Prosthetics and Orthotics International最新文献

The International Classification of Functioning, Disability, and Health (ICF) provides a universal framework for assessing the functioning of any person. To facilitate the application of the ICF in practice, ICF core sets are being developed. This study is part of a project intended to develop an ICF core set for upper-limb amputation (ULA) and aims to identify relevant concepts included in the outcome measurements used in studies of ULA. Articles involving ULA aged 18 years or older from January 2011 to December 2021 were searched on Cumulative Index to Nursing and Allied Health Literature, SPORTdiscus, and Medical Literature Analysis and Retrieval System Online. We included studies with particular designs (randomized controlled trials, before/after studies, cross-sectional studies, and longitudinal observational studies) and published in English. Relevant concepts were extracted from measurements and linked to the ICF using linking rules, and a frequency analysis was conducted. Sixty-one of the 1272 identified publications were included, from which 86 measurements were extracted. Concepts extracted from measurements were linked to 129 ICF categories. Three hundred twenty-six (29.23%) of the 1115 concepts were related to body functions, 643 (57.66%) to activity and participation, 96 (8.60%) to environmental factors, 19 (1.70%) to body structures, and 6 (0.53%) to personal factors. Twenty-five (2.24%) were characterized as "nd-not definable." "Fifty-four" categories identified in at least 5% of the publications will be considered for inclusion in the final ICF core set for ULA during the consensus conference. This review provides information about the content of measures, and the identified ICF categories reveal the research perspective for developing an ICF core set for ULA.

Background: Iterative design and modification are used to manufacture lower limb prosthetic sockets that meet users' needs while also fulfilling safety and mobility criteria. Greater understanding of the expectations of prosthesis users regarding prosthetic fit as well as their experiences at the time of socket fitting is needed.

Objectives: Describe lower limb prosthesis user perceptions and experiences of socket comfort and discomfort during their last fitting and compare this to their expectations for a perfectly fitting socket and their satisfaction with the socket they had fitted.

Study design: Mixed methods (quantitative and qualitative).

Methods: A questionnaire was designed and administered in consultation with Amputees NSW (an amputee advocacy group) and distributed through their membership database. Qualitative responses were analyzed to explore prosthesis user experiences of socket fitting, general wear, as well as socket comfort, discomfort, and satisfaction. Quantitative responses were analyzed using descriptive, nonparametric methods.

Results: Thirty participants with a range of lived experiences completed the questionnaire. Reported comfort and discomfort varied across participants and indicated that expectations and experiences of fit varied and changed over time, with some participants anticipating adjustment over time would be necessary. Qualitative analysis found experiences of prosthesis socket comfort/discomfort on the day of fitting and general experiences of socket comfort related to 2 key factors-the prosthesis itself and the individual prosthesis user.

Conclusions: Understanding the experiences and expectations of prosthesis users for comfort and intended activities is central to ensure success of the socket fitting approach. Investigation into fit changes over time could provide insights into follow-up requirements, user education, and funding mechanisms.

Background: An important part of the orthotic treatment process includes performing adjustments to the shape or design of the orthosis to improve its fit and function. However, the ability to adjust 3D printed (3DP) materials is not well understood.

Objectives: (1) To evaluate the usability of completing adjustments on 3DP ankle foot orthoses (AFOs) vs. traditionally-fabricated AFOs, and (2) to explore orthotists' perspectives on the advantages, disadvantages, and similarities of adjusting 3DP materials and identify potential solutions for disadvantages.

Study design: Mixed-methods cross-sectional study.

Methods: Ten participating certified orthotists performed a sequence of predetermined adjustment tasks on 3DP AFOs. The Single Ease Question and the System Usability Scale (SUS) were compared between traditional vs. 3DP AFO adjustments. Semistructured interviews were conducted, and a thematic analysis identified key themes.

Results: Single Ease Question scores were significantly lower for 3DP adjustments in 50% of tasks. The mean SUS total score was significantly lower ( p < 0.001) for tasks completed on 3DP AFOs compared with traditional AFOs. The thematic analysis identified challenges related to aesthetics, heating, grinding, brittleness, and timing of adjustments. Several similarities and some minor benefits were also noted. Despite challenges, orthotists demonstrated optimism about the 3DP material and proposed several solutions for improvement including optimizing techniques and introducing postprocessing.

Conclusions: 3D printed orthoses were more difficult to adjust and had lower usability for adjustment compared with traditional ones. However, orthotists felt that they would be able to use the material in clinical practice if some of the proposed solutions were implemented.

Background: Preferred walking speed (PWS), maximal walking speed (MWS), and walking speed reserve (WSR)-the difference between MWS and PWS-can be easily obtained from the 10-m walk test (10MWT) to assess walking ability and function. However, their test-retest reliability has not been determined in persons with unilateral lower-limb amputation (LLA).

Objectives: To determine the reliability of the PWS, MWS, and WSR obtained from the 10MWT in persons with LLA.

Study design: Test-retest with a 48- to 120-h interval between test days.

Methods: Test-retest relative and absolute reliability was assessed by the intraclass correlation coefficient (ICC) and the %change in mean (%CM) and coefficient of variation (CV), respectively.

Results: Preferred walking speed showed excellent reliability between day 1 (familiarization day) and day 2 (ICC = 0.97; %CM = -1.8; CV = 7.7) and a significant speed increase from day 2 to day 3 (ICC = 0.96; %CM = 8.5, p < 0.003; CV = 7.4). Maximal walking speed showed excellent reliability between day 1 and day 2 (ICC = 0.94; %CM = 2.9; CV = 8.3) and between day 2 and day 3 (ICC = 0.94; %CM = 1.8; CV = 8.6). Overall, WSR was poorly reliable between day 1 and day 2 (ICC = 0.65; %CM = 39.2; CV = 39.2) and between day 2 and day 3 (ICC = 0.74; %CM = 30.0; CV = 30.0).

Conclusions: Preferred walking speed obtained from a single 10MWT and MWS obtained after a 10MWT familiarization day are reliable walking speed measures for persons with LLA with similar characteristics to those of our sample. Nonetheless, it is critical that both PWS and MWS are obtained after a 10MWT familiarization to obtain a reliable WSR.

Background: Recent therapeutic and technological solutions aim to improve the daily living of people with limb amputation by considering various aspects of the phantom limb, in particular painless phantom sensations (PS) and voluntary phantom movements (VPM).

Objective: Although previous research has explored these phenomena mostly without considering the prosthesis, this study investigates the influence of prosthesis wearing on painless PS, painful PS, and VPM, in people with lower-limb amputation.

Study design: Cross-sectional study based on semi-directed interviews.

Methods: Semi-directed interviews were conducted with 111 people with major lower-limb amputations. They described their phantom limb without and with the prosthesis, in a static seated position. The influence of the prosthesis wearing on the intensity of painless PS, painful PS, and on VPM ability was classified into 5 categories: disappearance, decrease, modification, increase, and appearance.

Results: Prosthesis wearing leads mostly to an increase of painless PS intensity (44%), a decrease of painful PS intensity (44%), and an improvement of VPM ability (47%). The study also highlights the richness of prosthesis-related changes, including modifications in phantom limb position, shape, and size. The influence of prosthesis wearing on phantom phenomena was not related to the presence of referred sensations, the amputation etiology, the level of amputation, the time since amputation, or the use of medication, but might be related to the pressure applied by the socket on the residual limb.

Conclusions: This study provides valuable information on the influence of the prosthesis on PS and may allow for better consideration of this relationship in the context of research, engineering, and rehabilitation.

Background: Energy storing and return (ESAR) prosthetic feet often provide high energy return at the cost of increased foot height, compromised appearance, and reduced flexibility. An ESAR foot, Ottobock Evanto, with a novel compact design has been introduced (novel foot).

Objective: To characterize user preference and benefits of a novel foot compared with the subject's previously worn (everyday foot) and comparator foot, Össur Pro-Flex XC.Study Design:Multicenter, randomized, nonblinded, cross-over trial (ClinicalTrials.gov, NCT05628064).

Methods: Transtibial amputees using ESAR feet were eligible. Outcome measures included perceived mobility, the extent of meeting amputees' needs, pain intensity, EuroQol 5-Dimension 5-Level, Activities-specific Balance Confidence, pain interference, foot preference, and walking experience. The first 3 measures with the novel foot vs. the everyday and comparator feet were used for primary objectives.

Results: Data from 20 participants were analyzed. For all primary outcomes, improved scores while wearing the novel foot were obtained. The change in perceived mobility vs. the everyday foot score was highly significant ( P = 0.0007). The novel foot was the most preferred foot overall (55% participants) and for many activities, e.g., walking on inclines (85%) and over uneven terrain (70%). Participants confirmed that the novel foot made walking up slopes easier (95%), standing more flexible (85%), and heel strike more comfortable (85%) vs. their everyday feet.

Conclusions: The novel foot offers advantages compared with the tested feet, including making walking on uneven terrain and slopes easier and more comfortable heel strike. Activities in which the novel foot would perform worse than the other feet have not been reported.

Background: Functional capacity assessments have an important role in determining the level of mobility in lower-limb prosthetic users.

Objectives: Our aim was to investigate the reliability and validity of the Glittre activities of daily living (ADL) test in lower-limb prosthetic users.

Study design: A cross-sectional study.

Methods: The study included 66 people over the age of 18 years who had used a lower-limb prosthesis for at least 6 months and could walk at least 30 m independently. For construct validity, the correlation of the Glittre ADL test with the 2-min walk test, timed up and go test, and functional reach test was examined, and Bland-Altman agreement analysis was performed. Intra-rater reliability was examined with 2 tests performed by the same physiotherapist on different days, and inter-rater reliability was examined with a test performed by a second physiotherapist on a different day.

Results: The reliability of the Glittre ADL test was found to be excellent for intra-rater (intraclass correlation coefficient = 0.940, 95% confidence interval = 0.903-0.963, standard error of measurement = 26.03, minimal detectable change = 72.31) and good for inter-rater (intraclass correlation coefficient = 0.890, 95% confidence interval = 0.806-0.936, standard error of measurement = 36.80, minimal detectable change = 102.06, p < 0.001). There was a strong negative correlation between Glittre ADL test and 2-min walk test (r = -0.785), a strong positive correlation with timed up and go (r = 0.805), and a weak negative correlation with functional reach test (r = -0.266, p < 0.05). Bland-Altman plots showed 95% agreement for both validity and reliability measurements.

Conclusions: The Glittre ADL test is a valid and reliable test that can be used in the assessment of functional capacity in lower extremity prosthesis users.