-score (mean ± SD) was 53.2 ± 11.1. Men (n = 318) had better mobility than women (n = 137), with T-scores of 54.7 ± 10.4 and 49.6 ± 12.4, respectively (P < 0.0005). All hypotheses about assumed differences in T-scores between known-groups were confirmed (all comparisons; P < 0.0005). Internal consistency (Cronbach α, 0.962) and test-retest reliability (intraclass correlation coefficient 0.936, 95% confidence interval, 0.871-0.968) were excellent. Standard error of measurement was 2.02, and minimal detectable change (95% CI) was 5.59. Furthermore, floor and ceiling effect was 1.8% and 10.9%, respectively.

Conclusion: The Norwegian version of the PLUS-M 12-item short form is valid and has excellent reproducibility and psychometric properties. The overall T-score for the Norwegian LLPU is marginally higher compared to the mean ± SD T-score (50 ± 10) of the original development sample (N = 1091).

Background: The reliability of Dutch questionnaires assessing performance of activities of daily living (ADL) has not been established in chronic hand orthotic users.

Objective: To examine the reliability of the custom short form of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System-Upper Extremity (DF-PROMIS-UE) and the Michigan Hand Questionnaire Dutch language version (MHQ-DLV) in chronic hand orthotic users and evaluate the correlation between the DF-PROMIS-UE and MHQ-DLV ADL domain.

Methods: Seventy-four chronic hand orthotic users (mean [SD] age 60.5 [10.71] years, 60 female) completed the DF-PROMIS-UE and MHQ-DLV twice. Reliability was assessed as internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient), and agreement (95% limits of agreement, standard error of measurement, smallest detectable change). Furthermore, the Pearson correlation coefficient were determined.

Results: Cronbach's α for both ADL questionnaires was ≥0.90. The intraclass correlation coefficient was 0.88 (95% confidence interval [CI], 0.82-0.93) for the DF-PROMIS-UE and 0.81 (95% CI, 0.72-0.88) for the MHQ-DLV ADL domain. The limits of agreement were narrower for the DF-PROMIS-UE (-4.43 to 5.85) than for the MHQ-DLV ADL domain (-27.4 to 26.4). The standard error of measurement and smallest detectable change for the DF-PROMIS-UE were 1.91 and 5.29 points and for MHQ-DLV ADL domain 9.65 and 26.8 points, respectively. The correlation between the ADL questionnaires was 0.83 (95% CI, 0.75 to 0.89).

Conclusions: Although the DF-PROMIS-UE and MHQ-DLV ADL domain were highly correlated and showed good internal consistency, the DF-PROMIS-UE showed better test-retest reliability and lower measurement error than the MHQ-DLV ADL domain in chronic hand orthotic users.

Background: Racial health disparities are well documented in the United States. Implicit and explicit racial preferences can negatively affect patient-clinician communication and relationships and contribute to racial health disparities.

Objectives: To examine the implicit and explicit racial attitudes in orthotics and prosthetics.

Study design: Cross-sectional survey.

Methods: An online survey including the Race Attitudes Implicit Association Test was administered to a volunteer sample of clinicians, residents, students, and educators. Survey questions related to demographics, roles within orthotics and prosthetics, explicit racial preferences, and implicit racial bias. Implicit racial bias scores and group means were calculated. Group-level comparisons were made by role, gender, and race/ethnicity. Results were categorized using the 2-dimensional model of prejudice of Son Hing et al.

Results: The survey was completed by 454 participants (clinicians/residents: 294; students: 136; and educators: 24). Most participants reported no explicit racial preference; however, implicit racial preference was similar to that of the general US population. The majority of participants were aversive racists (low explicit, high implicit; pro-White n = 201; pro-Black n = 29), with the next largest group being truly low prejudice (low explicit, low implicit; n = 206). Implicit racial bias was lowest among Black individuals with slight preference for Black people on average.

Conclusion: Implicit racial bias in the orthotic and prosthetic community is similar to the general US population and does not differ by role. Efforts to elucidate, examine, and interrupt implicit racial bias are needed in orthotics and prosthetics to prevent common racial attitudes from negatively influencing patient outcomes.

Background: Wearing a prosthesis is one of the main ways for amputees to regain their mobility and reintegrate into society. Traditional prosthetic socket fabrication consists of many different stages and is difficult to quantify. More and more prosthetists are using CAD/CAM technology in the design and manufacture of sockets.

Objectives: The purpose of this study was to propose a method for designing the socket based on the soft tissue thickness of the stump.

Methods: The sockets with different parameters were designed based on soft tissue thickness, and the subjects were subjected to pressure test and walking test after wearing 3D-printed sockets and traditional manual sockets for 6 weeks, respectively.

Results: The pressures of the designed socket at the end of the tibia and the fibula head region as well as the maximum pressure at the stump/socket interface were significantly lower than those of the traditional socket. The results of a 2-minute walk test and socket comfort score showed a significant difference in walking ability and comfort when subjects wore different sockets.

Conclusion: The 3D-printed socket can meet the daily needs of amputees. Existing methods may be superior to traditional manufacturing methods for data storage and modification.

Orthoses are essential in managing musculoskeletal conditions, but factors influencing patient satisfaction and adherence are less known. This review seeks to address this gap. Online databases (CINAHL, Embase, Scopus, PubMed, Cochrane Reviews, Web of Science, and Google Scholar) were searched without time limitation till 2024. Studies were included if they addressed hand orthoses satisfaction and adherence. Data were extracted on factors affecting satisfaction and adherence related to hand orthoses. A thematic analysis approach was employed to develop and refine a comprehensive informal checklist through expert panel consultation. After eligibility screening, we included 20 papers published between 2000 and 2023. The review identified vital orthoses-related factors for custom-made orthoses, such as comfort, durability, and fit. For 3D-printed orthoses, factors like precision, printing efficiency, and safety were highlighted, affecting adherence to orthoses use. In addition, expert consultations contributed significantly, adding factors such as initial strength and surface smoothness for custom-made orthoses, ease of readjusting, design freedom, and environmental impact for 3D-printed orthoses. Two final checklists for patients and therapists were developed based on all extracted factors, which furthered our understanding of factors influencing orthoses adherence. This review highlights the significant orthoses-related factors impacting patient satisfaction and adherence. The derived checklists are beneficial tools for therapists and patients to ensure orthoses adherence, aiming for improved therapeutic results.

Background: Prosthetic care is limited in low- and middle-income countries. Finding solutions to improve prosthetic accessibility is commendable, and 3D printing presents a potential solution.

Objectives: To evaluate the durability and usage of 3D-printed transtibial prosthetic sockets, as well as to assess the impact of these prostheses on participants' functioning and health-related quality of life (HRQoL).

Study design: A longitudinal cohort study with 2.5 year follow-up.

Method s: Participants received a locally manufactured transtibial prosthesis with a 3D-printed prosthetic socket at the 3D Lab at Masanga Teaching Hospital in Sierra Leone. Baseline, 10-week, 9-month, 1.5-year, and 2.5-year follow-up assessments included (1) quantifying prosthetic longevity, (2) prosthetic use using activity sensors, (3) lower extremity functional status using the adopted Orthotics and Prosthetics User's Survey (OPUS) (range: 0-60), (4) disease-specific health-related quality of life using the adapted OPUS survey (range: 0-36), and (5) generic health-related quality of life using EQ-5D-3L (range: -0.145 to 0.9) and visual analog scale score (range: 0-10).

Results: Nine participants participated in the study. Six prosthetic sockets exhibited damage after 361, 398, 399, 553, 641, and 756 days. One participant used the prosthesis for 2.5 years, another had their socket replaced due to socket size problems, and one was lost to follow-up. At 2.5 years, the median wear time was 12.4 (11.4-13.5) hours daily, with 6906 steps (4277-9792), 65% (51%-82%) while wearing the prosthesis. Median scores at follow-up compared with baseline were as follows: OPUS Function (47-55 points), OPUS disease-specific health-related quality of life (17-34 points), EQ-5D-3L (0.741-0.744), and visual analog scale (6-10 points).

Conclusions: Most prostheses were extensively used. The study underscores the need for research on enhancing the durability of 3D-printed sockets.

Background: Many funding and accreditation bodies require orthotic and prosthetic (O&P) services to measure consumer satisfaction. While the Orthotics and Prosthetics User's Survey Client Satisfaction with Services (OPUS-CSS) module is a valid and reliable instrument to measure consumer satisfaction with O&P services, there are no normative population data to facilitate benchmarking.

Objectives: Describe normative population data for the OPUS-CSS in Australia and identify demographic and service-related factors for the most and least satisfied quartiles.

Study design: Retrospective cohort study.

Methods: Participants were adult O&P consumers, or parents/guardians of pediatric O&P consumers. Consumers were convenience sampled from O&P services enrolled in the Australian Orthotic Prosthetic Association Consumer Experience Program. As part of the Consumer Experience Program, an electronic survey was administered when a new orthosis/prosthesis was provided. The survey included demographics, service-related factors, and the OPUS-CSS module.

Results: Consumers (n = 180) were highly satisfied with the O&P service they received (OPUS-CSS median score 78.7, interquartile range 55.1-100); acknowledging the distribution of scores was positively skewed with a ceiling effect. The factors that varied most between the upper and lower quartiles included age, education, income, work status, number of comorbidities, identifying as Aboriginal or Torres Strait Islander, and speaking a language other than English at home.

Conclusions: On average, consumers were highly satisfied with the O&P services received. Given the ceiling effect, the OPUS-CSS may not adequately distinguish between consumers who were highly satisfied. These pilot data can help inform future research to identify the factors that most influence consumer satisfaction with O&P services.